EXPERT GUIDE

Ludwig Scale: Female Pattern Hairloss


Mike Kaine, MD

This text was written according to the highest scientific standards and reviewed by medical experts. Find out more about our quality assurance.

Written by Erin D. Updated on 24 Jul 2024

You’ve probably heard of the Hamilton-Norwood scale for identifying the different stages of male androgenetic alopecia. But have you heard of the Ludwig Scale? This scale is largely used by hair specialists to accurately diagnose and suggest treatments for women suffering from androgenetic alopecia.

What is the Ludwig Scale?

The Ludwig Scale has been in use since 1977 and is used by hair specialists to classify the severity of a female hair loss patient’s condition. In simpler terms, the scale helps doctors identify how far a patient’s female pattern baldness has progressed. Typical female pattern hair loss: The ludwig scale.

So that they can diagnose and suggest a treatment that fits the current state of their scalp.

The scale shows female pattern baldness advancing in 3 distinct stages.

  • Minimal thinning that can be covered up through hair styling
  • Moderate thinning that results in a significant loss of volume.
  • Excessive thinning that leaves a huge bald spot on the top of the scalp.

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Why is it important for assessing female pattern hair loss?

Diagnosing female androgenetic alopecia through observation alone can be tricky for doctors even though it is the major cause of hair loss in women. The scale helps them clearly identify where their patients stand in terms of their hair loss. 

Thus, reducing the chance of misdiagnosis and mistreatment, which can have catastrophic effects on the patient’s scalp and remaining hair.

Common Causes and Contributing Factors for Female Pattern Hair Loss

Female pattern hair loss is usually caused by two major factors.

  • Your genetic predisposition to hair loss: If your family history is rife with cases of hair loss, then it’s very likely you are going to develop female pattern hair loss as well. 
  • Hormonal Changes: Severe hormonal changes can leave you with increased levels of androgens (male hormones) that can shorten your hair growth cycle triggering female pattern hair loss. 

There can be a few other causes as well, including nutritional deficiencies, taking on too much stress and the side effects of certain medications.

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Differences Between Male and Female Pattern Hair Loss

Male Pattern Hair Loss (MPHL) Female Pattern Hair Loss (FPHL)
Typically starts with a receding hairline at the temples and thinning in the crown area. Typically begins with thinning over the crown and the top of the scalp, keeping the frontal hairline as it is.
More aggressive and can result in complete baldness in some areas. Not as aggressive as MPHL and rarely even results in complete baldness.
Divided up into 7 distinct stages on the Norwood scale Divided up into 3 distinct stages on the Ludwig Scale

Stages of the Ludwig Scale

We’ve already mentioned how there are different stages on the Ludwig Scale explaining the advancement of female pattern hair loss. 

Now we will focus on explaining the state of your hair and scalp during each stage. 

 

Stage I: Mild Hair Thinning

This mostly affects some regions near the top of your scalp, which can be easily covered up with clever hair styling. The thinning is also typically diffuse so you should only lose a minimal amount of your overall hair density.

However, it will slightly increase your hair parting width, which may be noticeable. But again, you should be able to cover it up with smart hair styling. 

 

Stage II: Moderate Hair Thinning

This stage decreases your overall hair volume and density enough that it starts becoming noticeable, especially around the crown area. 

All in all, your hair parting width may increase further and the significant reduction in hair volume may make your scalp more visible. 

 

Stage III: Advanced Hair Loss

There’s no way to sugarcoat this: If your hair loss reaches this stage, you should be looking to get a hair transplant or some alternative treatment immediately. Why? Well, for one thing, you will have lost so much hair on your scalp that it will look nearly bald. 

Plus, the thinning behind and on the sides of the scalp area will be incredibly extensive as well. The only section of your hair that should remain preserved will be your frontal hairline.

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Stage-Specific Treatments

Fortunately, female pattern hair loss isn’t untreatable and can be fixed at every stage on the Ludwig Scale. You just have to follow your doctor’s orders to the T. 

 

Recommended Treatments for Stage I

This is the stage where every recognized doctor in the world recommends getting treatment for your hair loss since it’s still earlier and easier to slow hair loss down with medications alone. 

The first thing your doctor will get you on in this stage of your hair loss is topical minoxidil, either 2% or 5%. Both of which are available over the counter. You will have to rub the medication directly into the balding areas of your scalp. 

We would also suggest changing up your diet to include more nutrients biotin, iron and zinc. You could also opt for supplements that give you those nutrients. 

 

Approaches for Managing Stage II Hair Loss

Your doctor’s probably going to advise you to start taking prescription medications for your hair loss at this stage. Your options include Finasteride (an FDA approved drug) or Dutasteride (non-FDA approved). You should also up your topical minoxidil concentration from 2% to 5%. 

You should know, however, that these drugs are known to have a few concerning side effects like reducing your sex drive, for example. 

We would also suggest either opting for LLLT (Low-Level Laser Light Therapy) treatment or PRP (Platelet-Rich Plasma) therapy treatment to speed up hair regeneration. 

 

Strategies for Addressing Stage III Hair Loss

There are no other treatment methods we can offer in this stage of your hair loss other than recommending that you get a hair transplant or maybe a scalp reduction. 

You could try increasing the concentration of your existing oral medications: Finasteride or Dutasteride. Alternatively, you could try to hide your hair loss using wigs or hairpieces, but we would not recommend that.

Lifestyle and Dietary Considerations

The diet you follow and the lifestyle you lead can have a huge effect on your hair loss. In fact, we have seen patients stop their hair loss in their tracks by consuming the right nutrients and opting for the right therapy. 

First of all, structure your diet in a way that you get a regular intake of protein-rich, iron-rich and zinc-rich foods. Also, make sure you are taking in the necessary minerals for maintaining your hair health like biotin and Vitamin A. 

There are also some habits you may want to avoid if you want to preserve your hair. Using heat tools on your hair for example should only be restricted for really special occasions. You should also refrain from tying your up too tight in a ponytail and overusing any hair products.

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Hair Care Regimen

Maintaining healthy hair is not easy for women, but it is something you have to do to prevent hair loss from female pattern baldness. Product-wise we would suggest opting for gentle, sulfate-free shampoos or volumizing/thickening shampoos from reputable brands. 

For conditioners, we would suggest going for both hydrating conditioners and leave-in conditioners to provide extra moisture and protection to your hair. 

There is also no point in rejecting the help of a recognized hair specialist when it comes to monitoring the health of your hair. 

So, make sure you go in for regular checkups with a thoroughly vetted specialist who can help you assess the condition of your hair and prescribe appropriate treatment. 

Sources

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