Challenging What We Know About Hair Loss
I’ve spent the last ten years researching hair loss, and the last four years sharing what I’ve learned on Perfect Hair Health — analyzing anything from clinical trials to treatment breakthroughs to my own theories on what causes hair loss (and how to reverse it).
Now, I’m excited to share some big news: I just published a paper in a scholarly journal.
The paper is called, “A hypothetical pathogenesis model for androgenic alopecia: clarifying the dihydrotestosterone paradox and rate-limiting recovery factors“.
I know that’s a mouthful. I also know that reading scientific literature is the last thing on most people’s to-do list. That’s why I wrote this article — to summarize the paper’s biggest takeaways, and more importantly, to give everyone a chance to ask questions about it.
What Is This Paper About?
I wrote this paper to reveal the major paradoxes in hair loss research — and to explain why I think DHT’s role in hair loss is misunderstood. I also wanted to build a better model to illustrate why men and women develop pattern hair loss — since no such model exists.
Essentially, the manuscript achieves four things:
- It presents evidence that challenges the commonly held belief that the hormone dihydrotestosterone (DHT) directly causes hair loss
- It looks beyond DHT and catalogues all other biological and physiological biomarkers also associated with hair thinning
- It builds a better pathogenesis model for what causes hair loss — a model that accounts for (1) these additional biomarkers, (2) DHT’s relationship with hair loss and hair growth, and (3) why DHT-reducing drugs stop hair loss, but rarely lead to full hair recovery
- It uncovers three targets to potentially improve treatment outcomes, and maybe lead to full hair regrowth
I’ll get into more details in the coming weeks — and even update this article to break down every part of the paper into lay terms. But for now, I’d rather just explain my motivations behind publishing.
Why I Wanted To Publish My Research
This is my first scientific publication, and it’s important (to me) for two reasons.
Firstly, it’s a major step toward legitimizing these theories behind what drives hair loss — concepts I’ve written about for years; concepts that are finally beginning to gain traction in medical literature.
Secondly, it creates an opportunity to share these theories at an academic level. The reality is this: no drug exists to regrow all our lost hair. This paper explains why. Moreover, it provides insights for research teams to refocus their treatment targets… so that we can improve hair loss outcomes for everyone.
The Paper Is Open-Access
Most scholarly journals protect their publications behind a paywall. That means that if we want to read beyond a study’s abstract — we need to actually buy the paper. This can cost anything from $7 for a paper “rental” to $200 per month for a full-blown journal subscription.
This is how journals financially survive. But there’s a downside: by restricting information behind a paywall, those journals also limit the number of people who see that information, and thereby benefit from it.
Fortunately, not all journals do this. In recent years, there’s been a push to adopt a policy known as Open Access. This is when a journal publishes all parts of a paper — and for free.
My paper is Open Access — meaning you won’t need to pay to read it. My hope is that this will encourage more sharing (and reading) of its content.
The Paper Is Also Peer-Reviewed
Peer review is the gold standard for scientific publishing. It’s the evaluation of any manuscript by professionals working in that field. In other words, investigators or academics familiar with pattern hair loss pathology had to read my paper, critique it, and then recommend whether to reject it or accept it.
Peer review is long and arduous (often several months), but it’s also a crucial step to publishing. Without it, we undermine the scientific process.
Lately, there’s been an explosion of pay-to-publish journals — where authors pay journal editors a fee to publish their manuscript. These journals are not taken seriously — nor are they indexed in most journal databases. This is why I made it a point to publish in a peer-reviewed journal. I want the paper indexed, and I want it to be taken seriously.
Want To Read The Paper?
You can access the entire paper right here. You can also download it… or read it on Science Direct… or read it on several other indexing databases.
If you have any questions about the paper — or my research — please feel free to leave a comment. I get back to everyone!
Rob English is a researcher, medical editor, and the founder of perfecthairhealth.com. He acts as a peer reviewer for scholarly journals and has published five peer-reviewed papers on androgenic alopecia. He writes regularly about the science behind hair loss (and hair growth). Feel free to browse his long-form articles and publications throughout this site.
Congratulations Rob! You’re hard work will benefit a lot of people. Thank you!
Thank you Wyatt! I really appreciate it.
hai rob i’m from indonesia what saw palmetto causes addiction?
Hi Amar,
Do you mean addiction as in dependency on the supplement for results? While saw palmetto can reduce serum DHT, I’ve yet to see any studies or anecdotes demonstrating that saw palmetto visibly improves hair loss for any pattern hair loss sufferer. So in order for their to be dependency on results, there needs to actually be results — which we’ve yet to see.
With that said — supplements that combine saw palmetto with other compounds have shown results, and typically, those results are dependent entirely upon the usage of the supplement. This is also true with finasteride (Propecia), and also of pretty much any hair loss topical (including minoxidil (Rogaine)).
Best,
Rob
Hi do you have an article giving specific recommendations to treat fibrosis and calcification?
Awesome work, Rob! You’re the best.
Wow, great job! Peer reviewed and everything, great accomplishment! On a side note, any update on that possible grey hair article you mentioned possibly coming out with ? 🙂
Hey Fernando — thank you. That article took a backseat recently, I’m sorry! I still have it on the agenda. So far, what I’ve read seems to suggest that greying hair and miniaturizing hair are from two separate processes, and there may not be much overlap. So it’s a bit like relearning everything! I’ll absolutely email you when it’s ready.
Best,
Rob
Rob,
you are the man. I am nominating you for Nobel/Albert Einstein prize!
Congratulations and have a great 2018!
Julián
Hi Rob ,
Congratulations on your paper.
Since undertaking scalp excersize to reverse calcification and fibrosis more than a year ago I noticed the following. Which adds further proof your hypothesis.
My scalp skin has become more pliable and loose, to a point where I can move my whole scalp over my skull, during for example a towel massage.
This has also coincided with hair regrowth and thickening.
I’m truly in debt to you , you helped me overcome a very stressful and anxious period.
I’ve also started essential oiling , and continue with the massage regimen.
Due to diffused thinning, my hair cycle is out balance, but it’s all there. This will take more time . ( Some hairs longer than other’s)
But overall it’s amazing to where I was , and now am .
Thanks.
Kind regards
Praz
Praz,
This is fantastic news. Congratulations! And thanks for reading and contributing to the articles on this site. I look forward to your continued success!
Hi,
Can you talk about what you actually do in terms of exercises please.
Thanks
Really good paper – congrats! I’ve had a few peer-reviewed papers published in a different field and it is not an easy thing to do.
I am currently reading your free book and much impressed – the best books do tend to be free nowadays.
I notice that you say of your paper that “It challenges the commonly held belief”.
Ironic in the context of the first quotation in my own book (Experts Catastrophe), at top of page 2 of Chapter 1 at http://www.pseudoexpertise.com, which specifically mentions challenging of existing beliefs as one of the taboo things to be avoided in a scientific career.
So you might find various quarters being dismissive of your efforts or at least unenthusiastic. Anyway let’s see.
Cheers, Robin P Clarke
I’m currently shaving my head after I started thinning on my crown and a slow recessing hairline. Can I continue the scalp massage techniques while continuing to shave my head, or do I need the hair to grow while massaging?
Hey Phil,
You can certainly shave your head. In many cases, people find that shaving makes it much easier to grip the scalp, and even apply topicals (since there’s less hair to get in the way). Having longer hairs is just a way to gauge progress.
Best,
Rob
Rob, can’t seem to find your blog post about which topical oils to use? Do you mind linking? I had been using black castor oil, but the odor was overwhelming.
Hey Phil,
I think you might be talking about this article:
https://perfecthairhealth.com/why-most-hair-loss-topicals-fail-to-regrow-hair/
To be clear — my understandings of the science have evolved since writing that article, but the takeaway is still the same: for the majority of people, most hair loss topicals do very little.
Best,
Rob
Such an amazing accomplishment – congratulations, Rob!
Congrats Rob, I remember the first time I spoke to you, I truly thought I was speaking with a Dr- your knowledge and research is astounding!
You are always bright, positive and happy to help and brain storm…
This paper is an achievement of life, but much more in the sense that it could help many others in the future cure this.
Congrats again. Great guy, great paper!
Thank you Paul! And I’m excited about some of the newer treatment avenues we discussed over the phone. I look forward to your progress!
Rob, amazing work as always. A single non-Doctor who is dedicated at heart can always win the race over a whole team of qualified hair loss “professionals.” Believe me when I say this is only one of the “first fruits” of your labor.
Thank you Matt! I’m excited to keep pushing aspects of this research and will definitely keep you updated.
Great job Rob,
Does this mean now you’re a scientist with an authority to debate on hair loss topics?
Thanks Reza! I don’t consider myself a scientist or an authority figure — though I may have an opportunity to contribute to a treatment pilot study for AGA this year (which I’m excited about).
In general, I think it’s healthy for everyone to discuss and debate science — and in this case, the science behind what causes hair loss. I also think it’s especially important to engage with others who disagree with your position — so long as the debate stays rational and respectful.
Sadly, this is getting harder and harder to do. The advent of social media has given us the ability to block, unfollow, remove, or publicly (and anonymously) smear any voice with whom we disagree. The ending result is that we all form into small camps of “echo chambers” — where we’re surrounded only by people who reverberate things we want to hear. In my experience — and in every aspect of my life — I’ve learned more from trying to understand the “other side” than I have trying to substantiate my own position.
So, healthy debates are a wonderful idea — and not just for hair loss!
Medical Hypotheses – I myself have had two papers published in Med Hypoths, accepted by the founding editor Prof David Horrobin. In his journal intro he explained the reason why he did not endorse “peer review”. Numerous others have likewise condemned “peer review” – my own writing includes probably the most extensive presentation on the subject.
Prof Horrobin died in 2004, and a few years ago the publishers Elsevier took over the journal and thereafter depublished two important papers which had already been accepted by the editorial people. That is the publishers interfered in the editorial process, which is seriously improper. The editor and entire editorial board resigned in protest and the publishers then imposed a “peer review” system in order to prevent “inappropriately” heretical things being published.
My own epidemics paper was refused by 18 “peer reviewed” journals including Med Hyp, on pathetically pseudic excuses, for the simple reason that it exposes such a gigantic crime of pseudoexpertise, millions devastated. (The whole subject is heavily censored.) I can’t copy in whole chapters or links here but will just add this quote from Prof David Healy:
“Academic journals and societies show an auto-immune response to information that should be the life-blood of medicine.”– Prof. David Healy, author of Pharmageddon
None of this reflects on the credibility or otherwise of your or any paper in the journal. Hopefully I will have time to read your paper later today, shortly before my last hair falls out.
Cheers etc.
This is complete bullsh*t: “The absence of full AGA recoveries from androgen inhibition is puzzling, and highlights the necessity to reevaluate AGA pathology consensus.”
You do not know anything about the underlying changes from androgenetic hairloss. Cotsarelis has already proven without a doubt that balding scalp creates ever increasing levels of PGD2 and PGJ2 which prevent stem cell renewal and ultimately follicle growth in general. Thus someone with recent loss CAN regrow remarkable amounts of hair on 5AR- or androgen inhibitors while someone who has lost it years ago will mostly only maintain what he currently has.
You are presenting your lack of knowledge as if others haven’t already figured out things that seem to go way over your head. What a travesty. Whoever “peer reviewed” you should be fired.
Hey Enden,
The data suggests 5-AR inhibitors like finasteride can stop hair loss and lead to a 10% increase in hair count. To me, that’s far from a full hair recovery – especially for those who are NW3+.
The mechanisms governing stem cell to progenitor cell failure are still speculative, though one pathway might be through PGD2 (like you said). Interestingly, PGD2 precursors also express in chronically contracted ligaments, and PGD2 is associated (in other body tissues) with the tissue remodeling we observe concomitantly in the balding process.
PGD2 inhibition protocols — at least anecdotally in hair loss forums — have yet to really move the needle in terms of hair regrowth. If stem cell to progenitor cell failure is entirely due to PGD2, it’s puzzling why we’ve yet to see better hair recoveries from PGD2 inhibitors — especially from people trying those in conjunction with finasteride.
