The Norwood Scale for Hair Loss: Stages, Pictures, and More

The Norwood scale (also called the Hamilton-Norwood scale) is a seven-stage classification system used to measure and categorize the different stages of male pattern hair loss. 

Men typically don’t lose their hair evenly across their entire scalp. Instead, hair loss caused by male pattern baldness (androgenetic alopecia) tends to follow a specific pattern.

Here, we’ll explain how the Norwood scale for hair loss works and list the seven stages (or Norwood levels) you may go through if you’re experiencing pattern baldness.

The Norwood hair scale breaks male pattern hair loss into seven stages based on the severity, pattern, and progression of hair loss.

The scale was originally developed by James Hamilton and called the Hamilton scale. However, it was later updated by Dr. O’Tar Norwood, a dermatologist and hair transplant surgeon. He revised and simplified Hamilton’s classification after he saw different patterns of hair loss in men. He also reduced the number of stags from eight to seven.

Here’s a look at each of the seven stages of hair loss, according to the Norwood scale.

Stage 1

Stage 1 on the Norwood scale involves no significant hair loss or hairline recession — or just a little bit of hair loss.

Although uncommon, some men maintain a Norwood type 1 hair pattern for their entire lives and never experience noticeable hair loss. 

Stage 2

At Norwood stage 2, you may begin to have noticeable hair loss, especially around the temples. This is sometimes called a mature hairline.

Recession is usually symmetrical on both sides of the hairline. 

Stage 3

A Norwood 3 hairline has much more visible hair loss at the hairline and is the minimum stage required to be considered “baldness.” During this stage, the hairline recedes more and takes on a clear M or V shape. For some men, a receding hairline is accompanied by small balding areas on the scalp.

Men with hair classified as Norwood 3 have obvious hair loss at the temples and the frontal area of the scalp. Some guys with a Norwood type 3 hairline also experience hair loss at the crown, also called the vertex. This is referred to as Type III vertex hair loss.

Men with more significant hair loss around the frontal hairline compared to the temples may be classified as having a Norwood type 3A hair loss pattern.

While Norwood stage 2 areas of hair loss are usually easy to conceal with the right haircut, Norwood type 3 hair loss is much more difficult to hide.

Stage 4

Norwood 4 hair loss is again more noticeable. Men with hair loss in this stage have lots of hair loss around their hairline, giving it a noticeable bald appearance.

They also have sparse hair or possibly no hair on the vertex of their scalp (top of the head).

Many men with stage 4 hair loss have a thick strip of hair separating their hairline from the balding area around the crown.

Stage 5

As hair loss progresses to Norwood 5, the band of hair separating the hairline and crown becomes smaller and thinner. In this stage, you’ll have significant, obvious hair loss around your hairline and crown.

Some men develop Norwood type 5A hair loss, with more substantial hair loss on the scalp and less of a separating band between the hairline and crown.

For many men affected by balding, this is when the classic horseshoe pattern of hair loss becomes more visible.

Stage 6

Norwood type 6 hair loss is very severe. By this stage, you’ll have lost almost all hair that previously made up your hairline and vertex scalp.

There may still be a band of hair separating these areas, but it will be sparse and thin.

Though you might still have some hair across your scalp, coverage will be minimal, and your scalp will be clearly visible through your hair in all lighting conditions.

By stage 6 of the Norwood hair scale, the classic horseshoe pattern of hair on the back and sides of the head is easy to see.

Stage 7

Norwood 7 hair loss is the most severe form of balding. By this advanced stage, almost none of the hair on the scalp will be left, aside from a few stray hairs or small areas with relatively mild hair growth.

At this point, the classic horseshoe pattern of hair around the back of the head and sides of the head will be all that’s left. This hair may be fine and lacking in density.

Before we get into how to treat each type of hair loss on the Norwood hair scale, you should know a bit about the causes of hair loss.

One of the top causes of balding is genetics. (You can learn more about this in our guide to the baldness gene, aka the AR gene.)

Basically, certain people are born with hair follicles that are more sensitive to the hormone dihydrotestosterone (DHT), a naturally occurring male hormone that’s converted from testosterone.

For people with hair follicles sensitive to DHT, even normal amounts of the hormone can cause hair follicles to shrink (a process known as miniaturization). Eventually, they’ll fail to grow, which creates the horseshoe-shaped hair pattern many bald men have.

Stages of Hair Growth

Human hair goes through four stages of growth:

• Anagen (growth) phase: Where hair actively grows from your follicles

• Catagen (transition) phase: Where hair growth slows and the hair detaches from your follicle. 

• Telogen (resting phase): Where hair stops growing but also doesn’t fall out. 

• Exogen (shedding phase): Hair actively falls out. 

For people with hair loss, more hairs are in the shedding phase than the growth phase.

No matter where you are on the Norwood scale, the earlier you take action to treat and prevent hair loss, the more hair you’ll usually be able to keep.

If you notice your hair advancing from one Norwood type to the next — or if you notice a receding hairline or other early signs of balding — it’s a good idea to take action as soon as possible. If you treat your hair loss while you’re still in Norwood stage 2 or 3, you might be able to keep most or all of your hair.

As hair loss progresses to the later Norwood stages of baldness, it becomes harder to treat effectively, even with surgical procedures like hair transplantation.

Your best bet is to contact a dermatology specialist, trichologist, or other healthcare provider. Hims can connect you with a provider who can assess your hair loss and discuss your treatment options.

Hair Loss Medications for Men

At Norwood stage 3 or 4, you may want to start looking into hair loss treatment options (if you haven’t already). The first treatment for hair loss is usually a combination of the medications finasteride and minoxidil, which have been approved by the Food and Drug Administration (FDA) and can potentially slow down or stop further hair loss.

These medications work in different ways. Finasteride (sold under the brand name Propecia^®) is an oral medication that blocks testosterone from being converted into DHT and encourages new hair growth.

Minoxidil, the active ingredient in Rogaine^®, works by moving hair follicles into a state of active growth and stimulating blood flow to the scalp. Essentially, minoxidil keeps the hair growth cycle going by encouraging new hair growth on your head.

Hair Restoration Surgery

At Norwood stage 5 and above, a hair transplant surgery might be a viable option to add some coverage to your scalp and hairline. But remember, you need to have some remaining hair for a transplant to be successful.

You can learn more about it in our guide to hair transplants.

Healthcare professionals and hair transplant surgeons commonly refer to stages of the Norwood scale to diagnose and treat hair loss in men.

Here’s what to keep in mind:

• The Norwood hair scale measures male pattern baldness in seven stages to determine the severity and pattern of hair loss.

• Norwood stages 1 and 2 signify early signs of hair loss, with either no signs of balding or the beginnings of a receding hairline and noticeable bald spots.

• Stages 3 through 5 indicate more significant hair loss and recession of the hairline, while almost all hair is gone in stages 6 and 7.

• Early Norwood stages are often receptive to treatment from medications like finasteride and minoxidil. Later stages may require hair transplants, though these aren’t always a guaranteed solution.

Healthy hair and regrowth are possible for many men. If you’re curious about effective hair loss treatments, get started with a free consultation — it’s quick, easy, and all online.