Norwood 5 at age 42 represents advanced hair loss where the frontal recession and vertex thinning have nearly merged. Only a narrow, thinning band of hair separates the two zones. At this stage, a hair transplant is the primary method for restoring visible coverage, and strategic donor management is essential to produce a result that holds up over time. Medication supports the surgical outcome by protecting whatever native hair remains.
Norwood 5 at 42: The Full Picture
At Norwood 5, the bald or severely thinned area covers most of the top of the head. The remaining bridge between the front and vertex is sparse and likely continues to thin. The horseshoe pattern of permanent donor hair around the sides and back is clearly defined.
Norwood 5 Profile
| Feature | Details |
|---|---|
| Frontal hairline | Severely receded |
| Vertex | Large bald or near-bald area |
| Bridge zone | Narrow, sparse |
| Grafts needed | 3,000-4,500 |
| Sessions likely | 1-2 |
| Medication alone sufficient | No |
| Primary approach | Transplant + finasteride |
Building Your Treatment Plan
Finasteride: Start Now
Even at Norwood 5, finasteride (1mg daily) plays a critical role:
- Halts further loss in 80 to 90% of men, protecting the remaining bridge and donor area
- Stabilizes native hair surrounding future transplant zones
- Prevents the worst-case scenario of Norwood 6 to 7 progression
- Side effects in 2 to 4% (sexual, reversible upon discontinuation)
Minoxidil (5% topical) has limited impact at Norwood 5 because most affected follicles have progressed beyond miniaturization. However, it may provide marginal benefit in areas where thin hairs still grow, particularly at the vertex edges.
The Transplant: Planning for Norwood 5
At Norwood 5, the transplant is a larger procedure that requires careful graft distribution.
Graft count: 3,000 to 4,500 grafts, strategically allocated:
- Frontal hairline and forelock (50-60%): This zone has the greatest impact on your overall appearance and gets the majority of grafts
- Mid-scalp transition (20-30%): Creates depth behind the hairline
- Vertex (10-20%): Lighter coverage or deferred to a second session depending on donor supply
Technique options:
| Factor | FUE | FUT |
|---|---|---|
| Recovery | 7-10 days | 10-14 days |
| Max grafts per session | 5,000 | 4,000 |
| Graft survival | 90-95% | 90-95% |
| Scar | Small dots | Linear scar |
| Better for Norwood 5 | Yes, larger single session | Yes, high graft yield |
Session planning: A single mega-session of 4,000+ grafts is possible, but many surgeons prefer two sessions (2,000 to 2,500 each) spaced 8 to 12 months apart. This approach optimizes healing and graft survival.
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 |
Donor Management Is Critical
At Norwood 5, you need a large number of grafts now and may need more in the future. The safe extraction limit is 45% of your donor follicles.
Donor Supply by Density
| Donor Density | Total FU Available | Safe to Extract (45%) | After Norwood 5 Procedure |
|---|---|---|---|
| 150 FU/cm2 | ~6,000 | ~2,700 | Limited reserve |
| 170 FU/cm2 | ~6,800 | ~3,060 | Some reserve |
| 200 FU/cm2 | ~8,000 | ~3,600 | Moderate reserve |
If your donor density is on the lower end, the surgeon will be more conservative with graft counts and focus on the frontal zone. For higher-density donors, broader coverage including the vertex is achievable.
Supplementary Approaches
- Scalp micropigmentation (SMP): Tattoo dots between transplanted hairs to create the illusion of fuller density. Highly effective at Norwood 5 where grafts may be spaced wider apart.
- PRP therapy: $500 to $2,000 per session, supports graft survival and native hair retention
- Body hair transplant: Beard or chest hair as supplementary donor source when scalp supply is limited
- Hair systems: Non-surgical option for immediate full coverage, can be combined with a transplant for the frontal zone
Results Timeline
- Days 1-3: Post-operative swelling and redness
- Days 7-10: Return to normal activities (FUE)
- Weeks 3-6: Transplanted hairs shed (expected)
- Months 3-6: New growth begins to emerge
- Months 12-18: Full result visible, continued improvement up to 24 months
Prognosis Without Treatment
Norwood 5 at 42 will progress to Norwood 6 or 7 within the next 5 to 10 years without intervention. The remaining bridge will thin completely, and the horseshoe pattern will become more pronounced. Finasteride significantly slows this timeline, protecting both native hair and any transplanted results.
Plan Your Restoration
Donor density assessment is the most important step before committing to a Norwood 5 procedure. It determines how many grafts are available, how to distribute them, and whether supplementary approaches like SMP are needed.
Get your free AI hair loss assessment at myhairline.ai/analyze to map your Norwood stage, measure donor potential, and build a realistic restoration plan for your specific situation at 42.
Review the complete Norwood scale guide or check 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.