To my knowledge, Cotsarelis and other investigators also have no explanation for the arrival of PGD2 in balding scalp tissues. My paper presents evidence to theorize one way this could happen. PGD2 expression in the scalp may be a symptom of inflammation induced by chronic tissue tension. This leads to slow, persistent tissue remodeling (fibrosis, dermal sheath thickening, calcification) that eventually culminates into hair thinning (a symptom of the remodeling).
To be clear: I’m not saying Cotsarelis is wrong, or that I’m right. All I’m doing is presenting a case that maybe, we should try to reverse pattern hair loss by targeting to reverse tissue remodeling — rather than mono-targeting PGD2, KROX20, IGF-1, lactate, DHT (to a degree), or anything that makes headlines as a “new hair loss breakthrough” but soon fizzles.
Evidence in mechanotransduction suggests that mechanically offloading tissue tension while simultaneously creating a wounding-healing environment can significantly revert scar tissue. Why not apply those same principles to the scalp in an attempt to better improve AGA outcomes? I don’t see what’s so controversial about that.
To summarize — I don’t understand your negativity here — because most of the comments you just presented still fit within the paper’s arguments, and in some ways, reinforce them. This gives me the impression that you didn’t read the full paper, or didn’t understand it. I’m happy to clarify.
There’s also no need to throw jabs —- we’re all trying to help each other.
And finally, I’m always open to the idea that I could be 100% wrong about everything. That’s part of the scientific process. Ideas are written, rewritten, and refined as more data is published. The paper re-evaluates many of the mechanisms behind AGA. But the only way we can test its hypotheses is with more studies.
Best,
Rob
Please actually read the whole paper enden
Re. Enden
I smell a vested interest in “pharmaceutical solutions.” Consider the source, Rob, and keep up the OUTSTANDING work.
In addition to all the fine qualities expressed in your work and your willingness to share information, I read your reply to this apparent ‘pharma shill’ and I admire your consistently positive, service-oriented attitude.
Recall the phrase, “You sir, are a gentleman and a scholar.” Well Rob, you are that…literally.
I scanned your paper and read carefully several sections. As always, I think you’re on the right track – and we all much appreciate your efforts. FWIW, I completely stopped my hair fall months ago after several years.
After six or eight months I MIGHT be seeing limited regrowth now as a result of these methods:
1. Galea flexing (for lack of a better term) ala Tom Haggerty
2. My own version of “massage” that involves two hands pressing the skin toward one another (scrunches/wrinkles/folds the tissue between the hands).
3. Weekly dermarolling with 1.5mm needle length.
4. Topical application of Essential Rosemary Oil in a Coconut Oil carrier
5. Increased protein intake (I eat very little meat)
6. Increased healthy fats intake (mostly as olive oil)
7. Learned to make and consume Bone Broth (mostly chicken feet)
8. Minimum of 320mg Saw Palmetto daily
I think these methods are in line with your hypothesis, and I’m proof at this point that hair LOSS can be stopped.
Thank you Tom. I appreciate the kind words. And congratulations on your success so far! A lot of the book’s first round of best responders also reported success doing the massages in conjunction with Tom Hagerty’s exercises. The biggest benefit to TH’s exercises is likely their ability to retrain those muscles out of chronic contraction — so your scalp can finally relax when you’re not doing them. Please keep us all posted as you continue on, and congrats again!
Hey Rob!
Congratulations on publishing your research paper. Having read both your book and the article more than once, I can only thank you for your extensive work. Although I do not have any scientific background, I can only imagine that your point of view might be heavily critizised by some fellow researchers, now that you have made it accessible for a broad public, as you have a valid argumentation against the main theories concerning hair loss as well as plausible alternatives on how to treat male pattern baldness.
I hope that you do not let yourself be discouraged by negative feedback and wish you all the best in your future endeavors.
I am currently at the 5 month mark of the massage regimen and the lifestyle/diet changes. Although I am still waiting for significant regrowth, my shedding has stabilized over the last few months and the condition of my remaining hair has changed for the better. My hair seems healthier overall, has a darker colour and “feels” thicker. I generally feel healthier and my daily energy levels are more stable throughout the day.
I want to get bloodwork done in order to rule out possible malnourishments (Vitamin D is a big suspect for me as I clearly do not get enough sunlight on a regular basis due to where I live, as well as possible hypothyroism) and spend blood more often.
I had discovered your website during a very dark period of my life and your diet/lifestyle/health advices have given me a lot of hope concerning my hair loss and health in general.
I hope that my results will be similar to some of your best responders and would be incredibly happy to share them with you in a couple of months, possibly even before the 1-year-mark.
I wish you all the best and please continue your hard work,
Sincerely, Michael
Hey Michael,
Thank you for your kind words. And congratulations on seeing some early signs of success. Please keep me posted with your vitamin D labs — I’m curious to hear your results. Winter shedding is certainly a reality for many people living far from the equator — which is when a lot of people generally notice a decrease in the quality of their hair. But interestingly, a lot of readers also report more shedding in combination with more thickening in the summer time. Vitamin D is likely one (of the many) substances that regulate this process.
I look forward to your progress!
All my best,
Rob
Congrats Rob, this is an amazing, amazing achievement. I always look forward to reading your work.
Congratulations Rob! I’m certain that this paper is a step in the right direction for the field of AGA.
Joe
So what should I do for my hair loss problem? Can you please tell me clearly?
Hey RJ — this is nearly impossible to do in a comment response — since this depends on what kind of hair loss you have (alopecia areata versus androgenic alopecia versus telogen effluvium) and your comfortability with the array of treatment options.
You can start by first trying to familiarize yourself with hair loss research — either by reading this site’s articles or signing up for the free email course.
Buy the book. Or read the articles .
Kind regards
Hey Rob,
This guy from immortalhair saying that you changed your mind about massaging,as you can see at bottom,can you clarify this? I cant seem to understand details of your paper very well.
Thank you
Hey Maya — I cut out the quoted text since it was so large of a copied/pasted segment. But to answer your question — no, that’s not true. That user appears to be misunderstanding (and thereby mischaracterizing) the paper’s presentation of evidence alongside its actual hypothesis.
If I had to guess why, it seems like they’re under the impression that mechanotransduction is synonymous with mechanical force, and that mechanical force is synonymous with mechanical tension and chronic tension. This is an easy mistake to make — but if made, it leads to a false interpretation of the paper. Those terms are related, but they aren’t interchangeable.
The paper actually argues that if we can relieve chronic scalp tension while simultaneously promoting a wounding-healing environment in AGA tissues, we may be able to reverse AGA-related fibrosis and thereby achieve better hair recoveries. That’s why the nuance in terminology is so important.
Best,
Rob
EDIT: to be clear, I think there are several ways we can mechanically offload tension in the scalp + create a wound-healing environment. The massages might be one way to do it. They certainly work well for some people — probably because they can improve elasticity and evoke some acute inflammation. But for non-responders, or for those who want better results, there are probably other (potentially more effective) ways to do this.
Hello Rob and fellow regrowers,
Rob, as I told you, I’m using topical coconut oil for diffuse thinning. You mentioned that shampooing in the morning would not harm the scalp since the oil is absorbed.
I haven’t been using shampoo and washed my scalp with warm water, however, I scratched my scalp today with my nails and it was clear the it was clogged with some residue from oil.
Is it wrong to scratch the scalp with my nails? or do you recommend shampooing instead, if so, which brand is the one you think would suffice (sulfate/paraben-free).
Thanks to you and all the readers for your support.
Best,
Julián
Hey Julián,
Let’s hop on a Skype call soon. I can answer these questions in better detail there — and discuss some new updates.
In general, if you’re using oils nightly, shampooing shouldn’t be too much of a detriment. In addition, the oil residue shouldn’t hurt either — nor should scratching this off with your nails.
Best,
Rob
Congrats rob! You’re slowly but surely changing the hair loss industry for the better.
Hey Rob,
Is your book updated with the full research of this paper?
I’m thinking about buying the book. Should I wait or it has the same content?
Hey Carlos,
The book isn’t updated with this research yet, but if I do release anything in the future, it will be significantly discounted for anyone who’s already picked up a book package.
Best,
Rob
Hello Rob,
I have a question. If castrated men don’t produce DHT how is their lack of hairloss explained? Is it because their bodies can’t produce inflammation on the scalp with the help of DHT? If they suffer from the same scalp tension how don’t they loose hair?
Thanks in advance 🙂
Hey Riszard,
It’s a great question, and one that’s answered in detail here:
https://perfecthairhealth.com/trans-hormone-replacement-therapy-hair-regrowth/
But the short answer is that pattern hair loss is likely a two-part equation: 1) inflammation mediated by chronic tension, and 2) our body’s response to that inflammation (ie, the arrival of DHT). The evidence seems to suggest that the concomitant presence of both DHT and TGFB-1 leads to scarring and thereby pattern hair loss. But castrated men produce 95% less DHT than non-castrated men. As a result, their “tool kit” for responding to inflammation favors other substances that aren’t DHT. The end-result is that even if these men are carrying a lot of tension in the scalp, they’re likely not responding to that tension-mediated inflammation with DHT — since they no longer have the testes to help produce the testosterone necessary to make it. As a result, they stop losing hair.
Best,
Rob
Hi Rob quick question.
Have you changed any of your opinions on diet ?
Ie gluten and grains.
How would the above effect pre and post puberty skull bone growth , in regards to standard mpb.
The difficult question is. Can one who does lifestyle and mechno therapy still consider a diet free from these foods.
Thanks.
Hey Paz,
This is a very difficult question to answer (ie, “Does diet influence skull bone growth or muscular tension in relation to AGA?”). To be clear — diet absolutely influences bone growth and muscularity — there’s no question about that. If you don’t eat, you won’t grow. If you stop eating, your muscles will eventually start to waste.
But in terms of “in relation to AGA” — I’m not sure yet. Here’s my working hypothesis:
An anti-inflammatory lifestyle / diet / environment changes 1) the severity of an inflammatory response, and 2) the substances our bodies use to respond to inflammation (ie, TGFB-1, DHT, etc.). So if you’re eating foods that you’re allergic to — and as a result, you’re increasing 1) your inflammatory response to other stressors (like scalp tension), and 2) your likelihood of responding with TGFB-1 and DHT (and thereby increasing your likelihood of scar formation) — then yes, diet / lifestyle / environment have a role in pattern hair loss pathology.
But from what I now understand, I think that if you’re eating generally well and you’re nutrient replete — this should have very little impact. The evidence seems to suggest that pattern hair loss is a localized phenomenon — with genes and androgens at the top of the flowchart in terms of its onset.
As a result — if you can correct the tension (via mechanical stimulation or other means), then there’s a good chance that, conversely, diet / lifestyle / environment will play an equally small role in its maintenance (provided you’re getting the basics right — generally anti-inflammatory, and generally nutrient replete).
Best,
Rob
Hey Rob,
Congratulations on your paper. I think we’re all one step closer to solving this problem for good.
I’m a diffuse thinner with hair casts and dandruff. I also suffer from face and shoulder acne. There’s definitely some kind of connection. My acne flares up and gets all red and itchy around the same time my scalp also starts to itch and shed more hair. My derm diagnosed me with Seborrheic Dermatitis and prescribed shampoos, vitamins and Clobetasol Propionate lotion. Can seb. derm really cause hairloss? And is it reversible ?
Thanks
Hey Michael,
Thanks for reaching out. Have you had a chance to read this article?
https://perfecthairhealth.com/p-acnes-bacteria-may-cause-hair-loss-heres-what-to-do-about-it/
In general, seborrheic dermatitis seems to often just be a symptom of scalp inflammation. Whether this is the result of pattern hair loss or just a fungal infection — it’s hard to say.
I’d recommend reading that acne-hair loss article as a start toward finding an effective treatment. There’s a chance you’re experiencing an overgrowth of pathogenic microorganisms surrounding SD and thinning hair sites — and that these bacteria are contributing to your hair thinning. But without more testing / treatment trialing, we won’t know for sure.
Best,
Rob
Hi Rob just to add to my question above regarding diet.
If the theory hypothesis skull bone growth.
How does this work on a demographic level ? , Ie nation’s which have more Mpb than other’s ?
