What’s the Norwood Scale? Understanding and Treating Male Pattern Baldness

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In healthcare, many diagnoses are reached by observing known patterns. A patient complaining of excessive thirst, fatigue, unexplained weight loss, and constant hunger may be diagnosed with diabetes. That’s because these symptoms are a common pattern of the disease.

Once doctors make a preliminary diagnosis, they know how to test for it and what treatment to prescribe. How severe the case is will determine whether simple dietary changes can help or if insulin is necessary.

There is also a pattern to male androgenic alopecia, commonly called male pattern baldness. Its causes include genetic, environmental, and hormonal factors. Once the condition is diagnosed, recommended treatment will depend on which stage the pattern has progressed to. For that, the clinician will use the Norwood Scale.

The Norwood Scale is used as a tool to diagnose and measure male pattern baldness. Here are a few things you should know about it and how it’s used to treat this common condition.

What Is the Norwood Scale?

The Norwood Scale, also referred to as the “Hamilton-Norwood Scale,” is a classification system. It categorizes the progressive stages of male pattern baldness, which clinicians use to determine the best treatment options. For example, using topical finasteride and minoxidil gel at Stage 2 may slow hair loss. But by Stage 4, hair transplantation may be the only way to restore growth.

There are seven stages in the Norwood Scale. Stage 1 is when there is no loss of hair. Stage 2 reflects a slight receding of the hairline at the temples. This happens as people age, but may also be a sign of male pattern baldness.

Stage 3 can present in two different ways, both with noticeable hair loss. The hair at the temples may recede significantly, leaving the hairline in the shape of an M, U, or V. Or the temples may not recede but hair at the vertex, the area on the top of the scalp, thins out.

At Stage 4, the hairline recession is worse than Stage 2 and the vertex is extremely sparse or bald. There is a circle of hair between them and around the sides of the head. In Stage 5, that band of hair becomes thinner. In Stage 6, the bald temples meet the bald vertex, leaving little or no hair across the top of the head. By Stage 7, only a band of thin, fine hair from ear to ear remains.  

There is also a variation of the pattern, referred to as Norwood Class A. This hair loss begins in the front and progresses uniformly back until only a band from ear to ear remains.

What’s Happening as You Move Up the Norwood Scale?

Scalp hair goes through four stages, growth, transition, rest, and shedding. The growth stage can last for three to seven years or longer as the hair is pushed out of the follicle. The transition phase lasts roughly 10 days as the follicles shrink and hair stops growing. Then, the hair rests for roughly three months before it falls out in the shedding phase.

Normally, the cycle begins again. The new hair will push the old hair out if it hasn’t already been shed. But if you suffer from androgenic alopecia, DHT shrinks the follicle and shortens the normal hair cycle. 

Your genes determine your sensitivity to androgens which comprise the hormones testosterone and dihydrotestosterone (DHT). These hormones are necessary for the development of the male reproductive system and sexual characteristics such as the Adam’s apple. But converting too much testosterone to DHT leads to male pattern baldness. This results in permanent hair loss that progresses through the Norwood Scale.

Fortunately, science and technology are making advances in slowing hair loss, stimulating growth, and reviving follicular activity. Where you are on the Norwood Scale will determine what treatments will work best for you.

What Treatment Options Are Available?

It makes sense that beginning treatment at the early stages of the Norwood Scale will help slow pattern progression. Finasteride and minoxidil, often prescribed for simultaneous use, help in the early stages. But they may also be used even after a hair transplantation procedure in later stages.

Finasteride is a DHT blocker, working to keep testosterone from converting to DHT. Productive hair follicles need a healthy blood supply, which is what minoxidil tackles. It’s a vasodilator that stimulates blood flow, delivering crucial nutrients to your follicles.

Once hair loss has progressed to at least Stage 3 on the Norwood Scale, you may need other types of treatment. Follicular unit extraction (FUE) and follicular unit transplantation (FUT) are two surgical procedures to consider. Both remove grafts of healthy follicles from other areas of the scalp and transplants them to balding areas.

FUE can also use follicles extracted from other areas of the body, such as the chest, beard, pubic area, or legs. This is promising for men who lack the necessary donor hair on the scalp. And advancing technology is making the procedure faster and outcomes more successful.

Platelet-rich plasma can be injected into the scalp to promote new growth as well. Scalp-reduction surgery, lasers, and changes in diet and lifestyle are other potential treatments. Which ones might be right for you, alone or in combination, will depend on where you are on the scale.

Scale Down Hair Loss

Patterns are part and parcel of nature and the manmade. But some that begin to emerge can be slowed or stopped, including male pattern baldness. No matter what stage you have reached on the Norwood Scale, odds are there is a treatment for you. You just need to weigh your options and recognize the pattern.


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