The Seven Stages of Hair Loss

A receding hairline, bald spots at the back of the head, thinning hair – hair loss affects millions of people. For many, it is also a serious psychological burden.

In this article, we will introduce you to the Norwood scale. This scale describes the different stages of male pattern hair loss. The Norwood scale is used to measure male pattern baldness, while the Ludwig scale is used to measure female pattern hair loss. The stages serve as an important reference point for doctors and patients to track the progression of hair loss and evaluate the effectiveness of treatments.

They can also directly help you to assess the degree of your own hair loss.

Hereditary hair loss is the most common cause

An accurate diagnosis of the cause of hair loss is crucial in order to choose the best possible treatment and achieve healthy hair. In some cases, stress, poor diet, harmful environmental factors, medication, or certain illnesses can contribute to hair loss. This is often diffuse hair loss or circular hair loss, also known as alopecia areata. The side effects of stress can lead to telogen effluvium, which is another common type of hair loss that affects people after they experience severe stress or a change to their body.

However, the most common cause of thinning hair by far is hereditary hair loss, also known as androgenetic alopecia(or androgenic alopecia) as well as androgenic hair loss. It is predominantly men who are affected by this type of hair loss. Even though this is a naturally occurring form of hair loss, it can have a massive impact on the well-being and self-esteem of those affected.

Hereditary hair loss is caused by hypersensitivity of the hair follicles to the hormone dihydrotestosterone (DHT), which leads to follicular shrinkage and ultimately to hair loss. In most cases, this hair loss follows a very specific pattern, as described in the stages of the Norwood scale.

How is natural hair loss measured?

In the 1950s, the American dermatologist Dr. James Hamilton developed a scale that can be used to visually record hereditary hair loss and describe it in stages. Since this so-called Hamilton scale was later modified by Dr. O'tar Norwood, it is also known as the Norwood-Hamilton scale or Hamilton-Norwood scale.

It is now accepted worldwide and is used by dermatologists, doctors and hair specialists to classify the severity of male pattern hair loss. It helps to track the progress of further hair loss and to plan the next steps.

The seven stages of hair loss

According to Norwood and Hamilton, the different stages of hair loss that progress to full male pattern baldness can be divided into the following types of hair loss:

Stage 1

A normal hairline and hair density with no or minimal signs of hair loss.

Stage 2

Slight hair loss at the temples, also known as a receding hairline. The line of the hairline gradually starts to recede, forming an “M” or “V” pattern.

Stage 3

Moderate hair loss at the temples and on the crown of the head. Hair loss is more pronounced. Onset of hair loss with baldness at the back of the head.

Stage 3 vertex

Bald patches on the crown of the head increase in size, while hair loss at the temples also becomes more pronounced. Hair loss can be observed in the crown of the head.

Stage 4

Bald patches on the top of the head increase in size, while hair loss at the sides of the head also becomes more pronounced. Hair loss can be observed in the crown of the head.

Stage 5

The bald area on the crown, or top of the head, continues to increase in size. Only a strip of hair, which resembles a band of hair, remains at the back of the head.

Stage 6

The remaining hair at the back of the head thins out.

Stage 7

The most severe degree of hair loss. Only a narrow strip of hair remains at the lower edge of the back of the head. The head area is practically bald - in most cases a ring of hair remains.

The progression and prognosis of hair loss

Three typical forms of progression can be distinguished, in which the seven stages are experienced at different degrees of severity.

Premature hair loss

The early stages of hair loss are characterized by early and rapid hair loss. It usually begins in the early 20s and can lead to a high stage on the Hamilton-Norwood scale before the age of 30.

Smouldering hair loss

By contrast, smouldering hair loss usually only occurs after the age of 30 and progresses comparatively slowly. This means that those affected often have more time to get used to the hair loss or to find suitable treatment options.

Late-onset hair loss

In the later onset, hair loss only begins after the age of 40 and usually progresses very slowly. This form is most common in men. Despite the slow progression, hair loss can still lead to considerable emotional stress.

Less serious forms of hair loss

Hair shedding, on the other hand, is a natural part of the hair growth cycle, occurring when some hairs fall out while others grow in. Hair shedding is not to be confused with female pattern baldness and the various stages of male pattern baldness. The resting phase of hair growth is called the telogen phase. During this phase, the hair follicle is dormant and the hair shaft does not grow. The telogen phase can last 3–4 months, and at the end of this period, some hair will fall out. This is often called "shedding" and it's normal to lose up to 100 hairs per day.

The catagen phase of hair regrowth is a transitional phase in the hair growth cycle that occurs between the active growth phase (anagen) and the resting growth phase (telogen). It's characterized by a transition into quiescence, where the hair follicle regresses and loses about one-sixth of its diameter. The catagen phase can last between 10 to 20 days, but for lashes it can last 2-3 weeks.

What options are there to counteract hair loss?

Fortunately, today there are many ways to counteract these problems, restart the hair growth phase, and stop or at least slow down hair loss.

Some of the options for new hair growth and slowing down hair loss are listed below:

Nutrition

A balanced diet with sufficient vitamins, minerals, and natural supplements is important for hair health. A deficiency of B vitamins such as vitamin B12 and vitamin H (biotin) can be associated with hair loss and dermatology problems. A lack of vitamin D, the so-called sun hormone, can also lead to hair loss.

Hair care

Using a good and gentle topical hair care routine also makes a small contribution to limiting hair loss. Avoid aggressive styling and use mild shampoos and conditioners.

Medication

There are several medications with ingredients such as minoxidil that have been specially developed to treat hair loss. For example, there are drugs that block the hormone dihydrotestosterone. Others use growth-promoting enzymes to stimulate hair growth. However, the effect of these medications is controversial and the effect diminishes as soon as the medication is discontinued. Some are over the counter, while others need to be discussed with your healthcare professional.

Autologous blood treatment

A popular and useful method is autologous blood treatment, in which the body's own blood plasma is injected into the scalp. The blood plasma contains growth factors that stimulate hair growth and hair restoration, and can therefore improve the appearance of the hair. You can find more information about the procedure and patient testimonials here.

Hair transplantation

Robbie Williams, John Travolta and most likely Elon Musk have done it too: hair transplants are a popular and efficient way to regain your original splendor with new hair. Hair transplantation is a surgical procedure in which the roots of the individual hairs are taken from an area of the head with dense hair and are transplanted to a bald area.

This method is particularly effective when people have already reached an advanced stage of hair loss. A study from 2019 showed that patients are significantly more satisfied after hair transplants.

For optimal results, hair transplantation can be combined with autologous treatments. We have compiled more information and before and after examples for you on our website.

Conclusion: We have hair loss treatments for every stage of hair loss

Hereditary hair loss is a widespread problem. Many men also lose self-confidence along with their hair. Fortunately, effective treatment options such as autologous treatments and hair transplants are now available to those affected.

The stages of hair loss described above help to classify the current condition of the hair on your head and find the most suitable treatment option.

Book a free appointment with us now to receive your individual consultation.