My vague answer would be growth genes ? From parents.
Thanks
Praz
Hey Paz — it’s most likely determined by genes and possibly even skull suture settlings in early childhood / adulthood. But there’s very little data on this, and so everything in this territory is entirely speculative.
Hello Rob just a suggestion could you form a whatsapp group for hairloss?
Hey Infino90 — I’m absolutely considering creating some sort of community for this site — and most likely a forum. But I’m apprehensive to create a Whatsapp group because that would mean I’m constantly accessible. I like to separate my day-to-day life from my professional life, and my professional life from this site — and with a Whatsapp group, I can’t do that. It’s the same reason why I also don’t have any social media (professionally or personally).
With that said, one of my goals this year is to create a way for readers to exchange ideas without my presence. So some form of the group is coming.
Best,
Rob
I’d say start with a discord server Rob. I haven’t used it much personally but I’ve seen all kinds of different communities use it to exchange ideas in real time and I think it would work out well here. You’d be able to have a place with a strong sense of community about this topic without necessarily needing to be online all the time to make it work. It should allow you the separation you need while still allowing people to connect more than they can with a comment section.
Just a thought.
Hi,
It is really difficult tu understand your paper as I havent taken a medical training, but still it is really hopeful to read someting academic about hair loss. so so hopeful. Thank you. Readers were mentioning about your book. How can I get it?
Hey Belma,
Thanks for reaching out. The book is a lot easier to understand and written for a general audience. You can check out some of the book packages here:
https://perfecthairhealth.com/book/
Best,
Rob
Hi Rob. Thank you for your answer. I would like to buy the whole package but need to consult about my case first. Doctors told me it is not genetic but it might be as well because I have this condition as far as I know myself, from infancy I mean. When I use medicine or some essential oils, my hair seems to respond. Doctors also told me I have active hair follicles. but still they do not reproduce enough hair it seems. I am 36 years old and live in Turkey btw. Thanks again for your support. It is really hopeful to be able to reach out something solid.
Hi Rob!
I would like to know your opinion about the research showing that peppermint oil diluted in jojoba oil helps hair loss more than minoxidil?
I also have another question. Can we say that if a particular oil (jojoba) works great for eyebrew regrowth, it also helps for scalp (for the same person)?
Thanks!
By the way, here is the paper : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4289931/
Hey Fifa,
The challenge here is that the study is done on mice, and unfortunately, when it comes to outcomes for androgenic alopecia, mouse models rarely translate to human models. This is because mice don’t suffer from androgenic alopecia, so any measurements to improvements in hair growth in mouse studies don’t mimic the same environmental factors at play in a balding scalp.
For the same reason, we can’t say that something that works well for eyebrow hair growth will also translate to the scalp. The environments are different.
Now there are always exceptions — but in general, this has been the trend in the data for years.
With that said, jojoba oil as a carrier for something like peppermint essential oil — or rosemary essential oil — applied to the scalp, may still help improve AGA outcomes. It’s just that we can’t take the results of that peppermint study and apply them directly to AGA.
Best,
Rob
Hi Rob,
Are there any cases of scalp relaxing/loosening in users of propecia that saw hair regrowth? If yes that could be another point for the tight scalp theory.
Thanks for your time
Hey Abo — unfortunately, I’ve never seen this as a measurement in any study! So we can’t say for sure. But I’ve also never heard this anecdote, so my assumption is that finasteride’s main benefit has less to do with scalp loosening, and more to do with just decreasing scalp tissue DHT.
Just wanted to say congratulations on getting the paper published Rob. You’re doing wonderful work here and I have to say that I’m noticing the cross over with different emerging areas of health I’ve seen, so I think that one day your years of research and hard work will go further than just within the field of hair loss. Your website and the original detumescence study gets mentioned a surprising amount on the Orthoropics youtube channel for example, a seemingly unrelated field, but I believe that it points to a growing trend for people to look deeper for answers to their health problems than the band aid approach to dealing with symptoms that the medical industry tends to present, and this is a wonderful thing in my opinion.
At the risk of getting quite philosophical, the internet is allowing us to start connecting and helping each other as opposed to being stuck with the lacklustre answers to some complicated health issues that those with the authority tend to leave us with. (Not trying to knock them or be negative, but there are things that they just can’t or won’t do for various reasons that are really limiting our ability to deal with many modern health issues in my opinion, and it’s an incredible thing that people are starting to use the internet to help themselves.)
Hair loss might just be classed as a cosmetic issue, but there are clearly many holes in that view on it within the medical industry and many obvious signs that it is an issue with our health and not something to be treated lightly in my opinion, and I think it’s wonderful to see people like yourself building communities like this that are actually digging deep and looking for real answers to these issues. The modern environment is causing so many problems for us as a species that this trend I’m seeing where real answers are starting to appear is something I look forward to seeing grow in the years to come.
On that note, please keep up the excellent work. Looking forward to what happens for you next.
Thank you Gray! I really appreciate the comments. There are more updates coming this year! It’s time we build a community around this site. That’s my goal for the next few months — and just as you mentioned, hopefully it’ll allow us to facilitate information better and faster — and maximize everyone’s potential for (and degree of) results.
Best,
Rob
Rob, did you read this book of David Wolfe’s?
https://books.google.it/books?id=GxSjWlUJFGYC&pg=PT224&lpg=PT224&dq=nanobacteria+hair&source=bl&ots=lJjrFmMhiH&sig=XFcEgWBN8ses3zmyqkdbqP-5RyM&hl=en&sa=X&ved=2ahUKEwiRxNjLsYDZAhWF3KQKHfusCF4Q6AEwD3oECAoQAQ#v=onepage&q=nanobacteria%20hair&f=false
He’s talking about calcification forming microorganism. And what he advises for calcification (horsetail extract, msm, dmso..) is also used widely by hair loss fighters. He is also mentioning deep tissue massage. I think it’s what really should be focused on.
Hey Mert,
I haven’t read David Wolfe’s books — but thank you for sharing. In general, I think calcification is an adaptive response to certain enviornmental stressors — and microorganisms can include that definition. For instance, we’ve seen in tuberculosis patients that lung tissues will literally form calcium deposits around infection sites — almost as if the body is attempting to wall off that infection from spreading beyond those tissues. And interestingly enough, we also see the disappearance of those calcium deposits later on (at least for ~30% of young patients).
Calcification can also result from mechanical stress — like the chronic pinching of a blood vessel. The blood vessels that provide most of the blood flow to our thinning regions above the galea have to weave through GA-connected muscles, and if those muscles are in chronic contraction, that’s almost a recipe for calcification of those vessels. So it’s all interconnected.
I’m not sure how effective horsetail extract, MSM, or DMSO will be for infection-related or mechanical tension-related calcification — since the pathology is so different despite the same outcomes.
Best,
Rob
Hi, Rob. I´ve been suffering AGA for almost 8 years, but somehow I`m not bald yet. So, I´ve been searching for natural treatments that could help me at least to halt my hair loss, and the best options I could find are your treatment (the mechanostimulation therapy) and Tom Hagerty`s scalp exercise (which I´m pretty sure you have heard about ). Reading your articles I found out that one of the main causes of AGA is chronic scalp tension – which is caused by muscular overdevelopment, and chonic contraction of the muscles surrounding the galea-. Before I read that, I was thinking that the only options I had for my hair loss was the scalp exercise and your therapy, so I thought about mixing both therapies every day with the hopes they would bring great results. But now, I really don´t know if the scalp exercise is really going to help me, because it is mainly based on the voluntary contraction of the scalp muscles to increase the blood flow that is coming to the hair follicles; and based on what you have written I think that it (scap exercise) could even worsen my condition.
Thank you, Rob!
Hi Mónica,
It’s a great question — and providing clarity of the mechanisms behind Tom Hagerty’s exercises might help to relieve some of your concerns.
In general, I think the benefits behind Tom Hagerty’s scalp exercises are that they teach us how to control specific muscle groups connected to the galea aponeurotica, and thereby become more cognizant of them. From trying his scalp exercises on and off for years — I can say that, without a doubt, I’ve always felt that these exercises actually helped “relax” these muscles out of a chronically contracted state.
In other words — while the exercises might’ve improved the development of GA-connected muscles, they also taught me how to keep them relaxed when I wasn’t doing the exercises. In my opinion, this is likely the biggest driving force behind why those exercises can help hair loss sufferers.
So I wouldn’t worry about mixing both therapies! In fact, some of the first book’s best responders did just that — and saw success.
Best,
Rob
It’s very similar to if you are trapezius muscles are really tight. What do you do? You actually tighten them really hard and engage them and it relaxes them.
Hope you been well Rob!
Chris P.
Rob just to add something I’ve been researching regarding calcification.
An article I read and a conversation I followed remarked how, magnesium deficiency and vitamin D3 deficiency, lead to unregulated calcium in high dairy consuming people.
For example tissue calcification of arteries and follicles could stem from low amounts of vitamin D3 and magnesium. All of which are low in a lot of Western people, and Diets.
A forum post from an individual stated how he believed that scalp tension was a process initiated by calcium overload and mineral deficiency.
So in other words less consumption of dairy , and more consumption of D3 and magnesium could help reverse calcification.
Now I looked at demographics of dairy consumption and hair loss.
Most consumers of dairy are European nation’s, and United States. Lowest amounts are Latin America. And china , Japan , Asian Nation’s, are not even on the list. ( I take the list with a pinch of salt)
And guess what, china , Japan, India and Latin America also have the highest number of non -balding people, and least suffer from hair loss.
Of course most of these diets culturally speaking consume more water based foods, and zinc , magnesium , vitimn D3 rich.
I’m not saying dairy is bad , it’s important for bones. But unregulated amounts due to deficiency in other minerals is rather striking.
Could consuming less dairy and sugar make a difference. As blood sugar levels also contribute to the process.
Also I’m shocked at the amount of female hair loss sufferes both on this site and in real life. Something is up , and I believe woman are facing hair loss due to hormone and diet issues via stress. If they have calcification, then it would be small amount s. And your doing a great job in offering them alternatives , via lifestyle changes and sibo awareness.
Kind regards
Paz
Hey Paz,
Thanks for sharing your research and thoughts — I really appreciate it. Lately I’ve been reevaluating whether dairy in my diet is helping or hurting. The science is sort of split depending on how we decide to look at it, but in general, I think the Ray Peat camp overstates dairy’s importance while the strict paleo camp understates its importance. It’s hard to draw a line between who’s wrong or right.
Things get more complicated when you begin to control for type of dairy (milk versus cheese versus ghee versus butter), separation (low fat versus whole fat), and quality (Jersey cows producing A2 beta casein milk versus Holstein cows and A1 beta casein milk.
Dairy also constitutes 60-70% of our dietary estrogen exposure — which can be problematic for men with an imbalanced t:e ratio who are already expressing the biomarkers of chronic inflammation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4524299/
For the time being, I’m probably going to start minimizing dairy again. I don’t have a lot of dairy already — mainly just once-monthly hard cheeses and daily as a creamer in coffee. But it probably wouldn’t hurt to reduce this even further — and make up for the loss in K2 through other means. While the research doesn’t support that the calcium in dairy causes calcification — I’m open to the idea that under the wrong circumstances, dairy could contribute to the inflammation that precedes calcification (and thereby be indirectly correlated, as you suggested).
Best,
Rob
Rob, what do you think of the importance of having at least a 1:1 ratio for calcium and phosphorus as being recommended by Ray Peat followers?
I know you are not that much of a fan of dairy but in your book, you listed one of your daily nutrition with Calcium and Phosphorus being not that far of.
That could be a day where you consumed dairy, since its almost hard to get more than 1k of calcium without dairy.
What about on days without dairy though… are you still mindful of your ratio?
Thanks!
Paz, how long did it take from getting your scalp loose and regrowth? I have now gotten most of my scalp looser than before, how long did it take for you to notice sonething after this? And how much regrowth have you had?
Hi Henry
It took me around 6 months of persistent regimen to get the scalp at a decent pliable rate and then further.
The skin may be still be tight, but gives in around 8-9 month mark.
This is where I could pinch my vertex with more ease . The hair line and ridge’s can take around the same time, make sure you do exactly as Rob mentioned in the book regarding the sides.
