The Norwood Scale has 7 primary stages plus one vertex subtype (3V), each with distinct visual markers, graft requirements, and treatment paths. This guide breaks down every stage so you can identify where you fall and what your options are.
Norwood Scale Overview Table
| Stage | Visual Pattern | Grafts Needed | Best Treatment | Cost Range (US) |
|---|---|---|---|---|
| 1 | Full hairline, no recession | 0 | Monitoring only | $0 |
| 2 | Slight temple recession (M-shape) | 800-1,500 | Medication | $3,200-$9,000 |
| 3 | Deep temple recession | 1,500-2,200 | Medication or transplant | $6,000-$13,200 |
| 3V | Temple recession + crown thinning | 2,000-2,800 | Transplant + medication | $8,000-$16,800 |
| 4 | Large frontal and crown loss | 2,500-3,500 | Transplant | $10,000-$21,000 |
| 5 | Bridge between zones narrowing | 3,000-4,500 | Transplant (possibly 2 sessions) | $12,000-$27,000 |
| 6 | Bridge gone, horseshoe remains | 4,000-6,000 | Multi-session transplant | $16,000-$36,000 |
| 7 | Extensive loss, narrow horseshoe | 5,500-7,500 | Multi-session transplant | $22,000-$45,000 |
Cost estimates based on US FUE pricing of $4-$6 per graft. Turkey pricing runs $1-$2 per graft, reducing total costs by 60-75%.
Norwood 1: Full Head of Hair
Norwood 1 is the baseline: a full, juvenile hairline with no recession at the temples or thinning at the crown. The hairline sits relatively low on the forehead without any noticeable changes.
What to Look For
- Hairline sits flat across the forehead or with minimal natural curvature
- No temple recession visible
- No thinning at the crown when viewed from above
- Hair density appears uniform across the scalp
Treatment at Norwood 1
No treatment is needed. If you have a strong family history of baldness, a dermatologist may discuss preventive finasteride (1mg daily), which halts progression in 80-90% of men. However, most practitioners will not prescribe medication at this stage without evidence of active loss.
Grafts needed: 0
Norwood 2: Slight Temple Recession
The first visible change. The hairline pulls back at the temples to create a shallow M-shape. Many dermatologists consider this a normal "mature hairline" rather than pathological hair loss. Most men reach Norwood 2 by their late 20s or early 30s regardless of whether they will progress further.
What to Look For
- Temples have receded 1-2 centimeters from the juvenile hairline
- A subtle M-shape is visible, especially when hair is wet or pulled back
- Crown density remains unchanged
- The recession is symmetrical on both sides
Treatment at Norwood 2
Medication is the primary approach. Finasteride (1mg daily) halts further loss in 80-90% of men, and roughly 65% see some regrowth. Topical minoxidil (5%) adds 40-60% regrowth when used alongside finasteride. Hair transplantation is generally not recommended at this stage because the loss is minimal and future progression is unpredictable.
Grafts needed: 800-1,500 if surgical correction is desired
| Treatment | Effectiveness | Timeline | Side Effect Rate |
|---|---|---|---|
| Finasteride 1mg | 80-90% halt, 65% regrowth | 6-12 months | 2-4% |
| Minoxidil 5% | 40-60% regrowth | 4-6 months | Scalp irritation |
| Combined | Best results | 6-12 months | Additive |
Norwood 3: Deep Temple Recession
This is the stage where hair loss becomes cosmetically significant. The temples have receded enough to create a pronounced M-shape or U-shape that is visible even with hair styled forward. Norwood 3 is the earliest stage where most surgeons will perform a transplant.
What to Look For
- Deep recession at both temples (2-4 centimeters from juvenile line)
- Clear M-shape or U-shape visible without manipulating the hair
- Frontal hairline may still be relatively intact between the receding temples
- Crown typically still has reasonable density
Treatment at Norwood 3
A combination approach works best. Many patients start finasteride to stabilize existing hair, then add a transplant of 1,500-2,200 grafts to restore the temple areas. FUE is the preferred technique at this stage because the graft count is well within its capacity (up to 5,000 grafts per session).
Grafts needed: 1,500-2,200
Norwood 3 Vertex (3V): Crown Involvement Begins
Norwood 3V is a critical subtype. In addition to the temple recession seen in standard Norwood 3, the crown also begins to thin. You may notice a small patch at the vertex where the scalp is becoming visible, or hair density at the crown has dropped noticeably compared to the sides.
What makes 3V different from standard 3:
- Crown thinning is visible when viewed from above or behind
- Two zones of loss require treatment planning (temples and crown)
- Higher graft count needed: 2,000-2,800 grafts
- Medication is especially important to slow crown progression
The distinction matters because treating both zones costs more and requires more donor hair than addressing temples alone.
Norwood 4: Frontal and Crown Loss Merge
Significant hair loss is present in both the frontal region and the crown. A thin bridge of hair may still separate the two zones, but it is visibly weakened. The overall appearance shifts from "receding" to "balding."
What to Look For
- Frontal recession extends well past the temples
- Crown bald spot is clearly defined and expanding
- A thin, wispy bridge of hair connects the front to the crown
- Donor area (sides and back) contrasts noticeably with the top
Treatment at Norwood 4
Hair transplantation becomes the primary treatment. At 2,500-3,500 grafts, a single FUE session can cover both zones. Surgeons typically prioritize the frontal hairline because it has the greatest impact on appearance, then distribute remaining grafts to the crown.
