The Norwood scale explained — how we assess your hair loss step by step

When you come to a hair clinic for a consultation, the doctor will almost always classify your hair loss according to the Norwood scale. It was developed by Dr O'Tar Norwood in 1975 and is still the international standard system for male pattern hair loss (androgenetic alopecia). Here we go through all seven main steps, what they mean visually, and which Norwood level gives the best conditions for a hair transplant. Norwood I — full hair growth This is the starting point. The hairline is intact across the whole forehead, no recession at the temples, no thinning on the crown. Technically, no one at Norwood I needs a hair transplant. Many young men are nevertheless convinced they are heading towards hair loss even though they are at Norwood I — and are then usually advised to wait. Norwood II — slight recession at the temples The hairline starts to recede slightly at the temples, but it is minimal. This is often the phase where men aged 25–30 start to notice hair loss. PRP treatment can be more suitable at this stage than a transplant because the follicles are still producing, but weakened. Norwood III — clear recessions The hairline has clearly receded at both temples, forming an M shape. This is the first level where a hair transplant often becomes relevant. At Norwood III we typically plan 1,500–2,000 grafts to restore the hairline. Norwood III vertex A variant of Norwood III where the crown also shows thinning. This is an intermediate class where both the hairline and crown may need addressing. Number of grafts typically 2,000–2,500. Norwood IV — thinning on the crown The recessions are clear, and a separate thinning area has formed on the crown. There is still a tuft of hair between the hairline and crown, but it gradually thins. At Norwood IV we typically plan 2,500–3,500 grafts. It is still a good Norwood level for a transplant because the donor area is intact. Norwood V — the bridge of hair shrinks The separating tuft of hair between the hairline and crown is now thin and starting to disappear. This is the highest level where a single transplant can give a natural result. At Norwood V we plan 3,000–4,000 grafts. The donor area is still dense enough to deliver grafts. Norwood VI — the bridge is gone The hairline and crown have merged into a single bald area. The only hair left forms a U shape around the sides and back of the head. At Norwood VI we are at the stage where a single transplant is usually not enough — we often need to plan two sessions 3–6 months apart, or accept that some areas will be less dense. Norwood VII — extreme thinning The most advanced stage. Only a narrow U shape of hair around the sides and back of the head. The donor area is often insufficient too, which makes a good transplant difficult or impossible. Many clinics, including us, advise against a transplant at Norwood VII and instead recommend accepting the appearance or using a hair system. When is a hair transplant suitable? With us we assess that Norwood III to V gives the best conditions for a natural and durable result. At Norwood II it is often too early — you risk using up the donor area's limited resource unnecessarily. At Norwood VI and VII there is not enough donor hair left to create full density. These are, however, general guidelines. The exact assessment depends on factors such as hair thickness, heredity, age, hair colour (dark hair against dark skin gives more contrast and shows more), donor area density, and what final hairline you are aiming for. How the Norwood assessment is done with us At the free consultation we take the following steps. First we make a visual assessment according to the Norwood scale. Then we measure the donor area's density with a trichoscope (microscope camera). We take photographs from five angles for documentation. Together we calculate the number of grafts needed for the result you want. Finally we discuss whether you are a good candidate right now, or whether we recommend waiting 6–12 months to see how the hair loss develops. Waiting is sometimes the right choice One of the most important things we do is advise patients against treatment when the timing is not right. For young men under 25 with early hair loss (Norwood II), a transplant today can mean we use up donor hair that is needed later once the hair loss has stabilised. We then recommend PRP sessions every six months and follow-up before moving on to a transplant.