I did
Hairline pinches 3 mins with both hands and around 3 mins two hand around like he shows.
Regrowth I strongly believe depends on individual weather it’s 5 months or more , even less.
My situation was slightly different as mine was to do with diffused / thinning hair , miniaturized weak hair , and hair which stopped growing full length, and strength.
My hair line was intact and receeded slightly at the right Temple, while my left Temple had been further for many years.
I believe tight scalp has caused disruption to my growth cycle, and nutrition lacking hair.
So I have been doing the massages for 14 months plus.
I can grab most scalp with ease , and can move the scalp more easily.
In terms of recovery.
Full . HOWEVER.
My growth cycle is slowly improving, thanks to continued massages, lifestyle diet and importantly rosemary oil twice weekly with pumpkin seed / coconut oil blend.
This week my left Temple is filling , it’s a Long process. But hell yes worth it. Almost miraculous for me.
My issue now is I have some hair longer than others , due to the cycle problems.
But it’s slowly growing.
My advice would be
1. Detumesence excersize twice daily for 12 months or whenever Happy with result
2. Essential oils if you have diffused hair or growth issues.
3. Healthy diet and lifestyle
Signs of improvement I noticed at the start.
Reduced itching , and sebum.
At month 4 -5 they all disappeared.
Then signs of regrowth .
I know Rob wanted my pics which I want to send but am reluctant for the following reasons.
1. I was too distressed to take pictures of thining areas close up .
2. The pictures from afar don’t show anything expect a greasy head , because I allowed my hair to grow.
3. My regrowth pictures won’t show much loss
All I have is my testament.
The process works if given time and dedication.
If you have standard pattern loss at a slow rate and no hair cycle issues…. Then it’s easier, as you just have to massage and diet .
Hope that helps.
Kind regards
Hi, Paz
I’m currently in the middle of my seventh month of massaging (no regrowth yet as far as I can tell), and still am experiencing shedding to a great extent (in my opinion); ~50 hairs per massage. It gets worse if I don’t shampoo my head once per week, as it gets really dry and falls out more often. I naturally also see a lot more dandruff, which my sister (who’s a hair dresser) finds problematic and puts me on some hard shampoo product.
I have male pattern baldness.
Thank you
Ben
Hello,
Did you ever experience dryness or brittleness of hair during that 4-5 month mark? I am doing the exercises 2x daily or happy with results, no shampoo, healthy diet and lifestyle. My hair feels kinda dry even when its oily. It feels brittle. My shedding has reduced since partaking the exercises and been doing them for over 2 months now. I guess I’ll just have to wait 4-5 months to find significant results (stopping hair loss) and then 8-9 months for regrowth?
I am at a lost and I just want to make sure I am on the right track and that there is hope for stopping hair loss and promote regrowth.
Thanks!
Abraham
Hey Abraham,
If your shedding is already reducing at month two, that’s typically an indication that you’re on the right track. As always, these changes take time (several months), and the data suggests that a stop in hair loss should be achieved around month five for the average responder.
The brittleness could just be the result of a more aggressive massage technique, which we talked about in our last email exchange together. There’s no harm in tapering the intensity to find an equilibrium. Regrowth is a long game, and if you’re finding that you don’t like the dryness of your hair currently, it’s okay to 1) reduce the massage intensity to see if this is part of the cause, and 2) adjust accordingly based on the data you get from the experiment.
Best,
Rob
Thanks for answering. I am hoping to get all of my scalp loose in 2-3 more months and in the next 6 months I hope to see regrowth.
If and when I have success, I will surely give a full and detailed report on here, and to Rob so he can get another example of what worked and how.
I would give it a lot more time if I were you. I’ve been doing the massages into my seventh month now, I have seen nothing but receding and a lot of hair shedding but my scalp has become somewhat looser. I expected to see at least a little regrowth around the fifth month, but I got quite disappointed, heh. Your situation might be different from mine, though. I have seen people say that they use to lose some hair before they start to regain, so I’m still going.
Just don’t be discouraged if you don’t reach your “deadlines” on time. This takes time.
Ben
Hi Benjamin
50 hairs , seems alot per session. But I use to see around 30 when I first started , and shedding would either decrease or increase depending on time and season.
Are you doing Rob’s massages like in the video ?
I also stopped using shampoos and did cold water rinse / showers which I believe may of helped my sebum production.
I started using rosemary Avalon organic shampoo which has no harmful substances, and found it good. This was after month 11.
Try cold water and no shampoo. How about diet ?
Shedding isn’t entirely bad in my opinion . Look at the type of hair that is shedding, if it’s weak or curled at the end.
Henry
I wish you the best of luck !
Kind regards
Hey, Paz
I am doing the massages shown by Rob to the best of my ability.
Some hairs are thick, some are even, some are barely visible, but overall the hairs tend to be thinner towards the root.
My mother also sheds hairs on a regular basis, but I don’t want to rest on the assumption that I have it from her.
I am doing cold water, and I went several months without shampooing until recently. I found that the longer I go without shampooing, the more prone I become to shedding.
Ben
Benjamin
I’m also using essential oils.
Two drops of rosemary oil on a table spoon of either pumpkin seed or coconut oil. After night massage, leave until morning and Wash out with rosemary shampoo. Twice a week
This has made a difference for me. Hair has thickened and improved.
Regrowth is a long and slow process.
Good luck.
Nice
I will try that.
Ben
Hey Rob,
Very nice stuff you have here. But I remember reading somewhere that scalp hair that is transplanted to the arm falls out at the same rate as the remaining scalp hair. Also, what about guys with DUPA? How do all these fit into your model?
Thanks
Hey Serena,
Thanks for reaching out. Right now I’m working on an article to address the few studies we have about hair transplants and transplant survival rates. In general, there’s a lot of misinformation surrounding the “donor dominance” theory and, in my opinion, a misinterpretation of that study’s original findings. This is partly covered in the discussion section about hair transplants:
http://www.medical-hypotheses.com/article/S0306-9877(17)31041-1/fulltext
I also covered a few more points here…
https://perfecthairhealth.com/the-case-against-a-hair-transplant/
I recently had an interview with Dr. Brian Freund (who piloted the botox-hair loss study), who also acknowledged during the interview that transplanted hairs still thin. So it’s a pretty widely recognized phenomenon — and it’s also one reason why most transplant surgeons will push hard for recipients to start taking finasteride for the rest of their lives.
In terms of diffuse unpatterned alopecia (DUPA)–
This is mainly believed to be androgen-mediated, but I’ve actually seen this present most often in men and women with hyperparathyroidism (as a symptom of the condition). I’ve yet to see research determining whether DUPA is scarring or non-scarring, but in either case, I’m not yet totally convinced that DUPA is actually a form of pattern hair loss. In any case, I’m happy to reevaluate as more information arrives.
Best,
Rob
There is an instructor in one of my classes. He is totally bald. Today I was examining his scalp, I’ve seen a skin difference in forehead and former hair area. It’s totally the same shape as galea, there is a V where galea connects to forehead. It’s not just the shape of old hair area, because when we are young our hairline is straight. But it’s obvious that scarred tissue is exactly the same shape as galea.
Secondly, what I noticed about myself after cutting my hair really short is, my temporalis muscles are super developed. When I chew, you can see strong muscles in the sides. Can it be somehow tied to hair loss and galea calcification?
Hey Rob, diffuse thinner here and I appreciate your work and as soon as I read your article it totally made sense to me. Right now I’m using microneedling, essential oils, emu/argan oil, minoxidil, topical panax ginseng/herbal DHT blockers every day and especially with microneedling. There are a lot of new studies on pubmed showing panax ginseng promoting hair growth and not just through DHT inhibition. You might look into it, very interesting stuff.
Do you think magnesium oil can help with scalp calcification, combined with microneedling perhaps?
I signed up for the email course. Do you list things that help fight calcification/fibrosis? The only things I know of are microneedling and maybe massage. Thanks for your work.
Hey Dustin,
Thanks for reaching out. I’ve looked into magnesium oil in the past, and even used to recommend it to readers a few years ago. Unfortunately, I’ve yet to see magnesium oil make a significant difference in improving hair loss outcomes — both anecdotally and in the literature.
The problem likely comes from deliverability. Theoretically, magnesium seems like something that would help to encourage calcium deposit degradation — but the calcification observed in AGA appears to be below the skin and in the blood vessels / arteries that run through balding regions. Magnesium oil deliverability is likely just limited to the upper parts of the dermis and epidermis, and as a result, won’t likely reach the targeted areas.
With that said, one of the success stories in the book (Joseph) used magnesium oil for a portion of his time massaging and dermarolling, and he reported some success. But aside from that, I’ve yet to hear other anecdotes — or see their progress appear in photos.
Best,
Rob
Hi Rob, great website and work you did to demolish the so-called science between hair loss. I’m a post finasteride syndrome sufferer, who have been told by doctors that finasteride is unlikely to provoke so serious problems. And now, after years of that nasty drug, I’m forced on TRT, after all the other treatments failed. I would like to ask you if you know any scalp massage device that could help in the daily massage process, hopefully making it shorter than 40 minutes, and what you think about LLLT laser combs (like this one https://tophairlosstreatments.com/product/deep-penetration-laser-comb).
Kind regards.
Hey Appassionato,
Thanks for reaching out, and I’m sorry to hear about your PFS. For post-finasteride syndrome, you might find these articles helpful:
https://perfecthairhealth.com/natural-dht-blockers-vs-finasteride-they-all-cause-sexual-side-effects/
https://perfecthairhealth.com/5-natural-dht-blockers-for-hair-loss/
And in terms of LLLT, I also wrote an article about this here:
https://perfecthairhealth.com/low-level-laser-therapy-does-it-help-with-hair-loss/
In general, I think the helmets are more effective than the combs.
Best,
Rob
Hi Rob. I’ve got a question that no one has been able to answer for me and I haven’t been able to find online. I understand that a ‘fibrotic’ or balding/bald scalp should be hard and difficult to pinch/move/press. My scalp however is very soft. I can pinch and move it around like crazy and even pressing with some force leave indentations similar to play dough haha. However I’m at NW4/5. No idea what the hell is going on. Any idea as to why this is?
Hey Curruthers,
I have a bit of similar experience, although I definitely have some hardened regions, the balding areas are very loose (probably because I’ve focused on them a lot for more than a year).
I’ve come to understand why Rob says that we should focus on all of the scalp, because it’s all connected.
In my opinion, you should implement the massages and focus on all your scalp. Even if you feel like it’s nice and loose, perhaps its a little bit less than it was before and you don’t realize it.
Do the massages twice a day, get some sunshine, a little exercise, relax and eat plenty and well for a year and there should be some sort of improvement. Don’t overthink this before you feel like your scalp is already ”very soft”.
Good luck!
Hi Curruthers,
The short answer is that tension at the epidermis (where you can touch your skin) isn’t always going to be the same as tension felt a few layers below the surface (the galea) — even if these tissues are fused.
The other thing is that as a function of this chronic tension (and the degradation of the arrector pili muscle (APM)), the skin literally remodels — and sometimes leaves increased fatty depositions in place of where the APM used to be. This could explain why your balding regions feel soft. When the dust settles, the fibrosis doesn’t always present as hard, tight, and visibly scarred.
Again — I’m happy to be 100% wrong about all of this. But based on the data, those are my best guesses.
Best,
Rob
Hey Rob,
Congratulations. I read your article a month ago and many times since then, in conjunction with a lot of the Peat litterature.
Based on my understanding, there are basically two pathways to act upon in terms of scalp mechanical stimulation: 1) using the massages to remodel the scalp and ”soften” hardened soft-tissues, and 2) decreasing overall tension.
Is this a correct perspective. In this regard, as others have mentioned, Tom Haggerty’s techniques as well as inversions and maybe even shoulder and back messages should be employed as they reduce muscle tension connected to the scalp.
Thanks again,
David
Hey Rob, to follow up on my comment above, can you tell me what you think of this video:
https://www.youtube.com/watch?v=24EvsAQOyp4
The first obvious thing is that the guy’s scalp is very malleable and soft, but more interesting is the massage techniques used, going all the way down the back.
