Norwood 5 at age 40 represents advanced hair loss where the frontal and vertex bald areas have nearly merged, leaving only a narrow band of hair between them. At this stage, a hair transplant is the primary path to visible restoration, and careful donor management is essential to ensure lasting results. Medication plays a supporting role by protecting the hair you still have.
What Norwood 5 Looks Like at 40
The defining feature of Norwood 5 is the narrowing separation between the frontal recession and the vertex bald spot. The horseshoe pattern of remaining hair is becoming visible. Hair density in the mid-scalp bridge is sparse, and the overall impression is of significant balding across the top of the head.
Norwood 5 Overview
| Feature | Details |
|---|---|
| Frontal hairline | Severely receded |
| Vertex | Large bald or thin area |
| Bridge between zones | Narrow, sparse |
| Grafts needed | 3,000-4,500 |
| Sessions likely | 1-2 |
| Medication alone sufficient | No, surgery needed for restoration |
Treatment Strategy for Norwood 5
Medication: Essential but Not Enough Alone
Finasteride (1mg daily) remains important at Norwood 5, but its role shifts from restoration to preservation. At this stage, it:
- Halts further loss in 80 to 90% of men, protecting remaining native hair
- Prevents the thinning bridge from disappearing entirely before or after surgery
- Stabilizes the donor area, ensuring long-term graft availability
Minoxidil (5%) applied to the vertex can provide modest density improvement in areas where follicles are miniaturized but not yet gone. Response in the crown tends to be better than the frontal zone, making it particularly useful at Norwood 5.
Side effects for finasteride occur in 2 to 4% of users (sexual in nature, reversible upon stopping). At 40, the risk-benefit calculation strongly favors treatment given the extent of loss.
Hair Transplant: The Core Restoration
At Norwood 5, surgery is required for meaningful coverage restoration. The procedure is larger than at earlier stages, and donor management becomes a central planning concern.
Graft requirements: 3,000 to 4,500 grafts. The surgeon must distribute these strategically between the hairline, mid-scalp, and vertex to create a natural density gradient.
Prioritization strategy: Most surgeons prioritize the frontal hairline and mid-scalp because:
- The front has the greatest visual impact
- The vertex is less visible in daily interactions
- Saving some donor capacity for future vertex work is prudent
Session planning: A single mega-session of 4,000+ grafts is possible with FUE (max 5,000 per session), but many surgeons prefer splitting Norwood 5 into two sessions spaced 8 to 12 months apart to optimize graft survival and healing.
Cost Expectations
| Location | Cost per Graft | Total for 3,000-4,500 Grafts |
|---|---|---|
| Turkey | $1-2 | $3,000-$9,000 |
| USA | $4-6 | $12,000-$27,000 |
| UK | $3-5 | $9,000-$22,500 |
Recovery Timeline
- Days 1-3: Swelling, redness in recipient area
- Days 7-10: Return to work (FUE), scabs fall off
- Weeks 2-6: Transplanted hairs shed (normal shock loss)
- Months 3-6: New growth begins
- Months 12-18: Full result visible
Donor Area Management at Norwood 5
This is the most critical consideration at Norwood 5. You need 3,000 to 4,500 grafts now, and you may need additional grafts in the future if loss progresses to Norwood 6 or 7.
The safe extraction limit is 45% of donor follicles. For a typical donor area:
| Donor Density (FU/cm2) | Approx. Total Available | Safe to Extract (45%) |
|---|---|---|
| 150 (African) | ~6,000 | ~2,700 |
| 170 (Asian/Hispanic) | ~6,800 | ~3,060 |
| 200 (Caucasian) | ~8,000 | ~3,600 |
If your donor supply is limited, the surgeon may recommend a conservative approach: restore the frontal zone now and reassess the vertex later. This preserves your options.
Supplementary Options
- PRP therapy: $500 to $2,000 per session, can improve density in partially thinned areas
- Scalp micropigmentation (SMP): Creates the appearance of density between transplanted hairs
- Body hair transplant (BHT): Chest or beard hair as supplementary donor source in limited cases
What Happens Without Treatment
Norwood 5 at 40 will almost certainly progress to Norwood 6 or 7 within the next 5 to 10 years without treatment. The bridge will thin completely, and the horseshoe pattern will become more pronounced. Finasteride can significantly delay this progression and protect any surgical investment.
Get Your Assessment
Accurate staging is essential before planning a Norwood 5 procedure. Donor density, miniaturization patterns, and the exact boundaries of loss all affect the surgical plan.
Get your free AI hair loss assessment at myhairline.ai/analyze to map your current stage, evaluate donor potential, and receive a treatment roadmap specific to your Norwood 5 pattern at 40.
See the complete Norwood scale guide for staging details or evaluate your hair transplant candidacy assessment.
This article is for informational purposes only and does not constitute medical advice. Consult a board-certified dermatologist or hair restoration specialist before starting any treatment.