The Ludwig scale explained: the grades of hereditary hair loss in women

When the hair on the crown grows thinner, a shared vocabulary helps. The Ludwig scale provides it: it sorts hereditary hair loss in women into three degrees of severity, from slight thinning at the part to a scalp that shows through widely on the crown.¹ This lets doctors and those affected describe the same finding in the same way, and it lets you place yourself roughly.

Two things first. The pattern in women looks different from the one in men: the front hairline is usually preserved, and the hair thins along the middle part and on the crown.¹ And the scale records how your hair looks right now. It does not predict how far the thinning will go. It is a snapshot, not a forecast.

What the Ludwig scale is and what it is for

The dermatologist Erich Ludwig described female hair loss in 1977 and sorted it into three degrees of severity.¹ In technical terms, the pattern is called female androgenetic alopecia, that is, hereditary hair loss. It is often also called female pattern hair loss, the more neutral term, because the influence of androgens, the male hormones, is less clear-cut in women than in men.

The value of this classification lies in its brevity. A single grade says how pronounced the thinning is, without a long description. A medical assessment can build on it, and at a later check-up a comparison shows whether the picture has changed. For you, the grade above all gives you a language for where you stand right now.

The Ludwig scale is tailored to the female pattern. For male hair loss, with a receding hairline and a bald spot at the crown, there is a separate classification, the Norwood scale. More on that below.

The typical pattern in women

In female hereditary hair loss, the hair thins broadly across the crown, most of all along the middle part. The front hairline at the forehead usually stays in place.¹ So there are no receding temples and no bald spot at the back of the head of the kind seen in men.

It is often noticed first at the part. When you part your hair, the part looks wider than before, and the scalp shows through more. In technical terms, this is described as diffuse thinning of the upper scalp region with a widening of the middle part.² The hair does not fall out in tufts; it becomes finer and thinner across the area.

The three grades: Ludwig I, II and III

Ludwig graded the pattern by the extent of the thinning into three degrees, colloquially also called Ludwig stages. The transitions are gradual, and many women fall between two grades.

• Ludwig I: Early, mild thinning on the crown. The middle part becomes a little wider, often noticed first when parting the hair.¹
• Ludwig II: The thinning on the crown is markedly more pronounced, the hair there noticeably thinner and sparser than on the rest of the head.¹
• Ludwig III: On the crown the hair is thinned so far that the scalp shows through over a large area. Even then, the fringe of hair along the front hairline is usually preserved.¹ This pronounced grade occurs less often than grades I and II.

The Sinclair scale and the Christmas-tree pattern: further classifications

The Ludwig scale is the most common but not the only classification. The Sinclair scale works with five stages and relies more heavily on the widening of the part.² And the dermatologist Elise Olsen described a variant in which the thinning is most pronounced at the front of the part and tapers narrower toward the back. Because this triangular shape resembles a fir tree, it is called the Christmas-tree pattern.²

For a rough orientation, the Ludwig scale is enough. Which classification fits best in an individual case is a question for medical assessment.

Why the Norwood scale applies to men

In men, hereditary hair loss follows a different course: the hairline recedes at the temples, and a bald spot forms at the crown. The Norwood scale, with its seven stages, captures this pattern. You can read how it is structured under Norwood scale.

Both scales serve the same purpose and share the same limit. They describe a pattern so that everyone involved means the same thing. Neither one predicts how far the hair loss will go in the end, or how fast. That is best judged over time and through a medical assessment.

How do I place myself roughly?

The easiest way is at the middle part. Comb your hair into a straight part and compare, in the mirror or in a photo, how wide the part looks and how much the scalp shows through, especially at the front of the crown. A second photo from above at an angle shows the area around the part.

Be lenient with the result. A self-assessment varies with lighting, hair length and hairstyle alone, and a slightly wider part need not mean much. The scale gives you a direction, no more.

Not every case of thinning on the crown is hereditary

Thinning hair in women has many possible causes, and not every case of diffuse thinning is hereditary. Telogen effluvium, that is, increased hair loss a few months after a trigger, can look similar. Iron deficiency, a thyroid disorder, hormonal changes or ongoing stress can also thin the hair.

These causes cannot be read off the pattern; that requires a medical review and often a few lab values. Which triggers may be involved in women is set out in the article Hair loss in women, and the role that strain plays is covered under Hair loss from stress. The difference matters, because telogen effluvium often resolves on its own, whereas hereditary hair loss usually needs ongoing treatment.

What the classification means for treatment

The grade is a reference point, not a treatment instruction. What matters most for treatment is how much of your own hair on the crown is still active. The earlier you start and the milder the thinning, the more can be preserved. As long as the hair roots are still producing fine hair, treatment can slow the loss and stabilise weakened hair.

In areas that have been completely bald for years, it looks different. There the hair roots have receded, and treatment no longer produces new hair. With the female pattern, however, the hair on the crown usually stays intact to some degree, and a completely bald crown is rare.²

Whether treatment makes sense for you and is medically suitable, and which one, depends on the overall picture: the pattern, the course, your age and your health. That is determined by a medical review, not by the scale alone. Many women find thinning hair very distressing, and an early classification at least takes away the uncertainty about what is happening.

Here is how it works with us: first you answer a medical questionnaire about your hair loss and your health. Our doctors review your answers and decide whether treatment is an option and, if so, which. A prescription is never guaranteed, and the starting point is the medical assessment, not the medication. How the medical review works is described in the article How the medical review works. The options available in general can be found on the page Treatments.