I’ve read in a few places that scalp tension can be connected to upper and lower back tension, so does it make sense to try to tackle and resolve trigger points in the back as a way to decrease tension in the scalp (and the galea)
That was a great watch David.
This looks good.
Hey Paz! Yeah I think it’s not only interesting but also a very relaxing video.
In my mind the big take away is that reducing tension in the neck/upper back has to be very important in an overall tension-reducing regimen. I’d read years ago how tension in the shoulders and upper back affects the scalps, but this massage really brought the point home.
David
Hey David,
I think it’s potentially a great idea to focus on tension further down from the scalp — particularly the neck and shoulders. I also think refocusing our attention on relaxing the muscles connected to the galea aponeurotica — which are all located along the sides of the scalp — is a great idea. Taking these muscles out of chronic contraction, and maybe even massaging the neck and shoulders, should help!
Hey David,
I think those are great ideas! And newer insights from the recent crop of best responders are revealing that it’s even more important than previously thought to target to massage the muscles surrounding the galea aponeurotica. So don’t skip out on the “sides” of the scalp — it may be that hyper-focusing on those muscle groups is a key toward the massage’s ability to tackle that tension, and thereby improve hair loss outcomes.
Best,
Rob
Thanks Rob! I’ve realized the importance of the sides only with experience, sadly…One thing I’ve noticed is how tension seems to accumulate in my scalp when I’m stressed. Let’s say I’ve got a deadline to meet or anything and I work all night on a project. 10 times out of 10, my scalp will be hard as a rock afterwards, as will my shoulders.
From doing yoga and focusing on the upper back a lot, I’ve found that it’s nearly impossible not to have a relaxed scalp if your shoulders and neck are relaxed and free of tension.
Years and years of this tension, compounded by calcification process, has to be a major factor. That being said, women are similarly stressed, but alas that is the complex nature of MPB.
BTW, I know you alluded to it before, but it is high time to create a forum or something so we can have these discussions in a more sane and organized manner.
-David
Hey David — re: forum, you’re absolutely right! It’s coming! Give me a couple months and I’ll have everything ready.
Best,
Rob
Hi Rob,
thank you very much for all the good work and effort you put into this.
I‘d be interested in the success rate of the tequniques described in the e-mail course and the book. I know it‘s difficult to say since everybody does it slightly different and you probably wont get a feedback from everybody, but that would help a lot in terms of motivation and staying focused even after a few months of not seeing results yet.
So I would really appreciate if you could give us your opinion on that. Like, is it closer to 20% or closer to 60%.
Thank you again for your amazing work!
Best,
Tim
Hey Tim,
Based on self-reported data from a survey, it seems like 70% of readers trying these methods are reporting a stop in hair loss or an improvement — with rates of regrowth varying by each individual. I hope this helps! I plan on writing an article about all of this soon.
Best,
Rob
Hi Rob and everyone else
I would like to emphasize the massages on the sides of the scalp.
I definitely did not ignore these ,even if they felt looser.
You have to make sure that you can grip and pinch the scalp ridge’s . If we look at the Galea structure , and Galea fusion then these areas are mandatory ! . These areas then allow the scalp to move freely over skull , for example when towel massaging after a shower the Galea should move .
I noticed this around month 13.
Everyone’s progress is different and personal.
I would also like to mention Danny Roddy and Ray peats emphasis on prolactin, cortisol, and estrogen reducing through diet and lifestyle. These are all connected to fibrosis and calcification.
Anyone wanting better chances of regrowth and improvement, need to focus on these areas especially all massages in Rob’s book.
I know on some forums people are picking and choosing Rob’s massages.
Kind regards.
Paz — this is great insight, and well-aligned with much of what the survey data suggests from past readers. Everyone should focus significant attention on massaging the sides of the scalp, and specifically, the muscles connected to the galea in an effort to relax them. Here’s a map of where they are:
https://patents.google.com/patent/US6299893
Best,
Rob
Hey Paz and Rob,
The scalp muscles map is fascinating. And you’re right about the ridges. I didn’t pay any attention to them after reading the Choy paper, and didn’t get any results even with close to 2 years of massages. If you feel out a woman’s (or a man with perfect hair) scalp, everything is just so ”even”. It’s really a shock when you compare to your own scalp and how it used to feel the same.
Hey rob,
Should I use eco nuts for washing my hair? And if I cheated one/twice on a paleo diet by eating grains and sugar, is it okay or will it just go no where with stopping inflammation?
Hey Zach — I don’t recommend using any shampoos or conditioners, but using either occassionally shouldn’t make a huge difference either way.
In terms of eating grains — it really depends on the individual. For instance, Cyrex testing reveals that I have a significant antibody reaction to gluten-containing foods — with my doctor recommending I eat gluten no more than once or twice per year due to its potential for inducing inflammation. Ironically, I feel great whenever I eat gluten-containing foods — and would’ve had no idea of the severity of my response had I not done the test.
Best,
Rob
Rob, ive just found out about some guys theory on Skull expansion, in that the potential real reason we recede is based on the skull bone growth changes as we get older. This causes the hair follicles to suffocate, in other words where the head is flat, hair grows. Where the head is round, hair doesn’t grow.
Skull expansion will cause the surface area of certain skull bones to increase. This will progressively stretch and pull tight the scalp tissue that overlies the skull (and can quite often also make the scalp feel very itchy and tight).
This disrupts the microvascular blood supply to the hair follicles. Blood flow is reduced and so the supply of nutrients to the hair follicles decreases. In time, this causes hair follicle miniaturization. Thinner, weaker hair growth then follows and hair loss develops.
Whats your thoughts on this Rob? I’d love to know if you’ve heard about this or even considered this as a possible theory.
Thanks again, reporting from New Zealand, over and out.
My bad, i didnt realize you have already covered this theory on skull expansion here:
https://perfecthairhealth.com/the-leading-theories-of-pattern-hair-loss/
I still think that Paul Taylor whom i originally found this theory from makes a lot of sense especially in his article here:
https://www.hairgrowthsos.com/what-causes-hair-loss.html
Just want to say thank you for your continued study into this subject, it gives people like me much hope!
Thank you Kieran! Yes, that link covers Paul Taylor’s paper. And his paper is also cited in the paper I just published. We’re getting closer to answers!
I definitely believe this is part of it.
I have some bony growths on my scalp in areas where it’s balding that I started noticing around 21, and then my hair disappeared really fast.
That’s why mechanical stimulation is so important, and you need to go kind of hard to undo these kind of changes.
I’ve tried the massages at a laid back pace for 2 years without any improvements. It needs to be a very involved regimen (including inversions, headstands, red light therapy, dermarolling, oil, scalp exercise, relaxation etc.) to make a difference I think.
Hi David, have you made much of a difference would you say?
Better yet have you got your juvenile hairline back? Wow now wouldn’t that be a success story to talk about!
Hey Rob,
Congratulations on publishing your paper. I’m currently making my way through your Perfect Hair Health book and accompanying materials. Really enjoying the content thus far-Gives one hope.
After all your research, personal experience, & the feedback you’ve received, do you personally believe that follicles in the MPB regions are genetically different from the ones in other areas less susceptible to loss? (e.g. more androgen receptors, etc.). Or do you believe that the follicles are the same & it’s the environment that results in MPB? A combination of both?
Thanks.
Hi RPM,
Thanks for the kind words, and for your support.
I think the question we want to ask is if AGA-prone hair follicles are epigenetically different from non AGA-prone hair follicles on the sides of the scalp — since genetically, all cells are exactly the same (but the genes turned on/off all vary). We know that at a base level, there are epigenetic differences — because at a minimum, there’s a difference in signaling protein expression (which indicates different activity levels for the genes that code for these signaling proteins).
However, the real question we want to ask is: are these differences due to epigenetic programming differences in those hair follicles… or are they due to influences on those hair follicles’ environment? I’m of the belief that it’s the latter. There’s an overwhelming amount of evidence to support this (much of it is discussed in the paper).
But if you really want to dive in deeper (and more evidence), check out Goldman’s paper from the 1990’s — which shows that even small changes in transcutaneous oxygen transport in hair follicle tissues may completely change the hormonal profilings of a tissue — and consequently explain a lot of the biological observations we see in balding scalps:
https://www.ncbi.nlm.nih.gov/pubmed/8628793
Fascinating stuff. On the other side of the coin, the strongest argument against the “environmental influence” of AGA is the concept of ‘donor dominance’ from hair transplants — the idea that transplanted hairs never miniaturize even when placed in AGA tissues. This concept was responsible for the dismissal of fibrosis as a consequence to AGA many years ago. But now, new research is challenging the validity of donor dominance (also mentioned in my paper), which is why I’m still of the belief that while you need the right (or wrong) genes to develop AGA, the mechanisms governing its onset all stem from slight changes to tissue environment.
Best,
Rob
Hi Rob,
You have done a great service for everyone suffering hair loss, thank you!
I am a woman (47 yrs old), and I have a question:
Will I find enough supporting material in your programme to address my hair loss cause?
The cause for my hair loss was Chemotherapy (completed Feb 2015)
My hair did grow back, but only by around 60%
It did gow long, past my shoulders, but is thinner and weaker, with most loss at crown.
This summer 10% of that meagre hair re-growth broke odd around 5-10 cm from the scalp (I am in Australia, so our summer has just finished for 2018).
I look terrible, and am terribly upset.
Interestingly, I have suffered from sebbhoreaic dermatitis on my scalp for 25 years, and have never been able to get rid of it. I was excited when one of your clients wrote that this condition went away for him!
My mother has tons of thick hair (at 74) my dad (75) is nearly completely bald (started losing at 23).
So, is it worth trying your protocol in an endeavour to re-grow my hair, in light of why it fell out?
You do mention your protocol has helped women re-grow lost hair from chemo (or am I reading that wrong?)
Kind regards,
Fiona
Hey Fiona,
Thanks for reaching out. Unfortunately the treatment protocols recommended inside the book are for pattern hair loss — and not necessarily hair loss related from chemotherapy. I don’t currently know of any readers who’ve seen improvements post-chemotherapy from these protocols. That doesn’t mean that they’re not out there. However, we can’t treat hair loss from chemo the same way we treat hair loss from androgenic alopecia — since the pathologies are a bit different.
With that said, I’ve heard of near-full hair recoveries from chemotherapy, and some cases where the recovery took about five years. So you’re still well within the interval for improvement — and the right diet/lifestyle/environment should all help encourage that improvement.
Best,
Rob
Wow-Thanks for the in-depth response Rob. Hope you’re right & by altering the environment we’ll get a more desirable genetic expression.
Hi, Rob. I have been using an organic shampoo: dr bronners organic baby shampoo and I add to it some caffeine and peppermint oil. I’m currently at the beginning of my second month of the scalp massages. Do you think that I can still use this shampoo or the best will be to stop using it?? And what about dandruff? I’m presenting a lot of it.
Hey Mónica,
In general, I don’t recommend the over-use of shampoo. But the reality is that shampooing once or twice a week probably won’t do much harm. Issues arise when someone shampoos every day — and sometimes even twice a day (I used to do that in college).
This should also help with dandruff — though there’s a chance that the dandruff will decrease as your scalp becomes more elastic and adjusts to the massages.
Best,
Rob
Rob I’m wondering if you have any thoughts on scalp peels for mpb? Thanks.
You can certainly try it — though there’s not yet a lot of data supporting its efficacy! The concept of scalp peels have been around for decades, and I’ve always been on the lookout for an anecdote of someone who did one and later showed photographic improvement.
Best,
Rob
Can you do these exercises too much? So i was wondering if its more effective to mix a combination of physical treatments like your exercises, as well as other types of scalp massages and inversion therapy, will that quicken the regrowth process? Or will that be counterproductive.
i heard somewhere that If you were to do it all the time, your scalp would quickly become accustomed to this treatment and would eventually slow the hair growth.
It’s the starting and stopping that keeps your scalp guessing. . . I guess, whats your thoughts on this?
Nah. Don’t go down this road. All the best responders have stuck to a 2x a day massage regimen. Trust me. I tried doing it halfway and coming up with rationalizations for massaging less and supplementing with ”other methods”, but at the core you need to do the massages, and quite hard at that. They’re key. But make sure to space them out 12h apart to leave room for repair.
