The Ludwig scale: grading female pattern hair loss

When doctors talk about how far female pattern hair loss has gone, they need a shared language. The oldest and best-known is the Ludwig scale. A review of hair loss classifications calls it, with the Norwood–Hamilton scale, one of the most widely used by patients and practitioners. ²

This guide explains the three grades, shows them as a drawing, and covers the newer scales that fill its gaps.

Where it comes from

The review says Ludwig studied 468 women with hair loss and proposed a classification based on how the loss evolves. ² His key observation was that women keep the front fringe of hair while loss spreads out over the top of the scalp. ² That is the main way women's pattern differs from men's. MedlinePlus Genetics describes the same difference: in women the part widens and the hairline does not typically recede. ³

The three grades

Most women never reach grade III. The review says severe loss of that degree affects less than 1% of women. ¹

What the Ludwig scale leaves out

The scale is simple, which is both its strength and its weakness. The review points out two gaps. ²

• The "Christmas tree" shape. Many women lose density toward the front along the part, in a triangle. Ludwig did not include that accentuation. Olsen later did. ²
• Male-pattern loss in women. Some women develop recession at the temples, like men. Ludwig's system cannot classify them. ² Later scales by Ebling and Rook allowed for it. ²

It also has only three steps, so it is coarse for tracking change. A woman can lose noticeable density and still be "grade I".

The scales doctors use alongside it

The Sinclair scale is the easiest to use at home, because it only needs a comb and a photo from above. Our guide to the widening part explains how.

How a grade is actually used

A grade is mostly a tracking tool. The review says these scales help determine the stage of hair loss and assess the response to treatment. ² DermNet says doctors can score shedding at each visit to judge how treatment is going. ⁴

A grade doesn't diagnose anything by itself. The American Academy of Dermatology notes that other conditions can look like female pattern hair loss, so a dermatologist should rule them out first. ⁵ A grade also doesn't predict the future. DermNet says the loss usually comes in bursts and pauses, and the pace differs between women. ⁴

If you grade yourself

Grading your own hair is fine, as long as you treat it as a note rather than a verdict. Use the same light, the same part and the same camera height each time. Look at the top of the head from directly above, not in a wall mirror. Compare photos months apart, because the loss tends to come in bursts. ⁴ If two photos a few months apart look the same, that is useful information too. It suggests a pause, not a failure. Write the date on each photo, and note anything that happened in between, such as an illness, a new medicine or a birth. Those events can cause shedding of their own a few months later. ⁶

How it compares with the Norwood scale

The Norwood scale for men has seven main stages and tracks recession at the temples and loss at the crown. ⁷ The Ludwig scale has three, and tracks density on top with the hairline kept. ¹ They describe genuinely different patterns, which is why a woman's hair loss is not usually graded on the men's scale. Our guide to the Norwood scale covers the men's version.

What to do with your grade

If you recognize grade I or II in your own photos, it is worth a dermatologist's opinion. The AAD says treatment for female pattern hair loss works best when started at the first sign. ⁵ If your loss has a patchy shape, a sudden start or a sore scalp, it may be something else, and that is a reason to go sooner.

General information, not medical advice. This article was drafted with AI assistance and checked against the sources listed above. Nobody at Balds is a doctor. If something here is wrong or out of date, tell us.