Determining Your Hair Class From the Hamilton-Norwood Scale

December 11, 2020

What is the Hamilton-Norwood Scale?

When it comes to deciding whether you will be a good candidate for a hair transplant, determining your hair class from the Hamilton-Norwood Scale can be a helpful piece of information to consider. The Hamilton-Norwood Scale & hair class is the leading classification system used to measure the severity of male pattern baldness. Men usually exhibit one of several common patterns when they are losing their hair. These patterns of hair loss generally progress over the course of a few decades.

For some men, hair loss begins in early adolescence while for others it may not begin until later in life. The Hamilton-Norwood scale was created in order to provide easy-to-reference imagery that indicates what is typical for each stage of balding. This can also be helpful for determining approximately how many follicular grafts will be necessary for a successful hair transplant.

Breaking Down the Hamilton-Norwood Scale in Stages

The Norwood-Hamilton scale & hair class system is broken into seven stages. Each stage describes the pattern of hair loss and its severity.

Stage One & Two

Stage 1 displays no significantly visible hair loss or recession of the hairline. DHT levels in the follicle are increasing causing the follicles to shrink, and the amount of hair fall to increase. However, it may not be obvious to the patient that they are in the first stage of hair loss.

At Stage 2 there is a slight recession of the hairline, and the hair may have started to thin at the temples. This is sometimes known as a mature, or adult hairline, because as we age a certain amount of hair thinning is normal. A patient presenting a 2 on the Norwood-Hamilton scale will not necessarily require a transplant. They may find medication such as minoxidil or low-level laser therapy to be helpful in preventing further hair loss and increasing hair density in the thinning areas.

Some patients will wish to undergo a transplant at this stage, especially if they are at a hair class 2a where the center front of the hairline displays more obvious thinning. As a general estimate, it will take between 500-800 follicular grafts for patients on the 2 or 2a Hamilton-Norwood Scale & hair class. This is a great way to increase the fullness of hair around the face and improve the symmetry of the hairline.

Stage Three

A patient at Stage 3 on the Hamilton-Norwood Scale displays the first signs of clinically significant hair loss. At this stage, the hairline is deeply recessed from the temples, and the hair will have a pattern that resembles the shape of either an M, U, or V. The receded areas will either be completely bald or have very sparse hair with a lot of scalp visible. A Hamilton-Norwood Scale & hair class of 3a will also include significant hair loss at the vertex or top of the scalp. 

A patient with a Norwood 3 will normally require anywhere from 1,00-1,400 follicular grafts. If a patient is presenting a Norwood 3a they will require as much as 500-1000 additional grafts on top of that. This is determined by the size of the balding area at the vertex of the scalp. At this stage, the hair at the back of the head is evaluated to determine that there are enough adequate grafts at the back of the head.

Stages 4-6

Stage 4 on the Hamilton-Norwood Scale is more severe, and the hair is much more sparse at the vertex. Or there is no hair at the top of the scalp at all. The two areas of the scalp experiencing hair loss are separated by a band of hair that connects the remaining hair on the sides of the scalp.

At Stage 5 this band becomes even more narrow and sparse. However, there are still two separate areas of hair loss. By stage 6 the balding areas at the temples join the balding area at the vertex. Additionally, the band of hair across the top of the head disappears altogether. Or, there may be a few remaining hairs, but it will be a very small number.

Stage 7 (Most Severe)

The most severe stage of hair loss, Hamilton-Norwood scale & hair class 7 presents itself with only a small band of hair around the sides and back of the head. This hair is normally pretty fine and not dense in appearance. The entire front and top of the head will be bald. When it comes to determining the necessary number of hair grafts, those with a Norwood scale of 4 or higher will require upwards of 2,500 grafts. Norwood 5 or 5a require over 3,000 follicular grafts and a scale of 6 or above will require as many as 5,000. When the number of follicular grafts required is that high, the surgeon will often recommend that the transplant be performed in stages, and not all at once.

What Should I Do if I’m Losing Hair?

If you suspect you’re experiencing male pattern baldness, a doctor can confirm this with a physical exam. They will also look at your overall medical history. If they suspect there are underlying health causes contributing to your hair loss they can order blood tests. Sometimes vitamin deficiency, hormone imbalance, or heavy metal exposure may be exacerbating the problem. Sometimes stressful life events, high fevers, or accidents can lead to increased hair loss as well. If you are young, female, or experiencing sudden or unusual hair loss, your doctor will want to rule out any significant indicators of a major health crisis. 

Another consideration when deciding if you’d be a good candidate for hair transplant surgery is the health of your scalp. There are certain fungal infections and other types of inflammation that can impact the health of the scalp, impacting the hair follicles as well. If the scalp is inflamed or congested it becomes harder for healthy hair to grow and flourish. A dermatologist or doctor specializing in hair loss can examine your scalp to determine whether there are any issues with the scalp that need to be addressed. For example, if the patient is experiencing a fungal infection of the scalp, it would not be a good idea to undergo a hair transplant until that issue is resolved. 


When it comes to male pattern baldness, patients have the most success with hair restoration when they start early. It’s a lot easier to slow down the progress of hair loss than it is to stimulate new hair growth. It only takes two years for hair follicles that have gone dormant to stop producing hair altogether. Once they’ve reached that point they can’t be reactivated again. If significant hair loss has occurred, surgical procedures may be the best option as far as restoring one’s hair.

Best Hair Transplant is the best place to schedule your hair transplant in Los Angeles. We’ve helped both men and women regrow their lost hair. But don’t take our word for it. We suggest learning as much as possible about hair restoration. Do so prior to making a decision on how to address your hair loss. Not every procedure is right for everyone.

At Best Hair Transplant, we’re proud of our results and happy to provide hair restoration services. Additionally, we’re proud to make hair transplants affordable and help you save money on a variety of hair transplants. To ensure your ease of mind, you can view our customer recommendations HERE. Furthermore, you can also see our Google reviews and Yelp reviews. We can’t wait to help you start restoring your lost hair.


Best Hair Transplant
1970 S. Prospect Ave., Suite 2
Redondo Beach, CA 90277
(213) 403-0455



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