7 Stages of Baldness; male pattern baldness Norwood scale

June 10, 2024

Fig: Stages of hair loss on Norwood-Hamilton Scale

There are different types of hair loss, and the most common one is male pattern baldness.

Norwood-Hamilton scale is widely adopted by doctors all over the world for assessing hair loss. This scale is a seven-stage classification system that measures the severity of male pattern baldness. Each stage represents a different level of hair loss, from the first stage representing almost healthy full hair, advancing to severe baldness until the seventh stage.

In this article, we will discuss the seven stages of hair loss according to the Norwood-Hamilton Scale.

Stage 1: Control stage

At this stage, hair loss is just beginning to occur, with a slight recession of the hairline around the temples. Hair loss is mild and not yet noticeable to most people.

This stage can be the start of your upcoming nightmares, so if you have a history of hair loss in the family, you better be careful.  Progression of the receding hairline can be prevented by taking good care of your hair and scalp. To prevent further hair loss, avoid tight hairstyles that pull on the hair, as well as harsh chemical treatments and excessive heat styling. Eating a balanced diet that's rich in nutrients like protein, iron, and biotin also helps to keep hair healthy and prevent further loss.

Stage 2: Mild recession from the front

Stage 2 on the Norwood-Hamilton Scale is characterized by mild recession of the frontal hairline and can also involve hair loss at the temples. This stage is often the first noticeable stage of male pattern baldness and can occur as early as the teenage years or in the early 20s. The recession is typically symmetrical on both sides of the head and forms a distinct "M" shape.

At this stage of male pattern baldness, the hair follicles begin to shrink significantly due to the effects of dihydrotestosterone (DHT), a hormone that binds to hair follicles and causes them to miniaturize over time. As the follicles shrink, the hair becomes thinner and shorter until it eventually falls out and does not grow back.

Basic control measures can be applied at this stage such as using oils, medications like minoxidil and finasteride, PRP therapy, etc. to control the further progression of hair loss. Maintaining a healthy lifestyle with a balanced diet, a stress-free schedule, proper sleep, and avoidance of toxicants are greatly influential in controlling hair loss at this early stage.

Hair transplant is not yet recommended at this stage, but some people transplant as little as 500-1000 grafts to maintain the hairline anyway.

It can be beneficial for you if you visit a doctor at this early stage so that you can be aware of the position you are in at present and what to expect in the future.

Stage 3: Moderate recession of the frontal hairline to the back

Stage 3 on the Norwood-Hamilton Scale is characterized by the moderate recession of the hairline and/or balding at the crown of the head. This stage can occur at any age but is most common in men in their 30s and 40s. The recession of the hairline is more pronounced than in Stage 2 and can form a deeper "M" shape. The balding at the crown can be circular or oval and may be partially or completely bald.

Stage 3: Vertex (significant hair loss at the crown)

Vertex is a sub-category of stage 3, referring specifically to a more pronounced balding at the vertex  (crown) of the head. It is considered one step more severe than Stage 3. This type of balding is often the first noticeable sign of hair loss in women and can be caused by several factors, including genetics, hormonal changes, and certain medications.

Now, this is the stage where the first hair transplantation is recommended along with other hair loss control treatments. Up to 3000 grafts of hair are transplanted on patients at this stage combined with PRP therapy after the recovery. Genetic hair loss can still be expected to continue around the area with time, but slower after the treatments. Another session of hair transplantation can be followed later on after many years if required.

Other treatment options for Stage 3 hair loss include medications such as finasteride and minoxidil, which can help to slow down or even halt hair loss in some cases. In addition, there are also non-surgical treatments such as scalp micro-pigmentation, which involves tattooing the scalp to create the appearance of hair, and low-level laser therapy, which uses specialized lights to stimulate hair growth.

Stage 4: Advanced Recession

Stage 4 on the Norwood-Hamilton Scale is characterized by a significantly receding hairline and an enlarging bald crown. The hairline recession extends further back than in Stage 3, creating a more pronounced "M" shape or a "U" shape. The balding at the crown of the head becomes larger with only a distinct bridge of hair connecting the front. The hair on the top sides of the head may become thinner as well.

At this stage, hair loss is typically more noticeable and can have a significant impact on a person's appearance and self-esteem. It's common for men in their 40s and 50s to experience Stage 4 hair loss, but it can occur at any age.

Hair transplantation is strongly recommended for Stage 4 hair loss if you want to restore hair to the balding areas and create a more youthful appearance. You may require up to 4000 grafts of transplantation at this stage.

Stage 5: Extensive Recession but not Bald yet

Stage 5 on the Norwood-Hamilton Scale is characterized by a more extensive and quicker hair loss than Stage 4, with only a narrow band of hair remaining between the balding areas on the front and crown of the head. The baldness in Stage 5 is typically more severe and noticeable than in previous stages, although you have some hair still left and you aren’t completely bald. At this stage, your scalp justifies the looks of an old man which can be frustrating if you are still in your early 30s.

Hair transplantation remains the only option to gain back your hair for Stage 5 hair loss, as it can restore hair to the balding areas. Up to 5000 grafts may be required for baldness of this degree. Many patients say that they got satisfying results from hair transplants even at this stage.

Stage 6: Baldness

Stage 6 is characterized by complete baldness on the front and top portion of the head. Only a handful of strands of hair will remain. The narrow bridge connecting the front to the crown in earlier stages finally disappears and the two balding areas merge. At this stage, only a band of hair remains on the sides and back of the scalp which are mostly resistant to hair loss. Some hair that has remained around the temples may be further thinning at this stage.

If you desire to restore your hair, hair transplantation may be recommended by the doctor after studying your complete case of genes, health, and medications. However, due to the extent of hair loss, it may be difficult to achieve a full head of hair with hair transplantation. In some cases, a combination of hair transplantation and scalp micropigmentation may be used to create the appearance of denser hair.

Stage 7: Most advanced form of Male Pattern Baldness

Stage 7 on the Norwood-Hamilton Scale is the most advanced stage of hair loss, characterized by complete balding across the entire scalp. All you have left is a narrow band of hair at the sides and back of the scalp forming a horseshoe shape.

At this stage, balding is confirmed to have been completed. The hair that remains on the sides and back of the head isn’t supposed to fall as they are insensitive and resistant to the hormones causing hair loss.

Hair transplantation may be a hope to restore some hair enough to give a younger look but the results cannot be promised. It also depends on how much donor hair you have. However, some patients have got their hair back even from this stage, and also some patients who had to be disappointed. So the chance is 50/50.

At Stage 7, you should consider a priority to maintain a healthy scalp care routine to prevent any damage to the bald head. Protecting the scalp from sunburn and harsh environmental conditions is important. Regular scalp massages and gentle hair care can also help to promote scalp health.


The Norwood-Hamilton Scale outlines seven stages of hair loss, each with its own unique characteristics, progression, and potential treatment options. We hope that understanding these stages will help you better understand your hair loss condition and make informed decisions about treatment options.

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