To build off David’s comments–
You can certainly do these too much! And 2×20 minutes per day seems to be the sweet spot for most individuals. With that said, recent survey data from past readers seems to suggest that those doing 20-30 minutes daily are getting comparable results to those doing 31-40 and 41+ minutes. So there’s a chance that even at 20 minutes per day, you may be getting 60-70% of the full benefit (meaning marginal diminishing returns — until after a certain point, those returns negate with too much time).
Additionally — the survey data also showed a linear relationship with perceived hair regrowth when multiplying months of massing by daily time commitment. What does this mean? That 1) the massages become more effective the longer you do them, and 2) results are likely dependent on the total amount of time you’ve massaged, rather than months or minutes.
Best,
Rob
Hi Rob,
I’m about to start the dermarolling and betadine / isopropyl alcohol swan treatment and I have two questions. In your book, you recommend a 1.5 mm, 192-count dermaroller, but the dermaroller you link in your book suggests that the 0.5 mm should be used for hair regrowth (with no checkmark under the 1.5 mm roller column along the hair regrowth row). Do you still suggest 1.5 mm? Second, the dermaroller site your referenced suggests using a numbing cream before rolling. What are your thoughts on that? Thank you for your time! Here’s the linked dermaroller page: https://mtdermaroller.com/shop/mtdermarollers/1-5-mm-mt-dermaroller/
Seems like a case of synchronicity – I had just asked some similar things in a personal mail to Rob before your questions appeared here…
*Hey Rob, is it OK if I try to help here by quoting your message..?*
Rob told me “the studies that have demonstrated regrowth in humans (not rats) have, for all cases that I’m aware of, used a 192-count 1.5mm roller. That’s why I recommend that needle length and size.”
Over to Rob about the numbing cream…
PS. As it happens, got my 192-count 1.5mm roller just today… (have had “suspect” 540-needlers before…)
Hey Clinton!
RE: needle length–
Yes, I still recommend the 1.5mm needle length. The 0.5mm needle length has demonstrated hair count improvements in rats, but not humans. The 1.5mm needle length has shown improvements in humans.
RE: numbing cream–
You can certainly try it. Some readers use it and haven’t reported any issues. However, I’m not sure how a numbing cream might affect the inflammatory response process. Unfortunately, there seems to be almost no research on this (based on my very cursory search of pubmed).
Best,
Rob
Hey Rob, I really hope you’ll answer my questions.
So, I’m on the verge of buying your book, I’ve been reading your articles and e-mail updates for quite some time, but there’s a few questions I’d like to ask.
First – I’m 22 years old, diagnosed with androgenic alopecia, and I’ve been losing ( dramatically ) hair since 19 years old. I’d say that your theory indeed makes sense because just when I ended puberty, my face shape started to slightly change ( along with scalp bones I suppose ) to some sharper construction ( jawline etc, more ‘eggy’ head shape, etc) . In these 3 years I practically went from NW 1.5 to NW 3.5 along with some moderately overall thinner hair ( except the sides and back of course ). My question is – do I have a better chance of regrowth since I didn’t lose all this hair a long time ago? I read somewhere that hair lost in the 3 year window has the most chance of regrowth. I also went from really thick hair to moderately thin hair, and it’s not like my temples are completely bald, they’re covered with vellus hair and even some terminal ones that are constantly miniaturizing. It’s like my hair generally ( aside from non-balding regions ) is just weak and really easy to strip away from the scalp, a mild pull is enough to pull it off the scalp. I do have seborrheic dermatitis which could be contributing to hair loss ( maybe ? ), my scalp gets oily real fast and scalp is constantly itchy also. I’ve tried all sorts of treatments except for Minoxidil and Finasteride, and of course, they didn’t work.
Second – Earlier here in the comments section, you mentioned that there are even more potent methods of mechanostimulations than massages, what are they? And are the scalp exercises (from Tom Hagerty) really necessary for a good regrowth?
Third – I’ve been having increased body hair growth since I started losing hair rapidly, do you think there’s a correlation? I’m thinking that that’s just the proof that my body is flooded with DHT and that I’m genetically predisposed to counter inflammation with DHT, so, my body sure doesn’t need to worry about the supply for DHT.
Fourth – I’ve been hitting the gym lately and I love it but I read somewhere that lifting weights will increase my hair loss due to increased DHT production. What’s your take on this?
Fifth – I can actually feel some really hard bumps on my temples which you’d thought are actually skull bones. I read that with your massages, people actually were able to ‘level’ this bumps back to normal ? I also do feel that some non-balding areas ( that don’t go bald ever) are also hard to pinch, why is that?
Thank you a lot for your time and contribution Rob, and I hope that you’ll find time to answer my questions.
Bump! These are some excellent questions, would like to hear Robs view on these.
Hey Ali, I’m a couple years older (3-4 ahead of you) and you story is very similar to mine. I’m not Rob but I’ve been reading on hair loss for a couple of years, including Rob’s stuff. Here are my thoughts on your questions:
1. Yes, the earlier the better. Plus you’re in your twenties so with a proper lifestyle your metabolism should aid your recovery.
2. Different approach form a synergy. IMO, Tom Haggerty’s exercises are very worthwhile (but quite hard to master in my case). They help ”relax the whole galea profundly, which is key honestly.
3. Same here. At 18 I had thick hair and a pony tail and no beard, and by the age of 25 I’d lost 75% of it but was hairier everywhere with a beard. Probably due to hormonal inbalances, which are probably the main drivers of your hair loss. Get in the sun, stop staring at screens, don’t watch porn so much, etc. We need to change our lifestyles and in turn the endocrine system will take care of the rest.
4. Hit the gym, but don’t go to failure, and have plenty of rest days. This way your T will go up, and the T/E ratio is a lot more important than minimizing DHT (which is super important so let’s not demonize it)
5. Those bumps appeared for me too. I’m trying hard to make them go away with the massages. The only thing you need is resolve and discipline.
Hey, David
Why is it necessary to avoid until-failure exercises? I’d reckon resting would suffice against this. I’m really curious as I’m about to start hitting the gym (as I don’t want to rock the lanky (eventually) bald look).
Also, how is your regrowth situation; how long have you been going and are you seeing any progress?
I have a near identical situation about my scalp as Ali, as I am shedding a lot of hair, have bumps and other hard spots on my scalp, and my hair pulls out easily. I can just slide my hand from the crown towards my forehead and a few hairs end up on my palm every time.
Blessings,
Benjamin
I’d also be interested in why going to failure is supposedly not a good idea. And how many rest days would you suggest?
I personally follow a push/pull/legs routine and go to the gym five days a week. Additionally, I try to get some cardio (running, biking) in twice a week. So I rarely have a day where I don’t exercise at all…
Hey Benjamin and Manuel,
You can go the failure if you wish, but I advise against it based on my own observations. Use biofeedback range-of-motion tests and also check your body temperature/pulse after training and the next day to see the effect it has on you.
Personally when I go to failure and/or do to much cardio my temps go down and overall metabolism feels sluggish. Whereas if I stick to progressive strength training and stop before failure I *usually* feel great and relaxed the next day. Your goal is to limit stress and tension and I don’t think going to failure or endurance cardio are helpful in that regard.
I would recommend reading Rob’s articles on exercise. About cardio I don’t think anyone suffering from MPB should do too much of it. If you’re training everyday, you better be careful. Rob’s main recommendations are walking (a lot, everywhere) and sprinting once a week. Any type of high-intensity interval training at low frequency (1x or 2x a week max) has been shown to boost hormones and overall metabolism.
Obviously think progressive strength training is helpful, and functional full-body movements like Squats, Pull-ups, Deadlifts, Presses, are really good and do wonders for the CNS and overall fitness. But those benefits can be had with consistent calisthenics work (pull-ups, pushups, pistol squats etc.) and yoga.
Proper strength training, sporadic sprinting, relaxation/meditation and yoga all lead to an increase in the T/E ratio and also contribute to lowering cortisol which goes a long way towards alleviating the initial drivers of hair loss.
As far as my personal progress, I started about 2 years ago. Did the massages badly for more than a year (15 months) , with no other lifestyle changes and saw NO results (obviously). 6 months ago I was sick from a weird lung infection and didn’t do any massages for a while. For the past 4-5 months however I’ve been making a lot of changes (meditation, inversions, red light, calcium/phosphorus ratio etc.) and the overall quality of my hair feels a lot better. There’s a lot of elements to consider, but I might be seeing some signs of regrowth. (spiky dark hairs on the vertex and vellous hairs around the hairline)
If we ever get a forum for this site, I might be able to post some nice pictures some months into the future. Hopefully. But at any rate I’m really hopeful for the first time in a long time.
Hey Ali,
To answer your questions–
RE: “…do I have a better chance of regrowth since I didn’t lose all this hair a long time ago?”–
The short answer is, most likely yes. It’s possible that scar tissue development (fibrosis) in AGA happens many months (or years) after than the disappearance of hair in a balding site; and that at AGA’s initial stages, hair growth is actually just muted by a substance known as PGD2. This prevents the conversion of hair follicle stem cells to progenitor cells, thereby limiting hair production. PGD2 is believed to be mediated by DHT, and interestingly enough, both DHT and PGD2 tend to be responses to inflammation.
So if you’re suffering from rapid onset AGA — it’s possible that those regions of loss haven’t yet become as ridden with fibrosis as others who’ve seen a slow progression of loss over decades. What does that mean? You’re likely going to be an incredibly strong responder to finasteride (Propecia) — because finasteride inhibits the enzyme type II 5-AR, which means it reduces scalp tissue DHT, which means it may reduce PGD2, which means that those hair follicle stem cells should start becoming progenitor cells again, and you should see significant hair recovery.
With that said, you must decide if finasteride is the right move for you. Chances are it’ll help significantly, and in your case, maybe better than most “natural” methods. The natural route is almost always the harder case to argue. It often requires more work, is less-studied, and doesn’t always work for everyone. At the same time, finasteride is a lifelong commitment and comes with the risk of side effects. Finasteride also doesn’t work for everyone — though in your case, it might be particularly effective.
In either case — I can only help educate you on both sides of the argument.
RE: “…more potent methods of mechanostimulations than massages, what are they?”–
I’m still testing with a small group of readers, but right now, PDO needle threads and botox injections have both demonstrated, in independent studies, to be incredibly effective. Now we’re testing to find out if these findings match up to real-world results.
RE: “I’ve been having increased body hair growth since I started losing hair rapidly, do you think there’s a correlation?”–
Absolutely! Most people with a lot of body hair often also present with AGA later in life. An exception is Alec Baldwin. I don’t know what sort of voodoo magic he practices, but he has a crazy amount of body hair and almost no presentation of AGA.
Generally, it seems that more body hair may also correspond with elevated estrogen levels. There’s also a genetic component to all of this, so it’s very hard to say what’s going on with any one individual. I can’t comment on your specific case, but I would agree with your statement that your body is likely predisposed to respond to inflammation with DHT.
RE: “… I read somewhere that lifting weights will increase my hair loss due to increased DHT production…”–
I wrote an article series on the exercise-hair loss connection, which you can read here:
https://perfecthairhealth.com/part-1-of-3-the-exercise-and-hair-loss-connection/
https://perfecthairhealth.com/part-1-of-3-the-exercise-and-hair-loss-connection/
https://perfecthairhealth.com/part-3-of-3-the-exercise-hair-loss-connection/
RE: landscape of scalp–
I think that people who report changes to the bone structure from massaging are actually either just 1) becoming more familiar with their scalp environment, and misclassify the bones as changing; or 2) are actually feeling landscape changes, but are misclassifying what’s changing as “bone” — when it’s really the underlying fascia / skin tissue.
In terms of tight spots where you’re not balding — this is normal! According to the paper, tension precedes the balding process, so the tension comes first — and you may not present with hair loss for many, many years there.
