At Norwood 1, non-surgical options are not just the practical choice, they are the clinically appropriate one. Surgery is not indicated at this stage for hair loss. Every effective tool available to you is non-surgical, and the options range from FDA-approved medications to evidence-supported adjunct therapies.
This article is for informational purposes only and does not constitute medical advice.
1. Finasteride (Oral)
Evidence level: High. FDA-approved.
Finasteride 1mg daily is the most clinically supported non-surgical intervention for androgenetic alopecia. It works by inhibiting 5-alpha reductase type II, reducing scalp DHT by approximately 60%. This slows, halts, or partially reverses the miniaturization process in genetically susceptible follicles.
In a five-year randomized controlled trial, 83% of men on finasteride maintained or improved their hair compared to continued loss in 83% of placebo participants. Starting at Norwood 1, when follicles are still fully active, maximizes this benefit.
Practical notes: Take one 1mg tablet daily. Results take three to six months to appear. Side effects (reported in 2 to 4% of users in trials) include libido changes and sexual function effects; these resolve on discontinuation in most cases. Discuss with your prescribing physician before starting.
Cost: $15 to $40 per month (generic).
2. Topical Finasteride
Evidence level: Moderate to High. Not standalone FDA-approved (compounded).
Topical finasteride (0.25% to 1% solution applied to the scalp) is an increasingly popular alternative for men who want to reduce scalp DHT with less systemic absorption. Compounding pharmacies produce it to prescription.
Early pharmacokinetic studies show topical finasteride reduces scalp DHT effectively while producing lower serum finasteride levels than the oral form. This may translate to a lower incidence of systemic side effects, though head-to-head long-term data is still limited.
Practical notes: Applied once daily to the scalp (or as directed). It is compounded and not standardized across pharmacies, so formulation quality varies. Higher cost than generic oral finasteride.
Cost: $40 to $90 per month.
3. Minoxidil (Topical, 5%)
Evidence level: High. FDA-approved.
Topical minoxidil is the other cornerstone of non-surgical hair loss management. It works by extending the anagen (growth) phase of the hair cycle and is thought to act as a vasodilator, improving blood flow and nutrient delivery to follicles.
Clinical trials with 5% topical minoxidil at 48 weeks show a 45% greater increase in non-vellus hair count compared to the 2% formulation. In men with early-stage loss, response rates are at their highest.
Practical notes: Apply 1ml of liquid solution or half a capful of foam to dry scalp twice daily. An initial shedding phase (weeks 4 to 8) is common and temporary. Generic formulations work as well as branded products. Allow to dry before touching the scalp.
Cost: $10 to $25 per month (generic).
4. Oral Minoxidil (Low-Dose)
Evidence level: Moderate to High. Off-label use.
Low-dose oral minoxidil (0.625mg to 2.5mg daily) is increasingly prescribed by dermatologists as an alternative to topical application. It avoids scalp application and may be more consistent for users who find topical compliance difficult.
A 2020 retrospective study from Australia found that low-dose oral minoxidil produced significant improvements in hair density with a favorable side effect profile at doses under 2.5mg. The most common side effects are fluid retention and facial hair growth (hypertrichosis).
Practical notes: Requires physician prescription and monitoring. Not appropriate for individuals with certain cardiovascular conditions. Works systemically, so hair growth benefit may extend to the entire scalp rather than a localized application area.
Cost: $5 to $20 per month (oral generic, requires prescription).
5. Combination Therapy (Finasteride + Minoxidil)
Evidence level: High.
Using both finasteride and minoxidil together produces superior outcomes to either alone. The mechanisms are complementary: finasteride reduces the DHT-driven shortening of growth cycles, while minoxidil actively extends the growth phase.
A combination study published in the Journal of the American Academy of Dermatology found that men on dual therapy had significantly greater hair count improvements at 48 weeks than either monotherapy group.
Practical notes: Combination therapy is the most evidence-supported long-term regimen for preventing androgenetic alopecia progression. Clinicians often start with one medication and add the second after confirming tolerability at three months.
Cost: $25 to $60 per month (both generic).
6. Ketoconazole Shampoo (2%)
Evidence level: Low to Moderate. Adjunct only.