Grafts needed: 2,500-3,500
| Technique | Max Grafts | Recovery | Best For |
|---|---|---|---|
| FUE | Up to 5,000 | 7-10 days | Single-session N4 |
| FUT | Up to 4,000 | 10-14 days | Maximizing yield |
| DHI (Choi pen) | Up to 3,500 | 7-10 days | Dense packing in front |
Finasteride should continue alongside surgical treatment to protect remaining native hair. Without medication, progression to Norwood 5 or 6 can undermine transplant results within a few years.
Norwood 5: The Bridge Narrows
The bridge of hair between the frontal region and crown has thinned to the point of near-transparency. The two areas of baldness are close to merging. Total bald area is substantial.
What to Look For
- Frontal and crown loss zones are nearly connected
- Remaining bridge hair is thin, sparse, and likely miniaturized
- The horseshoe pattern of the donor area is becoming more defined
- From the front, the hairline may appear quite high on the forehead
Treatment at Norwood 5
A single mega-session (3,000-4,500 grafts via FUE) can address this stage, though some surgeons prefer to split treatment across two sessions spaced 8-12 months apart. This allows the donor area to recover fully and provides more grafts overall.
Grafts needed: 3,000-4,500
Strategic planning is essential at this stage. Surgeons must balance frontal density (what you see in the mirror) against crown coverage (what others see from behind). Most patients prioritize the front, accepting lighter crown coverage or planning a second session for it.
Norwood 6: Bridge Gone
The frontal and crown regions have fully merged into a single large area of baldness. Only a horseshoe-shaped band of hair remains on the sides and back. This is the stage where donor management becomes the primary surgical challenge.
What to Look For
- No remaining hair connects the front to the crown
- Bald area extends from the frontal hairline to the vertex
- Horseshoe donor band is clearly defined
- Remaining hair on sides and back may vary in density
Treatment at Norwood 6
Multiple sessions are typical. The first session (3,000-4,000 grafts) focuses on rebuilding the frontal hairline and frame. A second session (1,500-2,500 grafts) addresses the crown 8-12 months later. Total graft requirement: 4,000-6,000 grafts.
Grafts needed: 4,000-6,000
Donor limitations become real at this stage. The finite donor supply (typically 6,000-8,000 total extractable FUE grafts across a lifetime) must be managed carefully. Patients should discuss long-term planning with their surgeon, including the possibility that full coverage may not be achievable.
Cost Comparison by Region for Norwood 6
| Region | Cost per Graft | Total (5,000 grafts) |
|---|---|---|
| USA | $4-$6 | $20,000-$30,000 |
| UK | $3-$5 | $15,000-$25,000 |
| Europe | $2.50-$4.50 | $12,500-$22,500 |
| Turkey | $1-$2 | $5,000-$10,000 |
| India | $0.50-$1.50 | $2,500-$7,500 |
Norwood 7: Most Extensive Loss
The most advanced stage. Only a narrow band of hair remains on the sides and back of the head. The bald area covers the entire top of the scalp from the frontal region through the crown.
What to Look For
- Entire top of scalp is bald
- Remaining hair band is narrow and may be thin
- Donor area is limited in both area and density
- Hair texture in the donor zone may have changed
Treatment at Norwood 7
Full restoration is rarely achievable. The total graft requirement (5,500-7,500) often exceeds what a single donor area can provide via FUE. Strategies include:
- Combined FUE + FUT: Use FUT for maximum first-session yield, then FUE for subsequent sessions
- Body hair transplant (BHT): Supplementing scalp donor with beard or chest hair (lower survival rate, different texture)
- Strategic coverage: Focus grafts on the frontal zone for maximum visual impact, accepting limited crown coverage
- Scalp micropigmentation (SMP): Tattooed dots that simulate a shaved-head look, used alone or to increase apparent density between transplanted grafts
Grafts needed: 5,500-7,500
Realistic Expectations at Norwood 7
Complete coverage to the density of a Norwood 1 is not possible at this stage. Patients should expect a meaningful improvement in appearance, particularly from the front, but not a return to a full head of hair. Honest discussion with your surgeon about achievable density is critical before committing to surgery.
How Fast Does Progression Happen?
Progression speed varies enormously between individuals. Some men move from Norwood 2 to Norwood 5 in under a decade, while others stay at Norwood 3 for 20 years. Key factors include:
- Genetics: The strongest predictor. Family history on both sides matters.
- Age of onset: Earlier onset (before 25) often correlates with faster progression.
- DHT sensitivity: Higher sensitivity means faster follicle miniaturization.
- Medication use: Finasteride slows or halts progression in 80-90% of men.
Average Progression Timeline (Without Treatment)
| Starting Stage | Time to Next Stage | Notes |
|---|---|---|
| Norwood 2 | 3-5 years | Many men stabilize here |
| Norwood 3 | 2-5 years | Varies widely |
| Norwood 4 | 2-4 years | Progression often accelerates |
| Norwood 5 | 1-3 years | Bridge loss can be rapid |
| Norwood 6 | 2-5 years | Slower final stage |
These are averages. Individual experience can differ significantly.
Identify Your Stage with AI
Accurate staging is the first step toward effective treatment. Upload a photo at myhairline.ai/analyze for an AI-powered Norwood assessment. The analysis maps your hair loss pattern, estimates your stage, and provides personalized graft counts and treatment recommendations based on your specific situation.