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  5. Hair Loss Stages: From Thinning To Balding

Hair loss, while not being a life-threatening condition, can cause a lot of stress and anxiety. In many cases, people with hair loss suffer from a loss of confidence and look for ways to cover up their bald spots.

If you are experiencing hair thinning and hair loss, identifying the early signs is the most critical step to dealing with it. In this article, we discuss the various stages of hair loss and understand its root cause. Keep reading for more.

What Causes Hair Loss?

The signs of hair loss may include sudden loss of hair, unusual thinning of the hair, a receding hairline, and bald patches on some areas of the scalp.

The causes of hair loss can be hereditary, tied to hormonal changes, or a normal aging component. It can also occur due to an underlying medical condition. Some other common causes include vitamin deficiency, stress, hormonal changes, anemia, excessive use of heat styling tools, and scalp infections. A scalp examination can be useful to diagnose the cause of your hair loss.

There are several tools to assess the pattern, extent, and severity of hair loss. The most commonly used one is the Hamilton-Norwood scale, which ranges from stage 1 to stage 7. It helps you determine how severe your hair loss is and when you should consult a certified specialist to examine your scalp.

The Hamilton-Norwood Scale

The Hamilton-Norwood scale is a classification system for male pattern baldness that describes hair loss's various evolutionary stages(1). Along with the Ludwig scale for female pattern baldness, the Hamilton-Norwood scale is widely used to classify the stages of male pattern baldness.

James Hamilton set the benchmark with his classification system in the 1950s. Later, Norwood added a few more hair loss patterns in the 1970s, which became the updated Hamilton-Norwood classification, commonly used today to identify the different hair loss stages.

Doctors also use several other classification scales. However, the Hamilton-Norwood scale remains the most popular. According to Dr. Harish Koutam, the Chief Dermatologist at SkinKraft, while there is no fixed age at which the Hamilton- Norwood scale symptoms appear, they are usually seen in individuals above the age of 30.

Assessment of the scalp by a certified dermatologist to accurately diagnose your hair loss is critical for charting out a proper treatment method. Identifying the correct pattern of hair loss is vital if you are looking to take early action.

Stages Of Hair Loss

There are seven stages of hair loss, as classified by the Hamilton-Norwood scale, based on the severity and pattern of hair loss.

Stage 1

In stage 1, there is no significant hair loss or recession of the hairline.

Stage 2

In stage 2, the hairline shows a slight recession around the temples. This is more common in older adults and is also known as mature or adult hairline.

Stage 3

Hair loss typically starts to become noticeable during stage 3. The hairline tends to pull back from the temples, resembling a U, V, or M shape. It is during this stage that the first signs of balding can be clinically diagnosed. The recessed areas are often sparsely covered with hair or completely bare.

This type of hair loss is usually associated with aging, so if you're still young, it may be a sign of hair loss due to pattern baldness.

Stage 3 Vertex

People who experience stage 3 vertex balding will also begin losing hair on top of the scalp or the vertex.

Stage 4

By stage 4, the hairline recession is more severe. There is sparse or no hair on the vertex. However, there is still a strip of hair between the receding hairline and the bald spot.

In stage 4A, there may not be a bald spot but there is more severe hair loss seen in the front-temporal region.

Stage 5

Stage 5 is a more acute progression of Stage 4. The strip of hair between the receding hairline and the bald spot becomes thinner in this stage. In Stage 5, you may begin to notice early signs of a horseshoe-shaped hairline as the hair loss progresses.

Stage 6

In stage 6, there is a much thinner strip of hair extending between the two areas of hair loss. In some cases, this strip also becomes thinner or completely disappears due to hair loss, which classifies as stage 6A, where the two areas of hair loss become conjoined.

Stage 7

Stage 7 is the last and most severe type of hair loss, according to the Hamilton-Norwood scale. The horseshoe hair pattern, which you see early signs of in stage 5, becomes more prominent in stage 7. The horseshoe-shaped area of hair will remain, after the front temporal and crown areas of hair loss become conjoined.

When Should I Consult A Doctor?

If your hair loss is not related to pattern baldness, you must consult a dermatologist or a certified professional to identify its root cause.

Also, if you feel overwhelmed by the quantity of hair you are losing, and if a receding hairline is giving you stress, you must speak to a doctor about the early signs of hair loss and treatment to avoid further damage.

The Ludwig Scale For Women

While the Hamilton-Norwood scale is popularly used to identify the various stages of hair loss among men, the Ludwig scale is used to identify hair loss patterns among women.

In 1977, Ludwig studied more than 400 women who had reported hair loss to create a classification system to determine hair loss's various evolutionary stages. The Ludwig scale defines three broad stages of hair loss. In stage 1, the hair on the top of the head begins thinning. In stage 2, the scalp starts to become visible. In stage 3, all of the hair at the crown may be lost, resulting in baldness.

Ebling and Rook also developed a hair loss classification system with five stages. While its first two stages remain the same as the Ludwig system, during its stage 3, there is continued diffuse hair loss in the region, along with the initial hairline recession.

This classification is often considered an update over the Ludwig scale since it also accounted for hair loss in males. Some other classification systems for women include the Savin (1992) scale, which divided hair loss into eight stages, and the Olsen (1994) scale, which was similar to the Ludwig scale.

Treatments For Hair Loss

Woman smiling after hair treatment

While there is no cure for pattern baldness, you can slow it down by consulting a certified professional who can guide you to treat your hair loss accurately.

Some doctors may prescribe Minoxidil to prevent hair loss, but it is hardly a cure or solution for pattern baldness among men and women. A few doctors may also prescribe finasteride, but keep in mind that these medications only temporarily slow down the process.

There are also side effects to these medications that may interfere with your sleep patterns and cause other symptoms.

Wrapping Up

Try to stay positive. Remember, hair loss is a common condition, and you shouldn't feel embarrassed about it. The first thing to do is find a dermatologist, trichologist, or an endocrinologist who can diagnose your condition and get to its root cause. A proper treatment plan is crucial to managing hair loss. Also, ensure to get plenty of sleep, eat a nutritious diet, and manage stress properly.

Begin By Knowing Your Skin

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