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Did you know that more than 50% of men will suffer from hair loss to varying degrees before they reach the age of fifty? But the most important question is not if it will happen, but when and to what degree?
Hair loss can be a frustrating experience, but it's not a mystery without solutions. In the medical world there is a powerful tool used to accurately determine the progression of male pattern baldness, the Norwood Hair Loss Scale, which is a descriptive tool used to diagnose hair loss in men (the Ludwig Scale is used in women).
In this article, we will guide you on how to understand the Norwood scale and what it says about your hair, and together we will explore the treatment options available, from medications and topical treatments to modern techniques in hair transplantation. Read on to find out what stage you are in with Norwood's disease, and what options are available to you - including prescription hair loss medications, topical treatments, and hair transplants.
What is the Norwood hair loss scale?
The Norwood Scale (or Hamilton-Norwood Scale) is a classification system that identifies and classifies the stages of male pattern baldness. It was invented by Dr. James Hamilton in the 1950s, and then developed by Dr. Awtar T. Norwood two decades later. This modified version remains the most widely used classification system for male pattern hair loss today.
The scale itself measures the progression of hair loss, meaning that higher numbers on the scale indicate a higher degree of hair loss. While 1 represents no noticeable hair loss, 7 indicates almost complete hair loss, with only a horseshoe-shaped hair pattern remaining around the sides of the head.
Pattern baldness, which causes the most hair loss in men, is caused by an excess of dihydrotestosterone (DHT), a male sex hormone related to testosterone. Many other factors contribute to hair loss. Your age, race, genetics, and hair color will determine how much hair you may lose and whether you are a suitable candidate for a hair transplant.
Stages of hair loss according to the Norwood scale
Norwood Stage 1
Stage 1 on the Norwood scale represents normal hair density, without hair loss. It is considered an age-appropriate hairline, and natural hair maturation usually occurs from adolescence to adulthood. Therefore, Norwood Category 1 hair loss is not considered baldness.
It is possible, although unlikely, to remain at Norwood level 1 without experiencing further hair loss. The best way to know if your hair loss is due to aging or premature male pattern baldness is to consult a specialist.
Norwood Stage 2
Class 2 on the Norwood scale represents the beginning of a receding hairline and the appearance of a triangular “widow’s peak” on the forehead. Category 2 hair loss is not considered baldness according to the Norwood scale.
This early stage may be annoying for some, and may be followed by more noticeable hair loss. However, at this stage, hair loss is highly treatable, making stage 2 the ideal time for intervention. Medications such as finasteride and minoxidil prevent DHT (the hormone responsible for hair loss) from attaching to hair follicles. These medications have proven to be very effective in stopping hair loss and helping you maintain your hair.
Is hair transplantation an effective option at this stage? Most likely not, but only a qualified expert, such as the doctors of Rimo Hair Clinic in Istanbul, will be able to determine the suitability and need for the procedure at this stage.
Norwood Stage 3
In Norwood Hair Loss Scale stage 3, hair loss is most noticeable above the temples and forehead, and the hairline begins to form an M, U, or V shape. Hair loss may also occur in the crown area during this stage, which is known as vertex stage 3.
Hair loss in stage 3, and any stage after that, is considered baldness according to the Norwood scale. At this point, hair transplantation is a practical option, especially for those with Class III vertex who want to avoid hiding their bald spots.
It is important to consider the patient's age, family history, and expectations during the hair transplant procedure. Younger men may continue to lose hair around the front of the head and temples, so it is important that they continue to use minoxidil or finasteride to prevent hair loss in this area in the future.
Norwood Stage 4
Norwood stage 4 is considered a condition of baldness, in which hair loss becomes most noticeable at the crown of the head. Patients may also experience significant hair loss above the temples and frontal areas. A bridge of hair usually separates the crown of the head from the top of the head (the middle of the scalp).
A person with Norwood IV hair loss can get excellent results from a hair transplant. The doctor can fill in the bald areas at the crown of the head and temples, and the results can be maintained using medications. Doctors at Rimo Hair Clinic in Istanbul have helped thousands of men in Norwood IV stage get thick, healthy hair.
