The Norwood Scale, Stage by Stage

What the Norwood scale measures

The scale is a map of where hair loss is visible. It helps describe androgenetic alopecia, or pattern hair loss, but matching a drawing doesn't diagnose the cause.

James Hamilton published the first version in 1951. O'Tar Norwood revised it in 1975, and his abstract reports that it was based on 1,000 white adult men — not a representative sample of everyone who uses it today. We couldn't access either original full paper, so we don't quote their age-by-age prevalence figures.

For other causes and warning signs, see hair loss in men.

The seven stages

Two words help. The vertex is the crown, toward the back of the top of your head. The bridge is the strip of hair between frontal loss and crown loss.

Use a front view, both sides, and a crown view with a second mirror or a photo. This is a plain-language guide based on the published descriptions, not a validated self-diagnosis test.

The variants: 3 vertex and the "a" types

Some men don't follow the main sequence.

• 3 vertex: crown loss comes first, while the front recedes no more than stage 3. Check your crown even if your hairline looks unchanged.
• Type A (2a, 3a, 4a, 5a): the whole front edge moves back together, with no separate crown patch. At 2a and 3a it retreats toward ear level; at 4a it passes ear level; at 5a it reaches the crown.

"Ear level" means a line across the scalp above the ear openings. So 2a isn't "slightly worse than 2," and 3a isn't the same as 3 vertex. The difference matters when a trial or a clearance names an exact stage.

Stage descriptions: Gupta and Mysore; Wirya and colleagues.

Is Norwood 2 a mature hairline or balding?

Norwood 2 describes a shape, not a prediction. People often call modest recession a "mature hairline," but the label doesn't tell you whether your hairline is stable. Compare photos taken the same way over time, and get an assessment if it keeps changing.

Norwood 4, 5 or 6? Check the bridge

The useful landmark is the hair between the front and the crown. It's distinct at 4, narrower and sparser at 5, and gone at 6. Lighting and hairstyle change how convincing that bridge looks, so a borderline photo shouldn't drive a treatment decision.

Which stages were actually studied?

Who a trial allowed in, who it actually analyzed, and what a product is cleared for are three different questions. Here's how the main evidence lines up — a comparison, not a treatment plan by stage.

Lanzafame et al., 2013 (home light-therapy helmet). 44 men aged 18–48, Norwood–Hamilton IIa–V, Fitzpatrick skin types I–IV; hair counts after 16 weeks. No participants at stages VI–VII, and no proof that every eligible stage responds equally. Primary abstract

Jimenez et al., 2014 (home laser combs). Men aged 25–60 were eligible at IIa–V, Fitzpatrick I–IV; outcomes at 26 weeks. Full paper

Finasteride 1 mg (Propecia), US label. Studies in men aged 18–41 with mild-to-moderate loss: 1,553 with mainly crown loss and 326 with loss in the front mid-scalp. The label doesn't assign a Norwood range, and effectiveness for recession at both temples isn't established. Label, sections 1 and 14.1

Men's minoxidil 5% solution, US label. For thinning at the top of the scalp (the vertex). The label names no Norwood range and excludes receding hairlines from its intended use — a labeling boundary, not proof it has zero effect there. Drug Facts

What we found in the laser-comb data

Being eligible isn't the same as being well represented. In Jimenez's Table 2, none of the 67 men analyzed on an active device were at stage II, and only 1 of 36 on the sham device was. Everyone else in that table was at stage III–V. (The eligibility text says IIa while the table says II; we've kept that as written.)

That doesn't prove early loss can't respond. It does show that "included in the range" is weaker than "well represented in the results." A rise in hair count in a small area also doesn't mean someone moved to a different stage. These trials tested other devices, not Luxuel caps.

Stages VI–VII weren't studied in these home-device trials, so their results can't support a promise for advanced loss. For medicines, suitability depends on diagnosis, risks and contraindications — discuss them with a clinician. For a broader comparison, see laser caps, finasteride and minoxidil.

Three things a stage number hides

Clinicians can disagree. In one study, 7 dermatologists and 16 dermatology residents rated 43 scalp photographs. Their overall agreement scored 0.655 on a scale where 1 means perfect agreement (that isn't "65.5% accurate"). Photos aren't a full scalp exam, but it's a reason to treat a borderline self-rating with caution. Guarrera et al.

Pattern isn't density. The chart doesn't count hairs or measure miniaturization, the process where hairs grow progressively finer. Your outline can stay the same while density changes. The same study points to density measurements and fine-hair assessment as better gauges of severity.

Bare-looking doesn't always mean follicle-free. Lab research on bald scalp in androgenetic alopecia found that hair-follicle stem cells were still present, though some related cell types were reduced. That wasn't a laser trial: it doesn't show a cap can restore a bare area, and a mirror can't tell you which follicles are viable. Where follicles are truly gone, there's nothing for light therapy to support. Garza et al., 2011

Keep your baseline photos consistent in lighting, camera position and hairstyle, and use them to describe change to a clinician. For frontal recession specifically, read laser caps for a receding hairline.

What about women?

The Norwood scale isn't the usual fit for a widening part or thinning across the top of the scalp. The Ludwig scale grades female-pattern loss in three stages, and the Savin scale adds more detailed density patterns. There's no simple conversion to a Norwood number. Classification review

See laser caps for women for the relevant evidence and indication.

Where Luxuel fits

We sell laser caps, so this boundary matters. For men, Luxuel's FDA 510(k) cleared indication is androgenetic alopecia at Norwood–Hamilton IIa–V, Fitzpatrick skin types I–IV. A similar-looking hairline alone doesn't establish that you're in that group. Results vary.

Your stage is one part of choosing a device. It isn't a reason to pick a higher diode count or to expect a particular result. Start with a diagnosis and the laser-cap buying checklist.

Sources

Checked September 13, 2026. Stage descriptions come from the cited reviews; every figure comes from the abstract, paper or label named beside it. No stage images or patient outcomes were created for this page.

• Hamilton JB. Patterned loss of hair in man; types and incidence. Ann N Y Acad Sci. 1951;53(3):708–728. PMID 14819896. Citation verified; full paper unavailable.
• Norwood OT. Male pattern baldness: classification and incidence. South Med J. 1975;68(11):1359–1365. PMID 1188424. Abstract read; full paper unavailable.
• Lanzafame et al. 2013 men's study, PMID 24078483. Population and duration from the primary abstract.
• Jimenez et al. 2014 laser-comb trials, PMID 24474647. Full paper: Methods and Table 2.
• Guarrera et al. 2009 reliability study, PMID 20927233. Full paper: Methods, Table 1 and Discussion.
• Garza et al. 2011 human scalp tissue study. Publisher PDF read locally.
• Device indication checked against the K261253 Indications for Use form; see what FDA 510(k) cleared means.

Not intended to diagnose, treat, cure, or prevent any disease. The clinical studies referenced evaluated a clinically studied 650nm wavelength and the low-level laser therapy category broadly. Individual results vary and depend on consistent use over time. The FDA 510(k) clearance (K261253) is held by the manufacturer.