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The Hamilton-Norwood Scale: The 7 Stages of Hair Loss

The Hamilton-Norwood Scale: The 7 Stages of Hair Loss

Miriam Otero

5 min

March 9, 2023

Hair loss is an issue that concerns many people: 70% of men and 40% of women worldwide are affected by it – and it can severely affect their well-being.

The Hamilton-Norwood Scale (also known as Norwood Scale) provides an important tool for categorising and documenting the areas of hair loss and their progression.

In this blog article, we explain the seven stages of the Norwood Scale and take a deep dive into its practical use for hair loss treatments. At the end, you will also learn how to define your exact stage of hair loss with the help of a thorough hair analysis and learn more about its treatment options.

The Norwood Scale: An Overview

In the field of hair restoration and treatment, the Norwood Scale is a fundamental tool for assessing and communicating hair loss in men. Named after the renowned dermatologist Dr O'Tar Norwood, it is a method of classifying the stages of male pattern baldness.

The Hamilton-Norwood classification system divides hair loss into seven (sometimes eight) stages, starting with minimal hair loss and progressing to severe hair loss and balding areas. The scale provides a simple way of documenting the different stages of hair loss and discussing treatment options.

First Stage

At the first stage, the patient shows no signs of hair loss or only minimal hair thinning along the hairline. Type one is often considered a normal hairline.

Second Stage

Hair loss is minimal but more pronounced than in stage 1. There may be a slight shift in the frontal hairline or a recession of the hairline at the temples. Type two hair loss is also often referred to as mature hairline.

Third Stage

In type three, the receding hairline becomes more pronounced and the hair loss spreads further along the temples. The hair loss may also be noticeable on the top of the scalp, which is not yet completely bald.

Sometimes, this stage is further divided into “stage 3“ and “stage 3 vertex“, with the latter indicating first signs of hair loss at the crown of the head.

Fourth Stage

In type four, the receding hairline is deeper and the hair loss on the crown is more pronounced. There may also be hair loss  at the top of the back of the head, which is known as "vertex".

Fifth Stage

In type five, the receding hairline is deeper and the hair loss on the crown is more pronounced. Here, too, there might be hair loss on the vertex.

Sixth Stage

In this stage, the receding hairline is deeper and the hair loss on the crown is more pronounced.

In stage 6 there can also be a significant loss of hair at the vertex and on the sides of the head, with only a narrow strip of hair connecting the front and back of the head, resulting in bald spots. A fringe of hair usually remains above the ears around the entire back of the head.

Seventh Stage

The last stage of androgenetic hair loss (alopecia androgenetica) is known as type VII. This stage is characterised by advanced hair loss in which only a narrow band of hair remains at the back of the head, connecting the sides of the head.

Causes and Treatments for Hair Loss

Hair loss is a complex problem that is influenced by various causes such as hormonal changes and medical conditions such as androgenetic alopecia (hereditary hair loss).

One of the main causes of hair loss is the hormone dihydrotestosterone (DHT), which can lead to hypersensitivity of the hair follicles in some people, resulting in thinning hair.

However, there are also other causes of hair loss such as stress, autoimmune diseases, malnutrition or thyroid problems. Male pattern hair loss is the most common type of hair loss – an early diagnosis can be very helpful here.

The treatment of hair loss requires an individualised approach that is tailored to the specific needs of each individual. Modern treatment methods such as drug therapies to inhibit DHT production or stimulate hair growth as well as topical hair loss treatments can be considered.

Furthermore, lifestyle and dietary changes can help to slow or stop hair loss. Hair growth can be stimulated again and new hair can grow over the years.

In various countries such as in the UK, Switzerland, and Turkey, there are hair surgeons who can cater to the individual needs of patients and develop customised treatment plans. Standardised medical documentation is crucial to accurately track the progression of hair loss and assess the effectiveness of the treatment methods used.

The Importance of the Norwood Scale in Hair Loss Treatment

Fortunately, there are numerous options for treating hair loss, ranging from drug therapies such as minoxidil (better known by its brand name Rogaine/Regaine) to creating an optical illusion with micropigmentation on to surgical procedures such as hair transplants.

If you suffer from hair loss, you can therefore hope for an effective solution and regain self-confidence thanks to advanced technologies and treatment methods. Here, the Norwood Scale can be an essential tool in helping to assess the stage of hair loss so that early action can be taken.

At What Stage Is a Hair Transplant Not Possible Anymore?

A hair transplant is generally not possible if the patient is already at an advanced stage of the Norwood scale, especially in stages 6 and 7, where the hair loss is so advanced that there are no longer enough donor hairs available for a successful transplant.

In stages 6 and 7, the hair loss is so advanced that there is only a narrow strip of hair at the back of the head connecting the sides of the head.

In these cases, it can be difficult to find enough donor hair in the donor area to perform a natural and aesthetically pleasing transplant.

In addition, transplantation at these advanced stages may not achieve the desired results and may lead to insufficient hair growth.

Therefore, it is important that patients with significant hair loss seek medical advice in the early stages to discuss the best treatment options. In some cases, alternative treatments such as non-surgical hair restoration may be considered.

Treating Advanced Hair Loss

The earlier hair loss is treated, the better. However, as long as it has not reached stages 6 or 7, we at HAIR & SKIN offer mega-sessions for treating advanced hair loss.

These sessions include transplantation of 3,000-5,000 grafts and can be booked in a discounted package along with autohaemotherapy to further promote hair regrowth.

Are you unsure about which hair loss treatment might be right for you? Do not hesitate to book a free appointment at HAIR & SKIN to discuss your variety of treatment options with one of our experts.

With just one click, you can book a personal free consultation, including a thorough hair analysis, at our HAIR & SKIN clinic in London where you will learn more about your exact treatment options.

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Advanced Solutions at HAIR & SKIN

At HAIR & SKIN, we offer comprehensive treatment options for various stages of hair loss. From transplanting grafts during a hair transplant surgery to autologous blood treatments for promoting regrowth, our hair transplant surgeons offer customised solutions tailored to your needs.

As the market leader for hair and skin treatments in Switzerland, we are now also your first port of call for FUE hair transplants in London.

Book your no-obligation consultation at our London HAIR & SKIN clinic today and find out how to get back from sparse hair to healthy hair.