norwood hamilton scale

The Norwood Hamilton scale explained

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Androgenic alopecia, most commonly referred to as male pattern baldness or pattern hair loss, follows a certain progression. Though it is not exactly the same for all men, there are general stages that characterize this type of hair loss.

An attempt to classify them using images was first created in the 1950’s by Dr. James Hamilton. It was a good scale that already could depict hair loss accurately. Dr. O’Tar Norwood improved it upon however, in the 1970’s. This further expanded the different stages of male pattern alopecia that made it easier to categorize its progression.

The Norwood Hamilton Scale is often used by scalp micropigmentation professionals, usually for quotation purposes and to estimate how many sessions you will need. The scale is also used by hair transplant physicians, alongside the Ludwig Scale for hair loss in women, to diagnose a patient’s hair loss and assess its stage and likely progression. It has also aided the medical profession in other ways, such as assessing heart disease and prostate cancer.

Knowing where you are on the Norwood Hamilton Scale will better facilitate your search for quotations.

The different stages of the Norwood Hamilton Scale

an infographic of the norwood hamilton scale for hair loss
An infographic of the norwood hamilton scale for hair loss

Stage 1

The first stage of the Norwood Hamilton Scale depicts scant to barely detectible hair loss.

Stage 2

The frontal temporal region is starting to exhibit recession. There is a hypothetical line that exists just before the ears a few centimeters where the recession stops. The hair all over the head is still thick. Only the inward progression is apparent.

Stage 2A

Same as Stage 2 coupled with a thinning of the hair in the front central area above the forehead.

Stage 3

Recession has increased in the frontal temporal region up until the hypothetical line along the ears. There is a pointed shaped patch of hair at the frontal central area of the scalp. Baldness is marked at this stage.

Stage 3A

It is the same as Stage 3 regarding areas in the frontal temporal region. The pointed shaped patch of hair has disappeared and the central area is flatter.

Stage 3V (vertex)

It is the same as Stage 3 and 3A regarding the frontal temporal region. There is now recession in the vertex area of the scalp as well. The frontal central area has a semblance of Stage 3A’s.

Stage 4

The frontal temporal area has exhibited further recession that stops right at the hypothetical line of the ears. There is further thinning of the hair in the frontal central region. The vertex region has a broader circumference of baldness compared to Stage 3V. A bridge-like band remains connecting the sides of the head and delineating the frontal from the vertex regions.

Stage 4A

It is the same as Stage 4 regarding the frontal temporal area. The vertex region is still intact. There is only a scant hair growth in the frontal central area however.

Stage 5

The vertex region is exhibiting a larger range of hair loss whose size is about the circumference of a large apple. The bridge-like band that connected the sides of the head has reduced in thickness and density. A triangle-shaped patch of hair that is separated from this bridge-like band is all that remains of the frontal central region.

Stage 5A

It is the same as Stage 5 regarding the frontal temporal area except that the bridge-like band has now disappeared. There only exists a scant amount of hair over the entire vertex region.

Stage 5V (vertex)

It is the same as Stage 5 regarding the frontal temporal region with the exception of a formation of an M-shaped hairline. There is almost the inexistence of the bridge-like band that is attributable to a wider circumference of the vertex area.

Stage 6

The recession here is a more severe characterization of Stage 5A. There is complete baldness in the vertex region and the hair loss has stopped short at the sides and back of the head that is still dense in its upper regions. Scant hair is all that remains from the bridge-like band that separated the vertex from the frontal central region.

Stage 7

There is total baldness in all the regions of the upper portions of the scalp. The temporal, frontal central and vertex regions are devoid of hair. A horseshoe-type band covers the lower regions of the sides and back of the head.

These stages of the Norwood Hamilton Scale characterize the different types of androgenic alopecia or male pattern baldness. Please consult with a hair expert to find out the accuracy of the progression of one’s hair loss.