Best,
Rob
So my plan to tackle this is as follows (I’d like your opinion):
In no particular order:
1. Heal and balance systemic imbalances in the body. (Whether that be hormones, nutrition, inflamation etc.)
2. Bring back blood flow to the scalp region through Robs exercises by getting rid of calcification and fibrosis.
(In this section i am tempted to add multiple different exercises from other people who have their own theories like Paul Taylors exercises for ‘skull bone expansion’, perhaps also Tom Haggerty scalp exercises. I dont see how doing lots of massaging/scalp exercises coupled with dermarolling etc can be that bad, its not like a muscle where it needs time to repair right? So i assume more is good, get that blood flow going.)
3. Deal with DHT in the scalp region.
(Im thinking even if you were to break away the DHT from the scalp with massages, you’ll still be getting a new flow of DHT back into the scalp again so you’ll have to suppress it somehow, you do see a lot more success stories for using conventional DHT anti-androgens like Finestaride and Minoxidil than people who use natural alternative therapies like scalp exercises and organic shampoos. But in this case i’d rather not take oral supplements that could ruin my health internally, so i’d rather use something that has effects of minoxidil but healthier. I’ve heard RU (RU58841) is effective, and i havent heard many side effects, or CB anything healthy enough to stop DHT in the scalp, even natural DHT blockers if its shwon to be decently effective)
4. Use Concealers for the time being, like Toppik.
So there we have it, thats my plan.
Again I’m not Rob, but here are my thoughts:
1. This is the most important part. You need to spend a bit more time reading and understanding the inflammatory causes in your life and read a lot on improving your metabolism and your hormones. (Danny Roddy is a good start)
2.Additional therapies are always useful and complementary, but make sure that they don’t come at the expense of the main scalp exercises (do those religiously)
3. It’s not DHT that’s the problem. DHT accumulates in response to inflammation. Reduce that tension, breakdown that calcification and fibrosis and it won’t be an issue. Focus on having healthy levels of Testosterone. If you want to lower DHT nonetheless, try Saw Palmetto and/or Pumpkin Seed oil for the next 2 years.
4. Don’t use Toppik. If you can shave your head or get a buzz cut and own up to your hair loss. Wear in hat in winter or a cap in summer if you’re more comfortable that way outside but don’t use stuff to conceal your hairloss, it’s messy and I believe it puts you in the incorrect frame of mind. This will be a lenghty process, all the best responders took more than a year to get noticeable regrowth (by noticeable I mean to other people)
Thanks David for your response.
I am wondering though why it is that when people take finesteride/minoxidil and they gain regrowth, but then when they stop using it they lose all their growth why is that? Whats actually going on? Is it a huge surge in DHT towards the scalp?
The mechanisms of minoxidil are not clear, even to this day. It definitely increase circulation in the scalp. I used minoxidil for a year and saw good (but not perfect) regrowth. Then I stopped and lost all the gains progressively.
The problem is that in my case it dried my skin really fast and left me with under eye circles that I still have 2 years after I stopped. Avoid minoxidil at all costs. It’s a band-aid on a more serious problem, you’ll have to use it for the rest of your life, 2x a day, and it’ll age your face problably.
As far as finasteride goes, it really is much simpler. Basically it kills your DHT. (Or reduces it by 70%) and that is usually enough to get 50% of your hair back (except in regions with heavy calcification). But within 3-5 years it’s loses a lot of its effectiveness and leaves many with lasting hormonal impacts. (low libido, energy, erectile disfunction etc.) There are plenty of horror stories with finasteride. It works for some (at least for a while), but when it doesn’t it’s terrible.
Hi David,
Yes but why does hair fall out progressively after you stop minoxidil/finasteride? Why does it do this?
What happens if you take minoxidil but ALSO do all the things rob teaches and you heal your body internally and you do all the natural approaches, and then when your body is healthier and you’re doing the scalp massages ect you start weening off of minoxidil, will you start losing regrowth? if you do, will you regrow healthier hair instead because of the fixes in your lifestyle and massaging?
Im becoming a little desperate now because i’m very quickly progressing towards Norwood 3 and even though im fixing my health and massaging, i know that it is a long term solution, however i need something now to stop this progression of hair fall.
Hey Rob, so I recently purchased a 250 watt infrared bulb. What are your thoughts on red light therapy for hair thickening? Thanks!
Hey Sierra,
I wrote a bit about LLLT and infrared light here, which may be of help:
https://perfecthairhealth.com/low-level-laser-therapy-does-it-help-with-hair-loss/
It’s hard to say if infrared light is better than LLLT — or if your bulb will help — because it all depends on how we define LLLT. After all, there can be such a thing as infrared LLLT — it’s just low level laser therapy positioned with infrared light. There can also be red LLLT — if the wavelength is changed.
What complicates things more is that the efficacy of any light treatment depends not just on wavelength, but also on pulse rate, duration, diameter, area of treatment, condition treated, etc.
So I don’t have any opinions on infrared bulbs specifically! The data is pretty limited here.
Best,
Rob
Rob, great website and information. I’m wondering if there is any machine that can substitute for the hands for the massages, as I am recovering from bicep tendonosis, and doing the massages does flare it up a bit.
I am in the early stages of diffuse thinning, but am going to be proactive with this and fix diet, gut health, and scalp tension. Maybe finasteride a couple years down the road if your techniques don’t work, but the ‘science’ behind this seems sound to me
Hey Kevin,
I just got an email from a reader who has been building a machine! He said it may be ready by this summer. In the meantime, some readers have referred me to this product, which they say is great because 1) it’s battery powered with a built-in timer, 2) it grips well and doesn’t rub or create skin friction, and 3) it works the scalp well, and, according to them, helps them cut down on their total massage time:
https://www.amazon.com/PowerDoF-Handheld-Portable-Removable-Attachments/dp/B0747N98MH/
I’ve never tried the device before, and I’m not affiliated with the company.
Best,
Rob
Hey Rob,
I am using scalp exercises for quite 2 years now. But i still continue to loose hair. I am confident about my massage techniques. Though i did not pay much attention to diet. I tried gluten free for 3 months with no results. Also i did blood work and found myself deficient in Vitamin D and Vitamin B. I took the supplements as per doctor . Though i didn’t see any results , i still continues with massages once a day as my hair felt good.
Then i saw the article on rosemary and dermaroller. So i started a new regimen. Where i oiled with rosemary and coconut oil every alternative day to my hair and dermarolling every week.
This is during winter and i still see hair falling at great rate showing bald patches.
Also most of the hair fall ..90% is in my left temple area. And interestingly i see..this hair fall started with winter and also i started feeling pain under the scalp in that left temple area during that shedding time.
So i have the following questions
1. What does the pain in the scalp in the hair loss region signify.Is it because of intense scalp exercises and dermarolling. I read some places that it may be about new hair growth coming. Does it mean more inflammation in that region.
Also i would like to add that the area paining is really tender.. I mean not hard.
2. How important is being deficient in Vitamin D and 90% of hairloss happening in Winter play here. Does that mean the hair loss is temporary ? But my problem is it really exposing bald areas in my left temple and i m just 21 now
3. How do you see trying Scalp massages for 1.5 years without any results. Should i look over and find something new to try.
Hey Sans,
To answer your questions–
1. If you’re experiencing pain in thinning regions, I’d ease off the massages. Pain indicates unresolved inflammation.
2. Seasonal changes affect our hair greatly. Depending on the season, our hair volume can be 15% below baseline, and all due to a simple, prolonged change in weather and the response of our natural hair cycle. Vitamin D is a huge factor here. Typically, in seasonal changes, the hair loss is temporary.
3. Survey data from past readers suggests that at the two-year mark, 75% of people report +1 or +2 regrowth results (out of a -2, -1, 0, +1, +2 scale) — meaning great response rates for those that stick with massaging. If you’re not yet seeing any results at all, it may be a good idea to pursue other treatment options. But I’m still digging into this data to see if there are commonalities amongst the non-responders in this group, so I hope to have more to say in the coming months.
Best,
Rob
Hi, Rob.
I’m almost 2.5 months since doing the massage and I havent seen/feel much (or better said any) sebum production when Im doing the massages. Do you think Im doing it wrong??
Not necessarily. Excess sebum production isn’t a requisite for results — it’s only a commonly reported early-stage effect of the massages.
Have you managed to get your scalp loose, pliable and easily pinchable? I think that is the important thing; not how long you have been massaging.
Henri — I agree! Those factors are significantly more important. Thank you.
Hey David, thanks for dedicating your time to answer me.
Well actually, I do have a daily walk where I walk at least 1.5 kilometers ( around 0.93 ) miles, and as you suggested, I used to have basketball sessions once a week which surely counts as high-intensity training and this was prior I started lifting. I tend to go outside as much as I can, I don’t watch porn at all, my diet could be the main culprit though – but as Rob also stated prior to having his success with massages – that diet wasn’t his problem. I mean, I had the same diet prior my hair loss too. I try to get as much of sun as I can, but this time of year is really chilly in my country with hardly any sun at all. Do you think Vitamin D supplementation could be an alternative until summer?
First of all, I’m really happy for you that you’re finally on the upside! But it’s kinda demoralising for me that you spent first 15 months of massaging without absolutely no results. It makes me second guess if I should start at all, considering you had no success in the first place, but on the other side, what sort of lifestyle changes did you make when you actually started to see improvements besides adding inversions, scalp exercises, dermarolling etc. ? I’m mostly concerned about not finding out what’s ‘wrong with my body’ in time to make some serious regrowth, and that’s what’s keeping me away from fighting the hair loss battle ‘from the inside and naturally ( via massages and lifestyle changes )’ the most… Generally, I do feel healthy, only thing worth mentioning is that on recent blood exams, one thyroid exam index was miiildly increased. To be precise – TSH was somewhere about 4.12 I think, while the reference upper range was 4.10 ( in other labs, the upper reference rage was even higher, about 4.20-4.30, so you might consider my results non-increased at all), T3 and T4 were in good ranges.
I do feel like this hair loss being so rapid is taking toll on me, I feel like I would’ve accepted it much easier if it was ‘stretched’ to at least 15 years, because at this rate, I might be NW 5 in 2-3 years if I don’t stop it.
P.S. still hoping for Rob’s opinion on all of this too 🙂
Hey Ali,
I just answered your first set of questions above. I hope this helps.
Moving forward, I’m happy to have a long-form discussion about your specific case over a Skype call — particularly regarding diet, troubleshooting extraneous health issues, etc. But out of respect for those who’ve purchased Skype calls, I have to limit the degree of personalized help I can give in the articles’ comment sections.
With that said, your first five questions were great — and worth answering publicly to (hopefully) benefit others as well!
Best,
Rob
Hi all ,
Sans , Ali , and David.
Sans
Do you do the massages twice a day , and all 3 as ascribed in the video. What is your skin elasticity like ? Is it pliable ,looser easier to pinch ?
Vitimin D and B are vital. Their is an article Rob has on the site regarding vitimin D.
Have you looked at eating an anti estrogen diet or food, like Danny Roddy / peat .
I think diet plays a part if we look at ray peats opinions.
However people have regrowth without much attention to diet. I think it comes down to each individual.
Im massaging 15 months in and people are noticing results.
I’ve incorpated rosemary oil and pumpkin seed oil twice a week and rosemary shampoo. I’ve noticed benefits to be honest and much much less shedding.
I hardly she’d hair during massages , maybe 10 at the very max .
But shedding happens during winter. As shedding is seasonal.
Sometimes losing gain , actually means regrowth , ie look at the hair your shedding, what quality is it ?
This is a long process.
I wish you best of luck, and stay stress free
Hi rob,
What do you think of this guys video about MPB? Seems legit.
https://m.youtube.com/watch?v=taMu2UOYQmY
Hey Mark!
Thanks for sharing. I agree with much of what the narrator says, but not everything.
But in general, I think everyone interested in AGA research should watch that video!
Best,
Rob
Hey Rob,
What are you thoughts on supplementing with Saw Palmetto and its effects on exercise? I haven’t been able to find any conclusive evidence out there about how it can impact performance good or bad.
