Norwood Scale Explained: The 7 Stages of Male Pattern Baldness
The Norwood Scale (also called the Hamilton-Norwood Scale) is how doctors classify male pattern baldness. It has 7 stages, from no hair loss to the classic "horseshoe" pattern. Understanding your stage helps determine the best treatment approach.
What Is the Norwood Scale?
A visual classification system created by Dr. James Hamilton in the 1950s and updated by Dr. O'Tar Norwood in the 1970s. It's still the standard tool used worldwide to diagnose and track male pattern baldness.
Key insight: Hair loss is easier to slow down than reverse. Earlier stages respond better to treatment—which is why knowing your stage matters.
The 7 Stages of Male Pattern Baldness
Stage 1: No Hair Loss
No Treatment NeededA full, intact hairline with no visible recession or thinning. This is the baseline—the "juvenile hairline" you had in your late teens.
What to do: Take baseline photos for future comparison. If you have a family history of baldness, consider preventive monitoring. No treatment is needed or recommended at this stage.
Stage 2: Slight Recession (Mature Hairline)
Monitor/Consider TreatmentSlight recession at the temples, often forming a subtle M-shape. The hairline moves back 1-2 cm from the juvenile position. This is sometimes called a "mature hairline" and isn't necessarily balding—most adult men have some temple recession.
Key question: Is it progressing? Compare photos over 6-12 months. If it's stable, you may just have a mature hairline. If it's clearly receding further, you're likely heading toward Stage 3.
Treatment options: This is a good time to consider minoxidil if you're concerned about progression. Hair transplants are NOT recommended—too early to justify.
Stage 3: First Signs of Significant Balding
Treatment RecommendedDeeper temple recession creating a clear M, U, or V-shaped hairline. This is the first stage officially considered "balding" on the Norwood Scale. Little to no hair remains in the temple triangles.
Stage 3 Vertex: Some men also develop a small bald spot on the crown (vertex) at this stage while the front remains at Stage 3. This is called "Stage 3 Vertex."
Treatment options: Finasteride + minoxidil combination is highly effective at this stage. Can halt progression in most men and regrow some hair. Hair transplant may be considered once loss has stabilized (usually after 12+ months on medication).
Stage 4: Significant Hair Loss
Treatment Strongly RecommendedSevere temple recession plus a larger bald area on the crown. A thin band of hair may still connect the front and crown areas. The hairline has receded significantly back on the scalp.
Treatment options: Finasteride and minoxidil can still slow progression. Hair transplant becomes a strong option at this stage—enough loss to justify it, but still enough donor hair to work with. Expect 1,500-2,500+ grafts for meaningful restoration.
Stage 5: Extensive Hair Loss
Advanced StageThe band of hair separating the front and crown becomes much thinner or disappears. The bald areas at the front and crown are larger but may still be connected by sparse hair. Classic "monk" pattern begins to emerge.
Treatment options: Medications may still slow further loss. Hair transplant is viable but requires more grafts (2,500+) and expectations should be realistic—full density restoration is unlikely. Some men choose to embrace a shaved head at this stage.
Stage 6: Severe Hair Loss
Very AdvancedThe front and crown bald areas have fully merged. Only a horseshoe-shaped ring of hair remains around the sides and back. Hair on top is essentially gone or extremely sparse.
Treatment options: Hair transplant is still possible but requires extensive grafts and results will be limited. Many men find shaving the head to be the most practical and confident choice at this stage. Scalp micropigmentation (SMP) is another option that creates the appearance of a closely-shaved head.
Stage 7: Most Severe Hair Loss
Most AdvancedThe most advanced stage. Only a thin band of hair remains in a horseshoe shape around the back and sides of the head. This remaining hair may also be thin and fine.
Treatment options: Hair transplant is rarely worth pursuing—limited donor hair and limited coverage area. Shaving the head is usually the best option. SMP can create a "buzzed" look. Embrace it—many men look great bald.
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The "Type A" Variant
Some men don't follow the typical pattern. In the "Type A" variant, the hairline recedes straight back from front to back rather than forming an M-shape and developing a separate crown spot.
Type A baldness is less common but follows the same stages. The main difference is that there's no "island" of hair preserved in the middle—it's a more uniform retreat from hairline to crown.
Treatment by Stage: Quick Reference
| Stage | Best Treatments | Hair Transplant? |
|---|---|---|
| 1 | None needed. Monitor. | No |
| 2 | Consider minoxidil if progressing | No (too early) |
| 3 | Finasteride + minoxidil | Maybe (after stabilization) |
| 4 | Finasteride + minoxidil; transplant viable | Yes (1,500-2,500+ grafts) |
| 5 | Medications to slow; transplant option | Yes (2,500+ grafts) |
| 6-7 | Shave head; SMP; limited transplant | Limited benefit |
What Causes Progression Through the Stages?
Male pattern baldness is caused by dihydrotestosterone (DHT), a hormone converted from testosterone. Hair follicles on the top of your head are genetically sensitive to DHT—when exposed, they gradually shrink (miniaturize) until they stop producing visible hair.
Key factors affecting how fast you progress:
- •Genetics: The biggest factor. Look at your father, grandfathers, and uncles for clues.
- •Age: Loss typically accelerates in your 30s and 40s
- •DHT sensitivity: Varies by individual genetics
- •Treatment: Finasteride blocks DHT and can halt or slow progression significantly
How to Identify Your Stage
- 1. Check your temples: How far have they receded? Can you see a clear M or V shape?
- 2. Check your crown: Is there thinning or a bald spot on top? Use a mirror or take a photo from above.
- 3. Look at the "bridge": Is there still hair connecting your front hairline to the crown, or has it merged into one bald area?
- 4. Compare to old photos: Look at yourself 1, 2, 5 years ago. How much has changed?
- 5. Consult a professional: A dermatologist or hair specialist can assess you accurately.
Key Takeaways
- 1. The Norwood Scale has 7 stages from no loss to extensive baldness
- 2. Stage 2 is often just a "mature hairline" — not necessarily balding
- 3. Stage 3 is when significant balding begins and treatment is most effective
- 4. Earlier treatment works better — it's easier to keep hair than regrow it
- 5. Hair transplants work best at Stages 4-5 — not too early, not too late
- 6. Stages 6-7 may be best addressed by embracing baldness
- 7. Genetics determine your pattern — treatment can slow but not stop the underlying cause
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. For an accurate assessment of your hair loss stage and appropriate treatment options, consult a dermatologist or hair loss specialist.