Finasteride halts further progression in fewer than 50% of men at Norwood 5, which means medication alone is no longer a reliable primary treatment at this stage but remains essential as surgical support to protect remaining native hair and donor area quality.
Why Medication Response Drops at Norwood 5
The effectiveness of finasteride depends on how many follicles are still alive and capable of responding to reduced DHT levels. At Norwood 5, the frontal and mid-scalp regions have experienced prolonged miniaturization. Many follicles in these zones have progressed through multiple thinning cycles and have permanently shut down.
The Follicle Lifecycle at Norwood 5
Hair follicles at Norwood 5 typically fall into three categories:
- Dead follicles (majority in affected zone): These have undergone complete miniaturization and cannot produce any visible hair regardless of treatment. No medication can revive them
- Miniaturized but alive (minority): These produce fine vellus hairs and may respond to finasteride. They are concentrated at the borders of the balding zone and in the crown
- Healthy terminal follicles: Found in the donor area and in remaining fringe zones. Finasteride protects these from future miniaturization
Response Rates at Norwood 5
| Metric | Finasteride | Minoxidil (Crown) | Combined |
|---|---|---|---|
| Halt of progression | Below 50% | N/A (different mechanism) | ~50% |
| Visible regrowth | ~25% | 30-40% (crown only) | ~35% |
| Clinically significant improvement | ~15% | ~20% (crown only) | ~25% |
These numbers reflect the limited pool of recoverable follicles at this stage. The medication is working on fewer targets, not working less effectively per follicle.
Finasteride as Transplant Support
The most important role for finasteride at Norwood 5 is not regrowing lost hair. It is protecting the investment you make when you undergo transplant surgery.
How Finasteride Protects Surgical Results
A transplant at Norwood 5 typically involves 3,000 to 4,500 grafts placed into the frontal and mid-scalp zones. These grafts are taken from the DHT-resistant donor area and will survive permanently. However, the native hair surrounding the transplant zone is not DHT-resistant. Without medication:
- Native hair continues to thin over the following years
- The density gap between transplanted and native zones becomes increasingly visible
- The hairline may look unnatural as surrounding hair recedes further
- A second procedure may be needed sooner to address the expanding gap
With finasteride:
- Remaining native hair is protected (to the extent the medication is effective for that individual)
- The blending between transplanted and native zones is maintained longer
- The overall result ages more gracefully
- Second procedures can be delayed or avoided
Starting Finasteride Before Surgery
Most transplant surgeons recommend starting finasteride 6 to 12 months before a Norwood 5 procedure. This serves two purposes. It stabilizes whatever native hair remains, giving the surgeon a clearer picture of the true hair loss extent. And it establishes whether you tolerate the medication, which affects long-term planning.
Minoxidil at Norwood 5
Minoxidil (5% topical) retains moderate effectiveness in the crown area at Norwood 5. If your crown still has miniaturized follicles (visible as fine, short hairs under bright light), minoxidil can thicken and extend their growth cycle. Expect modest improvement in 30 to 40% of cases.
Practical Application
- Apply to the crown and vertex area twice daily
- Onset of visible effects: 4 to 6 months
- Best used in combination with finasteride, not as a replacement
- Minimal benefit expected in the frontal zone at this stage
The Realistic Role of Medication at Norwood 5
At Norwood 5, medication transitions from a potential solution to a maintenance and support tool. The honest framework is:
- Primary restoration: Hair transplant surgery (3,000 to 4,500 grafts)
- Support and protection: Finasteride (daily) and minoxidil (crown area)
- Cosmetic enhancement: SMP, concealers, or hair systems for additional density
The Norwood scale complete guide explains how medication response varies across all stages, and the FUE vs FUT comparison covers surgical methods for Norwood 5 patients who are ready to proceed.
Understand Your Options
Every Norwood 5 case is different. Your specific follicle status, donor density, and health history affect which combination of treatments will produce the best outcome. Upload a photo at myhairline.ai/analyze for a free AI analysis of your current stage and a personalized treatment recommendation.