What is the Hamilton-Norwood Scale?
The Hamilton-Norwood Scale dates back to the 1950s, when Dr. James Hamilton developed his seven stages of male pattern baldness, demonstrating the typical pattern of hair loss as the condition progressed. Later, in the 1970s, Dr O’Tar Norwood updated Hamilton’s work and fleshed out some of the stages in more detail – hence the “Hamilton-Norwood” Scale.
Of course, there will always be some variations depending on the individual, and it is also subjective due to being dependent on a clinician’s judgement of MPB. Furthermore, hair loss will progress at different rates for different people. However, the Norwood Scale is recognised as the standardised tool for grading MPB, and this can help inform decision making.
The 7 Stages of Male Pattern Baldness
Let’s take a look at each of the seven stages and how your hair changes over time.
Stage 1
At this early stage, there is either no hair loss or a very slight recession of the hair line around the temples. Any thinning of the hair will be very difficult to spot. If you have a family history of baldness (looking at your dad and granddad, for example) you might want to monitor your hair closely for the first signs of MPB, allowing you to start treatment while there’s the best chance of success.
Stage 2
The temple hair loss that may have started at Stage 1 now begins to increase, causing the hairline to recede a little at the left and right temple. You’ll now see the beginnings of the M-shaped hairline that is very common in men as they get older. The hair in the middle of the forehead may start to thin out a bit too. However, overall the hair loss is still fairly unnoticeable.
Stage 3
At this stage, hair loss is substantial enough to be categorised as “baldness” by the Norwood scale. Hair at the temples has receded so there’s very little hair left in those areas. A subcategory of Stage 3 is Stage 3 “Vertex”, where the hairline stays at Stage 2 but the hair around your vortex (the top of your scalp) becomes thinner. You may even start to see bald spots up-top.
Stage 4
Hair loss is now very obvious. As well as the clear M-shape of the receding hairline, the hair at your crown will be thinning out and there will be large patches of hair lost at the vertex. You’ll usually still have a band of quite dense hair left, running across the top of your head from front to back. This separates the two key areas of baldness at the temples and vortex.
Stage 5
We start to see signs of the classic horse-shoe shaped hairline (bald on top with hair around the sides of the head), as the band of hair across the top of your head becomes thinner and less distinct. At this stage, hair loss is becoming more severe and thus more challenging to treat with medication.
Stage 6
There’s extensive hair loss at this stage, with the hairline having reached the top of the head. At the crown, hair is thin and doesn’t provide much coverage for the scalp. The areas of baldness at the temples and vertex have now joined together, without the band of hair to separate them. There’s also further hair loss at the sides of the head.
Stage 7
This is the most advanced form of MPB. At this final stage, baldness is considered complete. You’ll see the classic horseshoe or cul-de-sac pattern, where the top of the head is fully bald but hair remains at the sides. The hair that is left may be finer and less dense than before. If you haven’t started treatment before this stage, unfortunately there’s now only very little chance of recovering your hair.
How to Tackle Male Pattern Baldness
Perhaps you’ve had a look in the mirror and you think you’re at an early stage of MPB?
Well, if you’re not happy to let nature take its course, there’s good news! Clinically-approved treatments for MPB hair loss are available.
You can try Finasteride tablets, which help block the damaging effect of the hormone DHT on your scalp hair follicles. Or you could go for topical Minoxidil, which revitalises the hair follicles by improving blood flow to your scalp. Both of these treatments have been proven to halt – and even reverse – MPB hair loss, and they are both fully-licensed and approved for use.
You’ll see the best results of treatment during the first three stages of the Norwood Scale, but up until stage six you may be able to stop further hair loss (even if regrowth is not possible). Also, don’t underestimate the power of a healthy diet on your hair. Foods rich in micronutrients like biotin (vitamin H), selenium, and zinc can all help nurture stronger, healthier hair.
Key Takeaways…
The Hamilton-Norwood Scale, with its seven stages of male pattern baldness, can be a useful tool to track your hair loss. It helps you to measure how your MPB is progressing, so – if you choose – you can start treatment early and give yourself the best chance of a thicker head of hair in the long-run.
While we've ensured that everything you read on the Health Centre is medically reviewed and approved, information presented here is not intended to be a substitute for professional medical advice, diagnosis, or treatment. It should never be relied upon for specific medical advice. If you have any questions or concerns, please talk to your doctor.
