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The Norwood Scale
The Norwood scale, also known as the Hamilton-Norwood scale, is the most commonly used scale when classifying male pattern baldness. It is used by doctors to diagnose the type and degree of male pattern baldness, decide on a treatment, and measure how effective the treatment is.
What is the Norwood Hair Scale?
Simply put, the Norwood scale is what doctors use when classifying male pattern baldness. It is used to tell what type of baldness you have and its progression.
The Norwood scale has 7 stages and looks at the pattern of hair loss as well as how much hair has been lost.
The 7 stages of hair loss
Norwood Stage 1
Norwood Stage 2
During this stage, the hairline may have begun to recede slightly. Hair loss normally starts around the temples. This stage is also known as an adult or mature hairline.
Norwood Stage 3
The first noticeable signs of hair loss appear, and this stage is classified as the first stage of balding. The hairline typically recedes more at the temples forming an M, U or V shape. The bald areas have either no, or very sparse hair.
Norwood Stage 3 Vertex
This is a variation of stage 3 where the hairline remains at stage 2 but thinning and balding appear at the top of the scalp (the vertex). This normally appears as a bald spot.
Norwood Stage 4
The hairline recedes further back on the scalp and the bald spot on the top of the scalp gets bigger with little or no hair on the vertex. A strip of hair remains between the receding hairline and the bald spot.
Norwood Stage 5
During this stage, the hairline continues to recede towards the back of the head and the strip of hair between the vertex and the hairline gets thinner.
Norwood Stage 6
The bald areas at the temples join with the bald area at the vertex and there is little to no hair on the top of the head. There may still be some hair on the sides of the head.
Norwood Stage 7
During this stage, hair begins to be lost at the side of the head and the head is encircled by a ring of thin, sparse hair.
Norwood Class A
Norwood Class A varies slightly from the standard Norwood scale and is used to classify a less common type of male pattern baldness. With Norwood class A, the hairline recedes uniformly from the front of the head to the back without a ring of hair in the middle or a bald spot at the vertex.
How the Norwood Scale can help you choose the right hair loss treatment
The Norwood scale allows your doctor to diagnose you with the correct type and degree of male pattern baldness to help choose the best treatment option for your needs. It also helps your doctor predict the likely progression of your hair loss.Can my hair stop receding at Norwood 2?
Norwood 2 isn’t typically described as male pattern baldness, but rather your hairline is changing from a teenage to an adult shape. Some men may progress rapidly to stage 3 or stay at stage 2 for many years. Some men may never progress to stage 3. Treatment at Norwood stage 2 can slow or prevent your hairline from receding further. Talk to your doctor about what treatments are available at Norwood stage 2.What should I do if I have a Norwood 3 hairline?
If you have the beginnings of male pattern baldness, you may have some hair recession at your temples and possibly hair loss or thinning on your crown (vertex).
If you think you may have Norwood stage 3 hair loss, make an appointment with a doctor. If you are diagnosed with male pattern baldness, you may be able to start treatment straight away to slow down or stop future hair loss if you want to.
How is male pattern baldness diagnosed?
Male pattern baldness is diagnosed with a physical examination. Your doctor will look at the appearance and pattern of your hair loss and make a diagnosis using the Norwood scale. Your doctor will also ask you whether you have a family history of male pattern baldness, as well as some questions about your general health, medical history, and any medications you are taking.
If you are below the age of thirty, female, or have unusual hair loss, your doctor may run some tests to check for another underlying cause. These may include:
- blood tests
- examining your scalp for signs of infection
- sending a sample of your hair to the laboratory for analysis
- taking a small sample of scalp tissue (biopsy) to check for disease
When do I need to see a doctor?
You should see a doctor if you notice that your hair is becoming thinner, or your hairline is receding. The earlier you are diagnosed and start treatment, the better chance you have of slowing or stopping the progression of your male pattern baldness.
How to treat male pattern baldness
Male pattern baldness can be treated in a number of ways. Treatment is most successful when started in the early stages of the condition as it is easier to slow or stop hair loss than create hair regrowth.
The right treatment for you will depend on where your male pattern baldness falls on the Norwood scale.