Ketoconazole is an antifungal agent with documented mild anti-androgenic properties in the scalp. A small clinical trial found that 2% ketoconazole shampoo produced density improvements comparable to 2% minoxidil, though this has not been replicated in larger studies.
Its primary role at Norwood 1 is as an adjunct to primary treatments, particularly for men with concurrent seborrheic dermatitis or scalp inflammation, which may contribute to follicular stress.
Practical notes: Use two to three times per week, leave on scalp for two to five minutes before rinsing. Available OTC at 1% or by prescription at 2%. Not a replacement for finasteride or minoxidil.
Cost: $15 to $25 per month.
7. Low-Level Laser Therapy (LLLT)
Evidence level: Moderate. FDA-cleared (not FDA-approved as drug).
LLLT devices emit red light at 650 to 670nm wavelengths. The proposed mechanism (photobiomodulation) involves stimulating mitochondrial activity in follicle cells, potentially prolonging the anagen phase. Several devices have received FDA 510(k) clearance for safety in hair loss treatment.
A 2014 randomized controlled trial found that men using an FDA-cleared LLLT helmet saw a 39% increase in hair growth rate versus sham devices over 16 weeks. Effects are real but modest compared to finasteride or minoxidil.
Practical notes: Use 20 to 30 minutes, three times per week. Consumer devices range from $200 to $900. Best used as an add-on to medical treatment rather than a standalone approach. Commitment to consistent use is required for results.
Cost: $5 to $20 per month amortized over device lifespan.
8. Platelet-Rich Plasma (PRP)
Evidence level: Moderate. Not FDA-regulated as a product.
PRP involves centrifuging your own blood to concentrate platelets and growth factors, then injecting the concentrate into the scalp. Growth factors in platelets (including PDGF and VEGF) are thought to stimulate follicle activity.
A 2019 meta-analysis across multiple trials found PRP significantly improved hair count, density, and thickness compared to control groups. Results vary considerably across studies due to non-standardized PRP preparation protocols.
Practical notes: Typically three initial sessions, four to six weeks apart, followed by annual maintenance. Most useful where trichoscopy has confirmed active miniaturization even at a Norwood 1 stage. High cost per session is the primary barrier.
Cost: $500 to $2,000 per session.
Comparing Your Non-Surgical Options
| Option | FDA Status | Evidence Level | Monthly Cost | Use Frequency |
|---|---|---|---|---|
| Oral finasteride | Approved | High | $15 to $40 | Daily |
| Topical finasteride | Compounded | Moderate-High | $40 to $90 | Daily |
| Topical minoxidil 5% | Approved | High | $10 to $25 | Twice daily |
| Oral minoxidil | Off-label | Moderate-High | $5 to $20 | Daily |
| Combination F+M | N/A (combo) | High | $25 to $60 | Daily |
| Ketoconazole shampoo | OTC/Rx | Low-Moderate | $15 to $25 | 2-3x/week |
| LLLT | 510(k) cleared | Moderate | $5 to $20 | 3x/week |
| PRP | Not regulated | Moderate | $100+ | Monthly (sessions) |
Frequently Asked Questions
What does Norwood 1 look like?
Norwood 1 is the baseline on the Norwood scale, characterized by a full, intact hairline with no visible recession at the temples or crown. Most men at this stage have the same hairline they had in their late teens. There is no thinning, no bald patches, and no significant miniaturization visible to the naked eye.
How many grafts do I need at Norwood 1?
At Norwood 1, most men do not require any grafts. Non-surgical options cover everything appropriate at this stage. Surgery is neither indicated nor recommended for hair loss treatment at Norwood 1.
What are the best treatments at Norwood 1?
The best non-surgical approach at Norwood 1 is combination therapy with finasteride and minoxidil, supported by clinical monitoring. Both medications are FDA-approved, available generically at low cost, and have the most robust evidence base for slowing androgenetic alopecia. A dermatologist can personalize your regimen.
Start with a clear picture of your current stage. Get your free AI hairline assessment at myhairline.ai in under 60 seconds. It costs nothing and gives you a documented baseline before any treatment decisions.