When a man notices that his hair is beginning to thin, he often wants to understand the extent of his hair loss and its potential progression. To determine this, dermatologists and hair specialists rely on a scale that measures male hair loss severity, known as the Norwood-Hamilton Scale. This scale helps gauge the stage of hair loss, making it easier to assess the most effective solutions for managing or addressing baldness. However, the Norwood-Hamilton Scale specifically applies to male pattern baldness. For female hair loss, specialists use the Ludwig Scale. Similar in purpose to the Norwood-Hamilton Scale, the Ludwig Scale helps track the progression of female hair thinning.
What is the Norwood-Hamilton Scale?
The Norwood-Hamilton Scale, also known as the Hamilton-Norwood Scale or simply the Norwood Scale, is a system for classifying the stages of male pattern baldness, providing a clear framework to measure hair loss progression. Developed in the 1950s by American anatomist Dr. James B. Hamilton, an expert in male hormonal research, the scale was further refined in the 1970s by Dr. O’tar Norwood as new medical insights emerged. This straightforward yet precise tool is widely used by hair loss specialists and transplant experts globally to diagnose androgenetic alopecia in men. It consists of seven stages, beginning with a full head of hair and ending with complete baldness.
The Seven Stages of the Norwood-Hamilton Scale
The 7 Stages of the Norwood-Hamilton Scale allow hair loss specialists to assess the extent and expected progression of androgenetic alopecia in men. This assessment provides valuable guidance on potential treatment paths to preserve existing hair or restore hair density through specialized options. The Norwood-Hamilton Scale is applicable across various hair types, from straight to curly hair textures:
Stage 1 – Control Stage
In the first stage, there is typically no visible hair loss. This represents a healthy head of hair, often seen in adolescence, where no recession or thinning occurs. Some individuals may naturally have a higher or lower frontal hairline, which is not indicative of future hair loss.
Stage 2 – Mild Recession at the Front
In this stage, there is a slight recession of the hairline, especially at the temples, creating what is often referred to as a “mature hairline.” This minor shift, typically a 1–2 cm receding of the frontal line, is common in adulthood. Although mild hair thinning may begin around the crown (vertex), hair restoration treatments like transplants are not usually recommended at this point, as hair loss may continue and impact adjacent areas. For those concerned, natural treatments (like argan oil or rosemary essential oil) might help nourish the hair but won’t halt androgenetic alopecia completely.
Stage 3 – Significant Recession
Hair loss becomes more prominent at this stage, with visible thinning at the vertex and/or a deeper receding hairline near the temples. This stage is quite common, marking the point where treatment options such as Platelet-Rich Plasma (PRP) therapy and low-level laser therapy may be explored to slow down hair loss and preserve the remaining hair. Hair transplants may also be considered as an initial step toward hair restoration.
Stage 3 Vertex – Center Scalp Thinning
At this stage, hair loss is concentrated around the vertex, or the center of the scalp, while the frontal hairline remains consistent with Stage 2, and the sides retain a thicker density.
Stage 3A – Receding Frontal Hairline
A significant retreat of the frontal hairline is observed here, causing deeper recession at the temples. PRP therapy and laser treatments are commonly advised to help slow down hair thinning and maintain the remaining hair.
Stage 4 – Advanced Hair Loss
Hair loss becomes more pronounced, particularly at the front, with most of the upper scalp losing hair, often leaving a narrow band of hair connecting both sides. The temples may also start receding further.
Stage 5 – Extensive Hair Loss (Some Remaining Hair)
In this stage, a substantial amount of hair has been lost, leaving sparse coverage across the top. However, there is still a thin band of hair that connects both sides at the crown area.
Stage 6 – Monk’s Baldness
Hair loss extends across the top of the scalp, spanning from the hairline to the vertex. However, a strip of hair persists around the sides and back, which remains resistant to hair loss and often serves as the donor area for transplants.
Stage 7 – Advanced Androgenetic Alopecia
This is the final stage, where most of the top scalp is bald, with only fine, variable-density hair remaining on the sides and back of the head.
When to Consider a Hair Transplant?
Experts in hair transplantation generally advise against waiting until Stage 7 to pursue a transplant. While Stage 3 may be too early for a transplant, as hair loss could progress further, making multiple surgeries necessary, the ideal time is typically from Stage 4 onward, when the frontal hairline or crown can be effectively restored. At Stages 5 or 6, a Follicular Unit Extraction (FUE) transplant can restore a fuller look, bringing coverage back to around Stage 3 or 4 levels. By Stage 7, a transplant is possible but requires a higher number of grafts, necessitating a longer procedure to achieve a natural look.
At Novesthetica, we offer tailored solutions for each case, including expert advice and, where necessary, hair transplant procedures designed to help patients regain their confidence and achieve natural-looking results.