The Norwood-Hamilton Scale also known simply as the Norwood Scale helps to categorize hair loss into various levels.
Male pattern baldness or Androgenic Alopecia is the type of the baldness affecting more than 70% of the men worldwide and 40% of the women. This is caused by the influence of the androgenic hormones. These hormones make the hair follicles to shrink, when this happens the nutrients cannot supply to the hair, hence, the hair follicles dies. This can be the fate of not just one hair, but for most of them when the hormones influence on them.
Why does our androgen cause Alopecia or baldness?
Under the action of the enzyme 5-alpha-reductase detected in cells of our hair bulb and hair papilla, testosterone is converted into the more active hormone called 5-alpha-dihydrotestosterone (DHT). Later, they act on the sensitive hair follicles and cause severe spasm of blood vessels, which causes the degeneration of follicles and leads to hair dystrophy. In fact, the hair on the head remains, but it is not fully-grown hair, but they forms short, thin and colorless, which are practically invisible, and they cannot cover the scalp, which shows us the picture of baldhead. The degenerated hair prematurely enters the telogen stage or the resting stage and they are not completed when they move on to the next stage. Therefore, the not fully-grown telogen age passes the hair to the next phase, which is the anagen, or the growth phase. Since the hairs in the telogen stage are almost dead, they can easily leave the skin during brushing, washing and drying. In addition, the hair follicles become small and thus the hair loses its length and the thickness.
The sensitivity of follicles to DHT is determined primarily by heredity. Tendency to hair loss in 73-75% of cases is inherited through the maternal line, 20% from the paternal line, and only 5-7% of the people experiences androgenic alopecia without any hereditary connection. Moreover, the hair follicles that are sensitive to the DHT or 5-alpha-dihydroxytestosterone are situated in the frontal as well as on the parietal region. This area can be described as the androgens dependent zone. However, the hairs on the occipital and on the temporal region are not sensitive to the DHT or 5-alpha-dihydroxytestosterone. Hence, they are described as the androgens independent zone.
Generally, there is no difference we can see with the mechanism of the development of the androgenic alopecia in men and in women, but the development of the alopecia pattern is different. Men are usually susceptible to the frontal hair loss and then the alopecia spreads to the parietal or the top most regions of the head. However, this is not true for women; they start from the middle region or of the parietal region and then the baldness spread to the frontal part of the head. However, the alopecia spares the occipital and the temporal region.
Hamilton-Norwood introduced a method to classify the stages of this baldness. These stages help in the treatment of the disease. The classification has 7 stages and each of them are distinguishable from each other.
Hair loss is a major problem, which affects millions of people around the globe. There is no one is an exception and every person has gone through the period of hair loss at least once during their lifetime. Hair loss can be severe and even it can create larger and wider hairless spaces on our head. These types of male pattern baldness are affecting a wide variety of individuals.
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If you would like to learn more about the stages of hair loss on the Norwood as well as to see illustrations Click HERE
Introduction to the Norwood-Hamilton Scale
Watch the video above of Dr. Huebner as he descibes the function and purpose of the Norwood-Hamilton Hair Loss Scale.
This is characterized by minimal hair loss along with the frontal hairline, especially in the forehead and on the temple.
A wise selection of the shampoo and conditioner is important and a Hair Transplant Procedure is an option at this point. It’s also advised to discontinue the use of any other hair products such as hair gels, wax, coloring, and so on.
Stage two is characterized by the hair loss on the frontal line along with the temporal areas take a triangular shape. Deepening of these areas can have a symmetrical or not symmetrical form of triangle. In this stage, deepening or baldness covers an area of not more than 2 cm from the front hairline. However, the hair recession causes less hair in the parietal region. Moreover, there is a clear differentiation between the density of hair on the frontal and on the temporal region.
This condition needs to be monitored and examined by a dermatologist. Do not try to be your own doctor. Shampoos with Minoxidil and Finasteride are highly useful. When selecting medications be sure to choose something FDA approved to limit side effects and protect your health. A Hair Transplant Procedure could also be conducted.
This is the highest degree of hair loss in the alopecia region. One can observe deep frontal and temporal receding hairline and they are usually symmetrical and sparsely covered with hair. At this stage the deepening of the hair loss covers more than the 2 cm from the hairline. In addition, this is the first stage to show a significant amount of hair loss that obviously needs medical treatment.
Medications or a Hair Transplant Procedure can be options at this stage. Treatments are aimed at stopping continued hair loss and regrowing hair at the same time. The recommended medication combination at this stage is Minoxidil with Retin A which has a synergic effect on the Minoxidil and increases the effectiveness.
Norwood 3 Vertex
At the Norwood 3 Vertex Stage the hair loss pattern is a deepening of the triangular or wedge-shaped pattern in the temporal areas (front corners) as seen in Norwood 2 in addition to the onset of hair loss in the vertex (crown). Often referred to as a “widows peak” the temporal areas (front corners) are barely covered or fully exposed with no hair growth combined with early hair thinning or hair loss in the vertex (crown).
Stage 4 is due to the fact that the frontal and fronto-temporal hair loss is very severe than in the previous stages. In addition, the parietal or the top most regions of the head show a partial or complete hair loss at this stage. Moreover, the frontal area and the crown show extensive hair loss, but these two areas are usually separated from each other by the hair on both sides of the head.
Stage 5 is determined by the fact that hair loss have the crown area is separated from it from the fronto-temporal region. However, the hair separation between them is very narrow and the hair is very rare. Meanwhile, the balding process covers a large area, resulting in a horseshoe shape instead of the triangular shape described on above stages.
Stage 6 is characterized by the hair separation between the crowns, the fronto-temporal region is gone, and there is no separation exists anymore. Therefore, the fronto-temporal region merges with the crown area and shows the largest alopecia region
Stage 7 is characterized by the most severe form of male pattern baldness. There is a total hair loss on the field, starting from the forehead and ending with the back of the head. Hair remains only on the side surfaces of the head (near the ears) and the lower borders goes near the neck for the occipital region.
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