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Ludwig Scale: Causes, Stages & Treatment
Dr. Michael May (FRCS)
Medically reviewed by
Dr. Michael May (FRCS)
Updated on April 30, 2024

Female pattern baldness is the primary cause of hair loss in women [1]. This type of female hair loss has many symptoms in common with other conditions, such as chronic telogen effluvium and alopecia areata, so it can be tricky to diagnose.

The Ludwig Scale helps hair loss specialists diagnose and suggest treatments for women experiencing female pattern hair loss (also known as female androgenetic alopecia).

The Ludwig Scale is just one of the female hair loss diagnosis tools we use at the Wimpole Clinic. As women’s hair loss is so hard to diagnose, we pair the Ludwig Scale with other diagnostic tools including hair loss blood tests and genetic assessments to get to the bottom of your hair thinning and find the best female hair loss treatment for you.

Learn more about the stages of female pattern baldness according to the Ludwig Scale, and how trichologists use the scale to treat hair loss in women.

Table of Contents

What is the Ludwig Scale?

The Ludwig Scale was proposed in 1977 to classify the progression of female androgenetic alopecia [2]. Like the Norwood Scale for male pattern baldness, the Ludwig Scale remains one of the most popular female pattern baldness classification charts in modern trichology.

According to the Ludwig Scale, female pattern baldness advances in 3 distinct stages. People with this patterned hair loss condition usually see diffuse hair thinning that starts along the hair parting and spreads evenly across the scalp. Hair is usually retained around the sides, back, and front of the head.

The 3 stages of female pattern baldness

The Ludwig scale used to diagnose the level of hair loss in individuals suffering from female baldness
The 3 stages of women’s hair loss according to the Ludwig Scale. Image credit: Classifications of Patterned Hair Loss: A Review
Photo examples of Ludwig stages 1, 2, and 3
Representative clinical images of type 1 (a), type 2 (b), and type 3 (c) on the Ludwig Scale [3].

Stage 1

Hair begins to thin, most visibly along the parting and around the crown of the head. Hair loss doesn’t affect the back and sides of the head. It also typically stops 1-3cm before the front hairline.

Stage 2

Hair loss is more substantial and widespread across the top of the head. The normal hair parting width expands further. The lengths of the hair may also feel thinner, thanks to decreased hair density.

Stage 3

The most advanced stage in the Ludwig Scale describes severe hair loss affecting the same areas as seen in stages 1 and 2. The crown of the bald may be completely bald. Often the hair at the front, back, and sides of the head has normal hair density, despite extensive hair loss across the top of the head.

How is the Ludwig Scale used in hair loss treatment?

The Ludwig Scale helps trichologists define and diagnose hair loss in women. Since there are some similarities between female pattern baldness and other conditions, a classification chart is useful for identifying the unique characteristics of female pattern baldness. These include:

  • A front hairline relatively unaffected by hair loss
  • No hair regrowth in balding areas
  • Negative hair pull test (i.e. hair is not easily dislodged from the hair follicle)

Understanding the cause of hair loss is essential for treating it. Conditions like telogen effluvium are temporary, so the hair usually grows back when you’ve addressed the underlying issue.

However, female pattern baldness is permanent — so by diagnosing it using the Ludwig Scale, your trichologist can help you determine the best way to address your hair loss.

Can you stop your hair loss from advancing to further Ludwig stages?

Yes, but the earlier you start treatment, the easier it is to slow hair loss and even restore your hair. So if you start to lose hair, it’s important to see a hair loss specialist as soon as possible.

At the Wimpole Clinic, we perform several hair loss assessments to find the root cause of your hair loss. We’ll then put together a bespoke treatment plan based on your specific hair loss triggers. This can include topical treatments like Minoxidil, vitamin supplements if you have any nutritional deficiencies and non-invasive treatments like low-level laser therapy.

The sooner the cause of your hair loss is diagnosed, the sooner it can be treated, reducing the risk of your hair loss advancing into the later Ludwig stages.

Treatments for female pattern baldness

While female pattern baldness is permanent, non-surgical hair restoration treatments like Minoxidil have been shown to promote hair growth in women experiencing female pattern hair loss [4]. These tend to be more effective in the early stages of hair loss. They’re also suitable as a supplementary treatment after FUT or FUE hair transplant surgery

Before and after results of using 5% Minoxidil for 12 months for female androgenic alopecia
Female patient before and after 12 months of 5% Minoxidil use twice a day.

Anti-androgen medication is also sometimes prescribed to treat genetic female pattern hair loss.

While research suggests a strong link between androgens (typically male sex hormones) and male pattern baldness, the link with female pattern hair loss is still unclear [5, 6].

Despite this, certain anti-androgen medications like cyproterone acetate and spironolactone have been shown to reduce hair loss and even promote hair growth in those with female pattern baldness [5].

Before and after results of using Spironolactone for 6 months
Female patient before and after taking 50mg of spironolactone twice a day for six months [7].

While non-surgical treatments are successful for many women, if your hair loss progresses beyond the early stages, your trichologist may recommend a hair transplant.

Hair transplants are becoming increasingly popular with women, as they offer a permanent, natural-looking solution for those experiencing advanced hair loss.

Learn more about hair transplants for women, including costs, success rates, and how to choose the right hair transplant clinic.

patient before and after female hair transplant

 Patient before and after a female hair transplant.

Find out more about treatments for women’s hair loss

Hair loss can have a serious impact on your well-being. It can also be a sign of an underlying condition, such as an autoimmune disease or depression. So if you notice thinning hair or see clumps of hair falling out in the shower, it’s time to get checked out.

Book a consultation at the Wimpole Clinic and we’ll help you find the right treatment to restore your hair.

Ludwig Scale: Causes, Stages & Treatment, Wimpole Clinic

Dr. Michael May (FRCS)
Medically reviewed by Dr. Michael May (FRCS)Updated on April 30, 2024
The Wimpole Clinic offers FUE Hair, Beard & Eyebrow Transplants & Trichology.
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