Treatments for male pattern baldness include:
- over the counter treatments
- laser treatment
- prescription medications
- procedures
- lifestyle changes
Over-the-counter treatments
Minoxidil (Rogaine) is available as a foam or liquid that is applied directly to your scalp. It works by stopping your hair from getting thinner and promoting the growth of new hair on the top of your scalp. You can buy minoxidil over the counter without a prescription either on its own or in combination with other treatments. You may need to use minoxidil for around three to six months before you see any results.
Laser treatment
Low-level laser therapy, also known as red light therapy or cold laser therapy claims to promote hair growth by increasing blood supply to the scalp and stimulating hair follicles. While some studies appear to show that laser therapy is a safe and effective treatment for hair loss, the results are inconclusive, and more research is needed.
Prescription medications
If your hair loss is severe, or if you have tried over-the-counter treatments without success, your doctor may prescribe a medication called finasteride (Propecia).
You take finasteride as a tablet once a day. It is also available as a topical treatment that is applied directly to the scalp. Finasteride is an effective treatment for male pattern baldness, however, the medication may cause unwanted side effects such as reduced sex drive and erectile dysfunction (impotence) in some men.
Procedures
There are several procedures for hair loss. These may be the best option for you if you have a high degree of male pattern baldness and significant hair loss.
Procedures for male pattern baldness include:
- micro pigmentation — during this procedure, tiny tattoos are applied to the scalp to give the appearance of a shaved head
- hair transplant — this procedure involves moving hair-producing follicles from one part of the scalp to an area where hair has been lost
- scalp reduction surgery — areas of bald scalp are removed, and the edges of the areas with hair are stitched together; this may be done in combination with a hair transplant
- scalp expansion surgery — during this procedure, a device is placed under the scalp to stretch the skin and reduce the appearance of bald areas; it may be done as part of scalp reduction surgery, or on its own
- micro-needling — a roller containing hundreds of tiny needles is applied to the skin to cause minor injuries; as the body repairs the injuries it is thought to stimulate hair growth
- platelet-rich plasma (PRP) — this is a relatively new treatment for hair loss that involves taking a sample of your blood, separating the platelet-rich plasma in a centrifuge, and injecting it into your scalp; the procedure is thought to increase blood supply to the hair follicle resulting in thicker hair, but more research is needed
Lifestyle changes
Male pattern baldness is largely genetic, but there are a few things you can do to reduce the risk of developing the condition or slow its progression.
Some things you can do to keep your hair healthy include:
- follow a healthy, balanced diet containing enough essential vitamins and minerals including zinc and iron
- avoid “crash” or extreme diets
- don’t smoke
- reduce stress
- reduce your exposure to pollution and chemicals like chlorine
- limit sun exposure, or wear a hat when in the sun
- limit your use of hair products and shampoos that contain harsh chemicals
In summary
Male pattern baldness is an extremely common condition that many men find distressing. Early diagnosis and the correct treatment are essential in treating the condition and preventing it from worsening.
The Norwood scale is a useful tool to diagnose the type and severity of hair loss in men with male pattern baldness. With an accurate diagnosis, your doctor can recommend or prescribe the most appropriate treatment.
Sources
PubMed: Classifications of Patterned Hair Loss: A Review January-March 2016 [accessed 5th April 2023]
American Academy of Dermatology Association: WHAT IS MALE PATTERN HAIR LOSS, AND CAN IT BE TREATED? 13th December 2022 [accessed 5th April 2023]
PubMed: Finasteride for hair loss: a review August 2021 [accessed 5th April 2023]
Cleveland Clinic: Male Pattern Baldness (Androgenic Alopecia) 9th December 2022 [accessed 5th April 2023]
NICE: Male pattern hair loss (male androgenetic alopecia) February 2022 [accessed 5th April 2023]
Finasteride BNF [accessed 5th April 2023]
Related Hair Loss Treatments
Further Reading on Hair Loss
- How To Stop Hair Loss
- What are the best products for hair loss?
- Side Effects Of Propecia
- Minoxidil For Hair Loss
- How To Stop A Receding Hairline
- Side Effects of Finasteride
- Are Hair Transplants Worth it?
- What Is Alopecia Areata?
- Do Hair Loss Vitamins Really Work?
- Can Stress Lead To Hair Loss?
- DHT Blockers And Hair Loss
- How To Get Thicker & Healthier Hair
- Male Pattern Baldness: Causes & Treatment
- Topical Finasteride