The Ludwig scale — female-pattern hair loss stages, plainly
Female-pattern hair loss follows its own map. The Ludwig scale is that map — and stage 1 is where most Londoners quietly sit for years before acting.
Dr. Amara Okafor
Consultant Trichologist · Harley Street
In short
- Ludwig 1: visible widening at the parting, front hairline preserved.
- Ludwig 2: obvious diffuse thinning across the crown.
- Ludwig 3: dense thinning — scalp clearly visible.
- Female-pattern loss is treatable at every stage; earlier is easier.
Female-pattern hair loss is the most common cause of thinning in women aged 30–65. It doesn't recede the hairline the way male-pattern loss does — it thins from the crown outward, keeping the front frame intact. The Ludwig scale captures that pattern in three stages.
The three stages
- Ludwig 1 — parting appears wider; ponytail feels thinner. The 'Christmas tree' pattern begins.
- Ludwig 2 — clear diffuse thinning across the crown; scalp visible under bright light.
- Ludwig 3 — dense thinning; scalp visible in normal lighting; sun-vulnerability appears.
Treatment at each stage in London
Stage 1 is the medical sweet spot: topical minoxidil 5%, oral minoxidil (specialist prescription), spironolactone if hormonally driven. Stage 2 adds procedural options: PRP, low-level laser, mesotherapy. Stage 3 opens transplant discussions, though female donor considerations differ from men — density transfer, not hairline rebuild.
What to check before treatment
Female-pattern loss can mimic — and coexist with — telogen effluvium, thyroid disease, iron deficiency and PCOS. A good London trichologist checks ferritin, TSH, vitamin D and free androgens before starting anything.
Female-pattern loss isn't inevitable. It's treatable. Earlier is easier.
Frequently asked
Common questions
Can Ludwig 3 be reversed?+
Partially. Transplant + medical therapy can restore significant density; a full reversal to your 20s is unrealistic.
Does the pill affect Ludwig progression?+
Some combined pills help; progestin-only pills can worsen it. Discuss with your GP.
Is menopause a Ludwig accelerator?+
Yes — most women progress a stage or half-stage during peri-menopause.
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