Norwood stage 5
Hair loss in Norwood stage 5 hair loss tends to be very noticeable, with most hair loss occurring in the frontal and crown area. The "bridge" between the crown (vertex) and the top of the head (middle of the scalp) begins to split, meaning the bald spots merge with each other. Hair transplantation at this stage of hair loss can achieve great results.
Norwood Stage 6
In stage 6 of the Norwood Hair Loss Scale, the hair bridge disappears completely, leaving a large bald spot. Usually, some hair remains on the sides of the head. At this point, men are still eligible for a hair transplant, but results may be limited depending on the amount of hair donated. So, the goal here is to get natural looking hair using donated hair.
Norwood hair loss scale stage 7
Patients with Norwood stage 7 hair loss show the greatest hair loss. Hair often stays along the base of the head in a horseshoe-shaped band that wraps around the base of the scalp. There may be enough donated hair for transplantation; However, the patient may have to decide which areas to focus on, as there may be enough hair to cover only the frontal area, crown, or mid-scalp.
Information about male pattern baldness
The main factor in male hair loss is the effect of the hormone dihydrotestosterone (DHT), which is produced from testosterone with the help of the enzyme 5-alpha reductase type 1 and type 2. When DHT levels rise, hair follicles shrink and lose their ability to grow.
Male baldness is considered hereditary, as it can appear at an early age, 18-20 years, if there is a family history of the condition.
Contributing factors include stress, poor nutrition, vitamin deficiencies, and certain diseases such as thyroid disorders.
Suggested treatments to combat baldness: When does genetic baldness stop?
pharmaceutical:
Minoxidil, which stimulates blood flow to the scalp and promotes hair growth.
Finasteride, which inhibits the enzyme 5-alpha reductase and reduces DHT levels.
Non-drug treatments:
Platelet-rich plasma (PRP) helps improve the density and strengthening of follicles.
Laser treatment that improves blood circulation in the scalp and stimulates follicles.
Hair transplantation is considered the final solution in cases of permanent hair loss, as hair follicles are transferred from an area with density to areas affected by baldness.
Frequently asked questions
What is Trichotillomania?
Trichotillomania is a psychological disorder that causes the sufferer to compulsively pull out his hair, which leads to visible gaps that may affect appearance and self-confidence. This behavior is linked to stress and anxiety and may be the result of a defect in the tear ducts.
In some cases, the affected person swallows hair, which causes health problems. Treatment depends on cognitive behavioral therapy (CBT) and medications in some cases, in addition to alternative techniques to reduce pulling. Finally, awareness and seeking support are the first steps towards recovery.
Is baldness related to sex?
Recent medical studies have shown that bald men have higher sexual ability due to higher levels of the male hormone testosterone. Research indicates that the level of testosterone in bald men may be 10-20% higher than in others, which affects hair growth and enhances sexual performance.
Conclusion
Hereditary baldness in men is no mystery. It affects millions of them, and it develops naturally, as defined by the Norwood Hair Loss Scale, in brief:
- Norwood stages 1 to 2 are not yet considered baldness. If you're concerned about hair loss, there are oral and topical medications such as finasteride and minoxidil, as well as natural supplements.
- Stages 3 to 5 are the stage in which hair loss begins to appear more clearly. This is the optimal time for intervention, such as medication, hair transplantation, or both.
- Stages 6 to 7 are more advanced stages, but patients can still get great results with hair transplantation. Results depend largely on the amount of hair the patient has remaining in the donor area.
Tracking the pattern of hair loss can help determine its cause. You can use your phone to periodically take photos of the front, back, and top of your head, and compare them over the course of several months. If your hair loss changes or progresses, such as in patches, it may be the result of a condition other than hereditary baldness. If your hair loss is sudden or is accompanied by flaking, pain, or redness, you should consult your doctor to determine the cause. Contact via WhatsApp to book a free consultation with the doctors at Rimo Hair Clinic in Istanbul!
No matter what stage you are in your hair restoration journey, Rimo in Istanbul, Türkiye, can help you. As one of the oldest and most trusted hair restoration centers, we have helped hundreds of thousands of men and women regain their hair and self-confidence. Book a free consultation today via WhatsApp to find out how we can help you!