The mechanism behind baldness
Genetically sensitive follicles react to dihydrotestosterone (DHT), a derivative of testosterone. With each cycle, these follicles produce a thinner, shorter and less pigmented hair — this is miniaturisation. After several cycles, the follicle stops producing visible hair.
Sensitivity to DHT is inherited from both sides of the family, contrary to the myth that it comes only from the maternal line.
How it progresses — the Norwood scale
In men, hair loss follows a recognisable pattern, classified using the Norwood scale, ranging from grade I (intact hairline) to grade VII (only the lateral and posterior crown remain).
- Grades I–II — slight, still subtle recession at the temples
- Grade III — noticeable recession at the temples; this is when most people seek help
- Grade IV–V — thinning at the crown and narrowing of the central bridge
- Grade VI–VII — the areas of loss merge; the donor area limits what's achievable
- In women, the Ludwig scale is used, describing progressive widening of the parting
What works and what doesn't
What works: DHT-targeted medical therapy, hair mesotherapy and PRP to stimulate still-viable follicles, photobiomodulation as an adjunct, and, for areas already lost, FUE hair transplantation.
What doesn't work on its own: miracle shampoos, generic supplements taken without a diagnosed deficiency, and treatments applied without a prior scalp assessment. Supplementing iron or vitamins only makes a difference when there's a genuine deficiency.
When to act
The best time is as soon as you notice a change in density or a receding hairline. Halting miniaturisation is always simpler and more affordable than restoring hair that's already been lost.
At Replace Clinic, assessment includes trichoscopy, standardised clinical photography and, when indicated, blood tests — to design a plan with an 18-month horizon and measurable results.
The stages of baldness on the Norwood scale
The Norwood-Hamilton scale describes the progression of male pattern baldness across seven stages and is the reference used in consultations to classify each case and plan treatment.
- Stages I–II — slight recession at the temples; the ideal phase for preventive medical treatment
- Stage III — deep recession at the temples and, sometimes, the start of thinning at the crown
- Stages IV–V — combined loss at the temples and crown, with the central bridge narrowing
- Stages VI–VII — the two areas merge, leaving only the lateral and occipital crown
- From stage V onwards, a transplant requires careful planning of the donor area
How many grafts are needed
The number of follicles required depends on the area to be covered and the density sought. As a clinical guide, correcting the temples typically involves 1,500 to 2,500 follicles, an isolated crown 1,500 to 2,500, and an extensive restoration of the top and crown can exceed 5,000 follicles, sometimes spread across two sessions.
The limiting factor is never the recipient area, but the donor area: everyone has a finite number of follicles resistant to DHT. That's why long-term planning matters more than the immediate result — especially in younger patients, whose baldness is likely to progress further.
Halting progression: what works
A transplant restores hair, but doesn't stop native hair from continuing to thin. That's why the plan almost always combines surgery with ongoing medical treatment — topical or oral therapy prescribed in consultation, hair mesotherapy, PRP and photobiomodulation.
Without maintenance, it's common for a gap to appear, years later, between the transplanted area and the original hair that carried on thinning. With maintenance, the result stays consistent over time.