Norwood stages 2 through 3V respond best to medication, with the crown region outperforming the temples at every stage. Finasteride and minoxidil become progressively less effective as standalone treatments beyond Norwood 4, where surgery takes over as the primary restoration method.
Medication Response by Norwood Stage
| Stage | Finasteride Response | Minoxidil Response | Medication Alone Sufficient? |
|---|---|---|---|
| Norwood 1 | Not indicated | Not indicated | No treatment needed |
| Norwood 2 | 80-90% halt, 65% regrowth | 40-60% regrowth | Yes, for most patients |
| Norwood 3 | 80-90% halt, 50-60% regrowth | 30-50% regrowth | Often yes, sometimes transplant |
| Norwood 3V | 80-90% halt, crown regrowth good | 40-60% crown regrowth | Crown: yes. Temples: marginal |
| Norwood 4 | 70-80% halt, limited regrowth | 20-40% regrowth | Rarely sufficient alone |
| Norwood 5 | 60-70% halt, minimal regrowth | 15-30% regrowth | No |
| Norwood 6 | Protective only | Minimal impact | No |
| Norwood 7 | Protective only | Minimal impact | No |
Response rates decline with advancing stage because there are fewer active follicles to rescue. Medication works by preventing further miniaturization and reviving weakened (but not dead) follicles. At advanced stages, most follicles in the affected zones are already gone.
Why Early Stages Respond Better
The Miniaturization Window
Hair follicles do not die instantly. They go through a gradual process called miniaturization, where each growth cycle produces a thinner, shorter, lighter hair than the one before. This process takes years per follicle.
Finasteride (1mg daily) works by reducing DHT levels by approximately 70%. DHT is the androgen that drives miniaturization. When DHT levels drop, miniaturizing follicles can recover and resume producing normal-thickness hair. But once a follicle is fully miniaturized and the hair it produces is invisible (vellus hair) or the follicle has scarred over, no medication can bring it back.
At Norwood 2-3, most affected follicles are still in the early-to-mid stages of miniaturization. There are still hairs to save and strengthen. By Norwood 5-7, the follicles in the bald zones have progressed past the point of medication rescue.
Crown vs. Temples: A Consistent Gap
The crown responds better to medication than the temples at every Norwood stage. Research shows:
- Crown regrowth with finasteride: Approximately 65% of patients see visible improvement
- Temple regrowth with finasteride: Approximately 35-40% see visible improvement
This gap exists because crown follicles appear to have more androgen receptors that respond to DHT reduction, while temple follicles may be influenced by additional factors beyond DHT alone.
For Norwood 3V patients, this difference is strategically valuable. The crown component can often be managed with medication, reducing or eliminating the need for crown grafts, while the temples are treated surgically.
Finasteride: Stage-by-Stage Breakdown
Norwood 2: The Ideal Window
Finasteride at Norwood 2 produces the best overall results. The hair loss is minimal, the follicles are mostly healthy, and the medication can halt progression in 80-90% of men. Many patients at this stage experience enough regrowth that they no longer notice their hair loss.
Protocol: 1mg daily, oral. Effects become visible at 6-12 months. Full results at 12-24 months. Side effects (sexual, 2-4%) typically emerge within the first few months if they occur at all.
Norwood 3-3V: Strong but Not Complete
Finasteride still halts progression effectively at these stages. Regrowth is common but rarely restores the hairline to its Norwood 1 position. Patients typically see thickening of miniaturized hairs and some filling in of thin areas, but deep temple recession rarely reverses fully.
For 3V patients, the crown responds well (often returning to near-normal density), while the temples stabilize without significant restoration.
Norwood 4-5: Supportive Role
At these stages, finasteride shifts from primary treatment to supporting actor. Its main value is protecting native hair that has not yet been lost, which preserves the results of a hair transplant. Without finasteride, patients who receive a transplant at Norwood 4 may continue losing surrounding native hair, creating an unnatural "island" effect.
Norwood 6-7: Protection Only
Finasteride can slow any remaining progression, but the density deficit is too large for medication to address. Its role is strictly protective: maintaining whatever native hair remains in the donor zone and transition areas.
Minoxidil: Complementary Treatment
Minoxidil (topical, 2% or 5%) works through a different mechanism than finasteride. It extends the growth phase of the hair cycle and increases blood flow to the follicle. It is most effective when combined with finasteride.
Best Response Zones
| Zone | Minoxidil 5% Response | Timeline |
|---|---|---|
| Crown | 40-60% regrowth | 4-6 months |
| Mid-scalp | 30-50% regrowth | 4-6 months |
| Temples | 20-35% regrowth | 4-8 months |
| Frontal hairline | 15-25% regrowth | 6-12 months |
Minoxidil's effectiveness also decreases with advancing Norwood stage, following the same logic as finasteride: fewer viable follicles to stimulate means less visible response.
When to Choose Medication vs. Surgery
The decision point typically falls around Norwood 3-4.
Medication alone is reasonable when:
- You are Norwood 2 or early Norwood 3
- Crown thinning responds to medication (Norwood 3V crown component)
- You want to stabilize before making surgical decisions
- You are under 25 and your pattern is not yet established
Surgery becomes the primary treatment when:
- You are Norwood 4 or above
- Temple recession has not responded to 12+ months of medication
- You want density restoration, not just halting of loss
- Your pattern has been stable on medication and your surgeon can plan confidently
Find Your Treatment Path
Your Norwood stage determines whether medication, surgery, or a combination is the best starting point. Upload a photo at myhairline.ai/analyze for a staging assessment with personalized treatment recommendations based on your current level of hair loss.