Male pattern hair loss
Male pattern hair loss is caused by DHT acting on follicles that are genetically sensitive to it. Those follicles shrink over successive growth cycles until they stop producing visible hair. It follows a predictable pattern – temples first, then the crown – and it is progressive, which is why what you do in the first few years matters more than what you do later.
The follicles at the back and sides of your head do not carry that sensitivity. They keep growing for life, and they keep that immunity when moved. That single fact is what makes transplantation work at all – and it is also why the donor area is a finite resource worth spending carefully.
What stage are you at?
The Norwood scale is the standard way of describing the pattern. It is not a prognosis – it describes where you are now, not where you will end up.
Hamilton–Norwood scale
Stages I–VII, including the III vertex pattern. Each panel shows the side and front of the head.
I
Minimal or no recession
II
Slight temple recession
III
Deeper temple recession
III vertex
Early crown loss
IV
Front and crown loss
V
Narrower bridge of hair
VI
Front and crown merge
VII
Narrow horseshoe remains
A-pattern variants
In these variants, the hairline recedes backwards without a separate area of crown loss.
IIA
IIIA
IVA
VA
The scale describes the pattern of hair loss today. It does not predict how far it will progress. Your surgeon confirms the stage during an assessment.
Classification: Hamilton–Norwood scale · Endotext. Artwork: Keministi · Wikimedia Commons (CC0), rearranged and recoloured.
Maturing hairline
Slight recession at the temples. Normal in most adult men and not usually treated surgically – but worth diagnosing so you know whether it is stable or moving.
Recession begins
Deeper temporal recession, sometimes with early crown thinning. The point at which medical treatment matters most, because there is still plenty to protect.
Established loss
Clear separation between the frontal area and the crown. Usually the stage at which transplantation gives its most dramatic improvement, typically 2,500–4,000 grafts.
Advanced loss
The frontal and crown areas of loss have joined. Restoring coverage may require 8,000 grafts or more, planned across two stages when donor reserves allow. Your surgeon assesses how much coverage and density are achievable.
Questions men ask
What causes male pattern baldness?
Dihydrotestosterone, or DHT, acting on follicles that are genetically sensitive to it. Those follicles miniaturise over successive growth cycles – each new hair thinner and shorter than the last – until they stop producing visible hair altogether. Follicles at the back and sides do not carry that sensitivity, which is why they keep growing and why they work as donor hair.
Is hair loss inherited from your mother's side?
Only partly, and the old rule about looking at your maternal grandfather is unreliable. The androgen receptor gene sits on the X chromosome, which does come from your mother, but many other genes are involved and they come from both parents. Family history on either side is informative; neither side is decisive.
Can I stop male pattern baldness?
You can slow it substantially and often regain some density, but it is a progressive condition and treatment holds ground without curing it. Results depend on starting while follicles are still miniaturising, not lost, and on staying consistent – stopping treatment returns you to the trajectory you would have been on.
Am I too young for a hair transplant?
Possibly. Loss in the early twenties is often still finding its pattern, and a hairline transplanted to suit a 22-year-old face can look wrong at 35 once the hair behind it has receded. The sequence for younger patients is treatment first, a period of observation, and surgery once the trajectory is clear.
How many grafts will I need?
The estimate depends on the stage and the area being covered. A Norwood III hairline typically needs 1,500–2,500 grafts; including the mid-scalp brings the estimate to 2,500–3,500. Extensive hair loss starts at 4,000 grafts. Advanced loss may require 8,000 grafts or more, so treatment is planned in two stages when donor reserves allow. Your surgeon assesses the donor area and confirms a realistic plan.