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Male pattern baldness is a fairly common issue, affecting roughly half of the men aged 30 to 50, but although it’s so widespread, it usually appears in a couple of distinct areas. There is also a predictable progression that happens over the years, which has allowed doctors to come up with a useful classification system, the Hamilton Norwood scale.
It breaks down the entire process into seven specific stages defined by reference images, making it easy for hair clinics to quickly assess a patient and come up with the optimal solution. We will go over the entire scale and show how it is used, and talk about the most effective treatment options.
Did you know?
Hair restoration is a growing field, with ISHRS members reporting an average of 668 patients per year in 2024 — including 156 surgical and 498 non-surgical patients — reflecting a nearly 20% increase since 2021.
Male pattern baldness is a fairly common issue, affecting roughly half of the men aged 30 to 50, but although it’s so widespread, it usually appears in a couple of distinct areas…
Progression of Hair Thinning
According to the Hamilton scale, there are a total of seven easily identifiable stages of male pattern:
- Stage One: Youthful appearance with no significant thinning or balding.
- Stage Two: The hairline recedes a little bit just above the temple area, creating a mature look.
- Stage Three: This is the first medically diagnosable stage of hair loss, where the hairline has moved back further, creating a characteristic “M” or “U” shape.
- Stage Three Vertex: The hair above the forehead is intact or slightly thinning, but there is much more hair loss at the top of the head.
- Stage Four: The hairline has moved back, and there is a noticeable bald area on the top.
- Stage Five: Both the bald areas are now quite pronounced, but there is still a thin band of hair separating the front and the top.
- Stage Six: There is now a continuous bald area from just above the forehead, all the way to the back of the head in a typical “Monk” look.
- Stage Seven: There is now only a strip of hair connecting the sides of the head.
How early in one’s life it starts or how quickly it progresses will vary from person to person, but it will always go through these steps.
How Doctors Identify Male Pattern Hair Loss
Typically, for men in their thirties and older, the doctor will be looking for a recession of the hairline and more significant hair loss or thinning at the top of the head. They will also potentially look at the patient’s medical and family history to determine if there is a genetic predisposition.
If there are large balding areas, it is a clear sign, but young men and women may have other medical issues affecting the hair loss, so additional bloodwork and tests may be needed to rule out other causes.
Treatment Options for Hair Loss
The most reliable and long-term option is a hair transplant. It works for anyone in Stages 3–6 on the Norwood scale, as long as there is enough healthy hair remaining in the donor area at the back of the head. These hair follicles are the most resistant and will keep growing for years and even decades after the procedure.
Modern surgery techniques like FUE involve extracting singular grafts with a micro punch device, and then creating tiny incisions with a sharp metal or sapphire blade in the bald areas, where each separate graft is then carefully positioned. There is also DHI, where a Choi Implanter pen is used to pierce the skin and place the graft at the same time.
These are minimally invasive operations that allow the patient to heal within a few days and resume their regular lifestyle within two weeks, while offering a dense and natural look within a year after the transplant.
Underlying Reasons for Male Pattern Baldness
There are several potential causes, which we will cover briefly:
Cause | Description | Influence |
Genetics | Androgenetic alopecia or sensitivity to DHT. | Primary driver of male pattern baldness. |
Hormonal Factors | Increased DHT levels shrink hair follicles over time. | Speeds up thinning. |
Age | Natural aging weakens hair. | Increases risk and severity. |
Poor Nutrition | Lack of protein, iron, or vitamins. | Weakens hair quality and growth rate. |
Medical Conditions | Thyroid disorders, autoimmune diseases, or scalp conditions. | Can mimic or worsen hair thinning. |
Medications | Chemotherapy agents, beta-blockers, or antidepressants. | Causes temporary or permanent shedding. |
Lifestyle Factors | Smoking, excessive alcohol, poor sleep, or lack of exercise. | Negatively affects scalp blood flow and follicle health. |
When you schedule a hair transplant in Turkey, the doctor will examine you more closely and determine the best approach.
FAQs
Can male pattern hair loss be avoided?
While it is impossible to avoid it because it is genetic, there are some things you can do to slow down the progression. For example, regular exercise can improve the blood flow to the scalp, strengthening the follicles.
Food rich in antioxidants and good hair hygiene can also help. The drug Finasteride is a DHT blocker, while Minoxidil improves blood flow to the follicles, and both are effective.
At what age does male pattern baldness usually start?
Most men will start to experience the first symptoms in their late 20s to early 30s, with a noticeably receding hairline and thinning. However, for some, this process can start as early as their late teens. It’s important to note that Stage 2 Norwood is considered a mature hairline, and many men can stay at this stage well into their 40s and 50s.
Does stress cause male pattern baldness?
Not specifically, as it cannot change the body’s reaction to DHT, but it can certainly cause a form of hair loss. When under overwhelming stress, the follicles may enter the resting phase earlier, which causes excessive shedding, though this is usually temporary. If the stress is chronic, though, it may speed up the process in those who are genetically predisposed.
Are there effective treatments available?
Of course. The two drugs we’ve mentioned, Monoxidil and Finastride, have been extensively tested and are FDA-approved with plenty of success stories. However, if you are looking for a permanent solution, then a hair transplant is the way to go.
Should I see a doctor if I notice hair thinning?
If you are under 30 years old and you’ve had a considerable amount of thinning or balding, it’s best to consult a doctor to rule out any other underlying medical issues. You may be able to reverse the effects or slow down the progression through medication or diet and lifestyle changes.
