I just don't 'get' the NW scale

[blkblk]

Everyone seems to be very confident that they know which NW rating they fall into, but I can't for the life of me figure out what I am.

 

My hair pattern looks quite similar to this guy however I feel that my hair has maybe twice the density in the front clump (it is quite strong there) and also on top.

 

Does the NW scale indicate the current state of hairloss, or is it an indication of the pattern of eventual hairloss?

 

I think what confuses me most is when I search for hairloss pictures by norwood scale and find ones like this listed as NW3, an this as NW5 (one example among many).

 

Ultimately these are just labels and the hair pattern is what it is, but I've always been curious as to why NW scale makes sense to everyone else but not to me.

 

I've always thought that I am NW5, but suspect (and hope) that maybe I am being a bit pessimistic here and maybe I am a 4 - any thoughts?

[NEWHAIRPLEASE]

To see a top quality doctor in person and he will be able to diagnose you correctly! Keep this important thing in mind though, the Norwood scale is not used for where you currently are but where you are expected to eventually go.

[blkblk]

I've seen several docs and keep forgetting to ask. I'm actually having my HT in less than two weeks, so it isn't something which is going to change my course of action - rather I was just curious.

[NEWHAIRPLEASE]

Who is doing your surgery? Good luck!

[blkblk]

Thanks. I'm going with Dr. Feller - currently in the pre-HT nerves stage right now, but I've been reading this forum for enough years to know that it is what I want to do and in the long term I will be happy to have made the choice.

[mahhong]

You've pretty much highlighted the limitations and problems with the Norwood scale!

 

There is some debate over how the NW scale should be used and how people interpret it and chief amongst these problems is whether people decide to use it to interpret current hairloss or perceived eventualy hairloss. The problem of course stems from the fact that nobody truly knows where your genes will ultimately settle your hairloss. Some guys can "look" like an NW3 at 30 but be well on their way to an NW6 by 35, and others can "look" to be headed towards an NW6 based on visual observation and miniaturisation analysis but, in the end, perhaps the vertex doesn't thin as much as suspected and the patient ends up an NW4 or 5 instead.

 

Strictly speaking it's probably only accurate in categorising final stage hairloss, but this is tricky. Some men have done all their balding by the time they're 30 and others are still balding aged 50 or 60 or even older. Some men never truly stop balding in their lifetimes!

 

So the NW pattern is really only useful for recognising trends in patients, or analysing patients whose hairloss has clearly settled down. So if a man reaches NW5 or 6 or 7, you can judge that much more accurately than a man who is an NW3 or 4. Similarly age is another factor; a man who is 50 and NW3 is unlikely to see a huge increase of further thinning, but a man who is 23 and NW3 could literally be heading anywhere.

 

It's just an approximation chart really. Even between the NWs there's a huge amount of of variation, so it's impossible to call. Some doctors and patients even suggest the whole thing should be overhauled or scrapped as it doesn't really offer much in the way of useful prognostic help.

 

The man in your first link is a prime example. Strictly speaking I would put him around an NW4 in terms of current loss, but there is clear thinning in the zones attributed to NW5 and 6 loss as well. Where will he end up eventually? Who knows! He could have the same amount of hair at 75 years of age, or he could be a full blown NW6 in 2 or 3 years time.

 

Without being pessimistic I would say the general rule of thumb is that if you have thinning in any area you would assume that area will eventually be bald one day. That's not always true, but better to erroneously plan for being an NW6 than foolishly convince yourself you're an NW3. I could probably pass as being an NW3/vertex at the moment, but I know for a fact I have thinning in NW5/6 areas and have to assume that's where I'm headed, even if I never get there. My father is the same; at 52 years of age he's caught somewhere between an NW5/6, with pretty high sides but a fairly large balding crown.

 

People tend to just use the NW scale for approximations and it has no prognostic value unless you're at one extreme of the scale or another. Your genes have already decided every single follicle that's going to be affected by DHT before you're even born, and the NW scale is just a pattern of general observations unfortunately. But, if you look like the guy in the photos, I would say assume you're on the way to an NW5, because it's always better to be cautious and end up pleasantly surprised!

[NEWHAIRPLEASE]

Thanks. I'm going with Dr. Feller - currently in the pre-HT nerves stage right now, but I've been reading this forum for enough years to know that it is what I want to do and in the long term I will be happy to have made the choice.

 

You have chosen a great physician!

[blkblk]

Thanks mahong, I think you've confirmed my thoughts precisely - excellent post.

 

NEWHAIRPLEASE: I've been reading these forums for approximately 9 years now - it is not a coincidence that I have chosen someone who is well regarded here

[Blake Bloxham]

Blk,

 

I've always looked at the Norwood scale as a helpful "guide," more than a "say all" diagnostic tool. I think it's very helpful when assessing a patient's hair loss, but obviously each individual is unique and will not perfectly fall into a pre-determined category (especially in cases of progressive hair loss and diffuse thinners).

[mattj]

The scale is used so much that it must be at least somewhat worthwhile. It's clearly just an approximation, though. What one person might call a NW2 another person might call a NW3. And then there are the fractions that some use (e.g. NW2.5), and don't get me started on the whole debate over where NW1 or NW0 indicates no hairloss!

 

I think it's reasonable to use the Norwood scale to classify a current hairloss pattern as well as, where possible, to describe a pattern which appears to be forming. There's no reason why it can't be used for both. As there won't always be any indication of how far a man's hairloss will progress, the scale can't be used primarily to describe an eventual pattern. If that were the case then classifying a man's hairloss on the scale would only be possible very late in life, making it about as relevant at age 25 as his obituary!

[galtsglutch]

I've always thought that I am NW5, but suspect (and hope) that maybe I am being a bit pessimistic here and maybe I am a 4 - any thoughts?

 

If you're only 30 years old and you're already a NW4/5, the you can probably expect to lose even more hair. Sorry to say it, but that amount of loss for such a young age does not portend a good future.

 

My advice is to start Propecia asap and see what it does for you. Good luck.