Hair loss is more than just an “annoyance” – it’s a widespread conundrum. Male pattern baldness is a condition that affects men worldwide and can significantly impact their self-esteem and confidence. However, understanding the extent of hair loss and subsequently identifying the appropriate treatment options can be challenging. This is where the Norwood scale comes in!
Introduced by James Hamilton and further expanded upon by Dr. O'Tar Norwood, the Norwood scale (or Norwood–Hamilton scale) is a classification system used to diagnose and assess male pattern baldness. The scale consists of seven stages, each representing a different degree of follicle loss.
Understanding the different stages of the Norwood scale can help men identify the extent of their hair loss and choose the most appropriate treatment options, which is why we’re here to elucidate the scale’s different stages!
Stages 1 and 2
The first stage of the scale represents zero major hair loss. At this stage, the hairline is typically straight across, and there is no evidence of significant hair loss on the scalp. This is considered a normal stage of hair growth and is the starting point for the Norwood scale’s reference.
Stage two, conversely, is characterized by a slightly receding hairline, typically in the distinctive shape of the letter “M.” During this stage, the hair loss is minimal and may not be noticeable to most people. However, this stage can be an early warning sign for men concerned about hair loss.
Stages 3 and 4
In stage three, most men begin noticing significant hair loss. At this point, the hairline has receded further, and there may be thinning on the crown of the scalp. The hair loss may be more noticeable when the hair is wet, and it may be difficult to style the hair in a way that hides the bald spots. The distinct “M” shape will likely be more pronounced at this stage.
Stage four is when the patient’s hair loss can be considered “advanced.” In this stage, the hairline recession and crown thinning become more severe, and the areas of hair loss may begin to merge. The "M" shape may also disappear in some instances, and the balding areas may become more extensive, leaving only a band of hair that extends around the sides and back of the head, with parts of the scalp becoming more and more visible.
Stages 5 and 6
Stage five is often characterized as a “severe” stage, with the band of hair that remains around the sides and back of the head becoming thinner and the balding areas at the front and crown merging. This stage is characterized by a horseshoe-shaped pattern of hair remaining on the sides and back of the head, with significant balding at the top and front of the scalp.
In stage six, the balding areas on the front and crown of the head merge completely, leaving only a band of hair around the sides and back of the head. The hair on the peak of the head may also be lost entirely, with the scalp becoming more visible. By this point, men are advised to consider more advanced treatment options such as hair transplantation or scalp micro-pigmentation to address their hair loss.
Stage 7 & Treatments
Finally, there’s stage seven, which represents the most severe form of hair loss when compared to the rest. At this stage, there is complete baldness on the top of the scalp, with only a band of (very sparse) hair remaining around the sides and back. The scalp is mostly visible, with the exception of the aforementioned band, with hair follicles on the top being incredibly sparse in density.
There are several treatment options available for men with hair loss. These include medications such as minoxidil and finasteride, hair transplants, and scalp micro-pigmentation. The appropriate treatment option will depend on the extent of the hair loss and the individual's preferences.
Minoxidil is a medication that is applied topically to the scalp. It is designed to stimulate hair growth and can be effective for men with mild to moderate hair loss. Finasteride is a medication that is taken orally and is designed to prevent further hair loss. It can be effective for men with early-stage hair loss.
Hair transplants can be effective for men with more advanced stages of hair loss, while scalp micro-pigmentation, a non-surgical procedure in which tiny dots are tattooed onto the scalp to create the appearance of a shaved head, is suitable for those suffering from complete baldness or those who prefer a shaved look.
Some Closing Notes
The Norwood scale is beneficial when classifying and diagnosing male pattern baldness. However, it is important to remember that it’s only a reference point since examiner conclusions can vary.
By understanding the different stages of hair loss and identifying the most appropriate treatment options, men can manage their hair loss and feel confident in their appearance. Whether through medications, surgery, or lifestyle changes, many options are available for men experiencing hair loss. With the right approach, men can maintain a healthy head of hair and feel good about their appearance for years.