Androgenetic Alopecia or Male Pattern Baldness is responsible for over 95% of hair loss in men. This is progressive in nature and will affect most men over 50 years of age. This process may start prior to age 21 for some unfortunate men. As psychologically stressful as hair loss is for men, it is even more stressful for women. Mistakenly thought to be a strictly male disease, hair loss in women can be absolutely devastating for the sufferer's self image and emotional well being. Unfortunately, society has forced women to suffer in silence.
The Norwood-Hamilton Scale for Men's Hair Loss
The extent and pattern of male pattern baldness is often classified using a scale. The pattern baldness classification system was modified to its current form by Dr O'Tar Norwood in the 1970s which was originally developed by Dr James Hamilton in the 1950s. In this classification system for baldness, the higher the number the more advanced the hair loss. The rate at which men lose hair is very independent. There are men that loose hair very rapidly in their 20’s up to a Norwood Class 3 or Norwood Class 4 and stay at that point for the rest of their lives. Other men can have no detectable amount of hair loss until they are in their 50’s, only to advance to a Norwood Class 6 or Norwood Class 7 in just a few short years. Typically, if the individual begins to thin early in life there is a very good chance that he is destined for a great deal of hair loss. You can only use your family history as a guide. Put it this way, if at least some people in your family have a good degree of hair loss and you are noticing signs at a young age then you may want to prepare yourself for more.
There are seven distinct stages of hair loss identified in the Norwood Scale. All Norwood patterns and/or stages are determined genetically as follows:
- Norwood Class 1 being a normal head of hair with no visible hair loss
- Norwood Class 2 showing the hair receding in a wedge-shaped pattern
- Norwood Class 3 shows the same receding pattern as Norwood Class 2 except the hairline has receded deeper into the frontal area and the temporal area
- Norwood Class 4 on the Norwood Scale indicates a hairline that has receded more dramatically in the frontal region and temporal area. Additionally, there is a balding area at the very top center of the head but there is a bridge of hair remaining between that region and the front
- Norwood Class 5 on the Norwood Scale shows that very same bridge between the frontal region and the top center, also called the vertex, beginning to thin
- Norwood Class 6 on the Norwood Scale indicates that the bridge between the frontal region and the vertex has disappeared
- Norwood Class 7 on the Norwood Scale shows hair receding all the way back to the base of the head and the sides just above the ears
The Ludwig Scale for Women's Hair Loss
Female pattern baldness has also been classified although the system is much simpler than the male classification design. Female pattern hair loss was arbitarily arranged into three basic types by Dr Ludwig. The three basic patterns are classed as Ludwig Type I, Ludwig Type II, and the most extensive hair loss in women is Ludwig Type III.
The classification shows a progressive increase in diffuse hair loss from the top of the scalp, but the frontotemporal hair line remains intact. The Ludwig system takes no account of male baldness patterns developing in females although this was noted by Ludwig, Hamilton, Dawber and others. Ludwig suggested that females with male pattern alopecia should classified according to the Hamilton or Norwood scales. Minimal diffuse hair loss is the most common form of female alopecia with up to 80% of affected women presenting with this mild form. Ludwig Type III is rare, found in 5% or less of women with androgenetic alopecia.
Based on 468 cases, Ludwig developed the grading system below:
- Ludwig Type I. Perceptible thinning of the hair on the crown limited by a line situated 1-3cm behind the frontal hair line.
- Ludwig Type II. Pronounced rarefaction of the hair on the crown within the area seen in Type I.
- Ludwig Type III. Full baldness (total denudation) within the area seen in Types I and II.