At Norwood Stage 6, the bridge of hair that divided the frontal and vertex (crown) regions is gone, so the two areas of loss merge into one large region. A substantial portion of the top of the head shows scalp, while a band of DHT-resistant hair remains at the sides and back. That side-and-back hair later serves as the permanent donor zone for any transplant.
Stage 6 reflects advanced androgenetic alopecia, but it still gauges severity rather than being a diagnosis. Here, medication's main role is preserving the remaining hair — especially the side-and-back margins — and slowing further progression. Evidence-based options such as minoxidil and finasteride take 4-12 months to show effect and require continued use, and filling an already widely bald crown with medication alone is not realistic. Finasteride and dutasteride carry a risk of fetal birth defects, so anyone who is or may become pregnant must not handle broken tablets.
When a transplant is considered, Stage 6 is sometimes cited with an illustrative range of roughly 4,000-6,000+ follicular units, and because the area is large it is often staged over multiple sessions. Since donor supply is finite, priority goes to restoring the face-framing frontal region rather than filling every area to native density. Non-medical concealment such as scalp micropigmentation (SMP) or wigs are also reasonable choices under honest expectations.
Grafts at this stage
A transplant at this stage may need roughly 4,000–5,500 grafts (varies with donor and hair caliber).
Try the free self-check →Sources: Patterned hair loss review (PMC) ↗
FAQ
At Stage 6, is there any point in taking medication?
Filling a widely bald crown with medication alone is unlikely, but preserving the remaining hair and the side-and-back margins, and slowing further progression, still has value. This also supports future transplant planning. Whether to start is best discussed with a dermatologist.
Can a single transplant cover all of Stage 6?
The area of loss is large, so it is usually staged over multiple sessions, and finite donor supply means the frontal region is prioritized. Filling every area to native density is difficult. A specialist will outline a feasible range after examining your donor area.
How do I know if I have enough donor hair?
A specialist directly assesses the density, caliber, and scalp laxity of your side-and-back hair to decide. The donor zone is a finite resource, and over-harvesting can thin it. That's why a careful allocation plan accounting for future stages is important.
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⚠️ When to see a doctor — don’t self-treat
- Sudden patchy or circular bald spots
- Redness, scaling, pus, pain or itch (possible scarring alopecia — treat urgently)
- Broken hairs or rapid loss
- Loss with body-wide signs (weight loss, fatigue, cycle changes, acne, extra hair)
- Loss right after a new medication
- Any hair loss in a child