Just a little bit of background, I have read your e-book and done 11 months of the scalp massage techniques (20 min morning and night everyday). I had decent results with some thickening of my receded hairline but no new hair regrowth. I have found it hard to keep this protocol sustainable as I started to experience elbow pain which eventually led to off and on shoulder pain as well. I would have to do manual tissue work constantly try and minimize the pain but combined with how much I exercise it’s been a struggle. I realize that excessive exercise also doesn’t help the hairline equation but it’s my profession and I also take many measures to lower overall tension and balance the equation (walks on the beach, breathing exercises/meditation, proper recovery protocols after exercise, proper nutrition from less inflammatory foods, etc).
Because of all this I have been looking for alternative methods and will mix in some scalp massages less frequently to minimize pain. I recently started supplementing with Nutrafol which has a lot of ingredients that I was already supplementing with individually like turmeric, vitamin d3 and an active b-complex. I now combine both of these but take lower doses of the 3 mentioned above to be in line with the doses I have been recommended by my naturopathic doctor.
Back to my original question…does supplementing with saw palmetto negatively impact the hormonal balance that would be beneficial to building and maintaining muscle mass?
Thanks for your time and I appreciate your feedback,
Eric
Hey Eric,
It’s a great question, and in general, anything that inhibits 5-AR has the potential to affect muscle mass. There are three widely-discussed forms of 5-alpha reductase — types I, II, and III. Different muscle groups express different forms of each:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253436/
Given that muscle mass is significantly mediated by androgens like DHT, and that 5-alpha reductase converts free testosterone to DHT — it’s likely that any 5-AR inhibitor (like saw palmetto) may have some negative effect on muscle mass…
…but I don’t think it would be much.
Rather, I think that you’re far more likely to see a negative impact in muscle mass from antioxidant supplementation — especially if you workout often. Antioxidants help counter the damages from reactive oxygen species (ROS), but ironically, after working out, our muscle tissues flood with ROS to promote repair mechanisms that allow for muscle growth. Examine.com did a great overview of this literature:
https://examine.com/nutrition/antioxidants-muscle-building/
I noticed the same phenomenon when supplementing with too much curcumin for a few months on end. Interestingly, Nutrafol’s ingredients list shows a lot of antioxidants. So if you’re losing muscle mass — my bet is that it’s due to the antioxidants more so than it is the (small) decrease to DHT production from 5-AR inhibition.
Best,
Rob
Hey,
I started doing the massages according to the demo video about 2 weeks ago.
I noticed that the muscles on the sides feel very big and swollen. Almost like there‘s some kind of fluid in there or whatever.
Now even after only two weeks, it has reduced in size and feels a lot better.
Has anyone experienced something similar to that?
Best,
Tim
Hey Tim,
That’s very commonly reported!
Best,
Rob
Hey Rob,
If you could help me it be great, I’m getting frustrated. It’s been 3 months in massaging my scalp. I can’t say if it’s working but I notice maybe some root strength and rarely any inflammation scalp and I’m still having hair fall. I thought about doing three 20 minutes of massaging, would that be a great add to life style? I’m 17 and I started losing hair since I was 14 years old. I only can do so much good for my diet. I had so much confidence in J.D. Moyers blog i need confidence in my journey again please if there’s anything you can do, Please?
Best,
Zach
What do you think of hard water Rob ?
Hey Michael,
In general, there’s not much evidence that hard water causes hair loss. We have to keep in mind that increased dietary calcium does not equate to increased calcification; that there’s no evidence that the incidence of hair loss in places with hard water is higher; and that even with more minerals in the water, the difference in total lifelong accumulation of these minerals isn’t much different than non-hard water locations.
Best,
Rob
Zach I wouldn’t do 3 times a day. I found I have had more success when I’ve gone hard on the massages but allow for full recovery. I actually break it up where I do the sides of scalp one day. And next day do front/ hairline in the early day and the crown/back part at night. I found that that works best for me and my life schedule after trial and error. Massaging too much is counter productive I think. Your still early in the process.
Hey Scotty
Thanks for the guidance I’ll use that. I just get worried that my diet will be my downfall. I have a question if anyone can answer, will my thickest of hairs stay rooted with this massaging going on? And stop them from miniatureizing?
Hi Zach.
Scotty is right
Do not do more. Stick with 20 min twice on , switching areas from sides ect.
For diet , take inspiration from both Rob and Danny Roddy. Focus on bringing down estrogen and increase t levels. Reduce stress hormones.
Your hair cycle will determine what falls out , and what it replaces.
The regimen takes time , more than 3 months sometimes to notice change.
The key to success is tackling 2 major areas.
1. Internal = diet, stress hormones, estrogen reducing foods, pro thyroid food
And Lifestyle.
2. External= tissue damage repair, via massages , dermaroling either one. I personally stick with massages to begin with. Essential oils later down the line.
Just focus on those two .
Make sure you get enough vitimin D, B, C, and A
Hey Zach — Scotty and Paz have given great advice here. Three months is far too early to make any judgments on the protocol, and in general — as long as you’re 1) nutrient replete, 2) not consistently ingesting inflammatory foods (i.e. allergens), and 3) don’t have an underlying digestive issue like gut dysbiosis — you’re likely doing everything you can from a dietary standpoint.
Purchased the book a few months back and have been applying the methodology with rigour since then (had been massaging for perhaps 1-2 months prior to purchase but have refined technique as per video since then). It’s obviously too early to attest to new growth, but I can say with certainty that the overall quality of my hair is better – thicker and healthier, if you will. I’m 34 and have been thinning at the vertex and somewhat diffusely all over since mid-20’s.
I will say this much – read the book in its entirety, adopt as much of the methodology as is practicable (diet/lifestyle/massage regimen) and permit yourself time and patience. Everything you need to know is within those pages. Rob, to his credit, is fastidious in respect of empiricism and providing primary source evidence. It’s all there for the taking, folks.
Hope this doesn’t make me a shill, Rob, and instead provides some direction for those querying regimen modifications etc. Cheers!
Hey BB,
Thank you for the kind words. And congratulations on your early signs of progress. I think that the majority of questions I receive through email / article comments are answerable with just the book — or in some cases, by reading the article in question more closely. Having said that, I always wonder if maybe I’m just not being clear enough. So I appreciate the affirmation.
Interestingly enough, some of my biggest learnings have stemmed from readers asking seemingly very simple questions in comment sections, and in my attempts to answer them, inadvertently going down a research rabbit hole. For instance, my response to a reader asking, “Why do male-to-female transexuals regrow so much hair?” — eventually culminated into the paper I just published.
In any case — it’s incredibly clear that a forum for this site is long overdue. I’ll get to working on that as soon as possible.
Best,
Rob
Zac as for your diet. I think it is best to rid the anti inflammatory foods as much as possible in the beginning more as a test run. When you do start feeling your scalp getting a little softer and easier to pinch try introducing foods that you want to and see if they have any affect on your scalp. For me I found that alcohol bingeing was by far and away the worst thing for my scalp. Gluten foods really don’t have as bad of an effect on me, but I think that’s also because I go to the gym and have other healthy habits to counteract their effects. I hope this makes sense.
Hi Rob,
Great book, really intriguing.
What is your opinion on taking a pine pollen and nettle root tincture to help with this?
Pine pollen naturally increases free testosterone, reduces estrogen,, contains phytoandrogens and amino acids and vitamins.
Also, do you think that dairy is a common inflammatory food for a lot of people. I notice headaches after having milk and cheese, wondering if this could be a sign of inflammation.
Thanks.
Hey Sam,
Thanks for reading! I’ve yet to experiment with pine pollen and don’t have much of an opinion on it, but you can certainly try it. In regards to dairy, I think it is a common inflammatory food for the majority of people. By the age of 65, only a small percent of the population remains lactose-tolerant. Dairy also accounts for a significant percentage of exogenous estrogens in our diet, so if we’re going to consume it, we should be doing it in relative dosages and from pastured cows.
Best,
Rob
Hi Rob,
What’s your thoughts on Brotzu? Seems compelling thus far.
https://bellicapelliforum.com/en/interview/exclusive-interview-with-dr-brotzu-for-bellicapelli/
Cheers
I’m cautiously excited about it! So many pilot studies demonstrate success in a journal, and never translate to real-life, tangible results for hair loss sufferers. Brotzu may be an exception. But we’ll have to wait and see.
Best,
Rob
BB
The interview with brotzu is very similar to Rob’s theory. Blood circulation and post puberty origins. But the lotion will only work on people suffering early onset.
This could because of the amount of fibrosis and calcification build up over the years.
I doubt this would work on Nw 4 effectively.
But I wonder how it would work along with DT
Greetings Rob.
A question regarding PACKAGE PURCHASE decision—
Supposing that I purchase what you’ve described as THE SELF SERVICE package and, within a few months—having become so delighted with your regimen—find myself wishing I had opted for the SKYPE CALL level of service from the outset …and, by then, here we are…months down the road from Self Service Buy Day.
Have you ever considered the possibility of pricing the 60-min SKYPE CALL on any such Later Plan basis? Curious.
I perhaps may be of interest to you, in that I INITIATED a HAIR GROWTH PLAN (term of 6 years) beginning on DEC 1, 2013, starting with 1” long hair. I began a photo-journal at that same time. So, not that I’m counting, but, it’s been 4 years, 4 months and 13 days (as of 6am today) and changes are occurring—one being a change in perception related to overall volume. I am…hanging on to 62 years of age.
Hey Mark,
Thanks for reaching out. You can certainly upgrade to the Skype call package at a later date, and I can refund your original purchase. Otherwise, you can purchase multiple Skype calls outside of any book package here:
https://gum.co/phh-skype/
Congratulations on your success so far! If we do connect, I look forward to meeting over Skype.
Best,
Rob
Hi, Rob! Over the last weeks, I’ve noticed that my hairline (specially on the sides) my hair is thinning and I have less hair in there. I’ve been doing the massages for almost 2 months. Is that normal or should I do something about it?
Thanks, Rob!
Hey Mónica,
For women especially, I’d recommend testing for the following conditions: hyperparathyroidism, hypothyroidism, PCOS, SIBO, and nutrient deficiencies (iron, zinc, vitamin B-12, and vitamin D). As mentioned earlier, for massagers, hair loss typically stops at month five, and two months is just too early to tell (unless your technique is too aggressive). But if hair loss persists, stop massaging and test for the above conditions — as they may be underlying your hair thinning, and resolving those first could a) resolve your hair loss, and/or b) make the massages exponentially more effective. I’m happy to speak more on a Skype call about this.
Best,
Rob
Hi Rob!
This is Victor from Spain. I bought your book last year, and after a year with your massage technique and with good results i am testing the dermaroller 1,5 mm protocol. But after watching this video:
https://www.youtube.com/watch?v=AqZ6Kf9W2ns
about dermapen, it seems a more healthy option than dermaroller. What do you think?? Do you think dermapen is equally effective than dermaroller??
Thanks a lot for your work
Hey Victor,
Congratulations on getting results. I’ve recently started the protocol too. Could you tell us how much recovery you experienced? In which area’s did you experience hair loss and gain recovery?
Wishing you continued success!
Very good results in the crown area, more hair and density, but not in the temples!
Hey Victor, congratulations on your results so far. It’s hard to say whether a dermapen is better than the dermaroller. Anecdotally, readers say it’s less painful, but the dermapen hasn’t been studied as extensively as the dermaroller — particularly for hair regrowth in humans — so while the mechanisms of action are likely the same, we can’t yet say if it’s worse, the same, or better! For instance, those “trenches” that a dermaroller creates in the skin might also be the reason for its efficacy.
If I come across any dermapen hair regrowth studies in humans, I will let you know.
Best,
Rob
Hey Rob!
I know the “high T causes baldness” is a myth but what about the opposite?
Can Low T cause baldness? Especially in young men?
He makes it clear in the book that imbalances in the T:E ratio partly contribute to baldness.
After reading multiple of your articles and others on using natural oils to help stop and reverse hair loss, I decided to jump head on with a regimen to start my battle with my receding hairline.
A little background on myself, I am 20 years old and have slowly and progressively noticed my receding hairline but just 2 months ago really noticed a increase in shedding and just how much my hairline has moved. It’s not terrible by any means. I’ve noticed about 1/4 inch recession at the temples and at the forehead. After considering rogaine, and even finasteride I decided it wasn’t worth the risk and long term commitment quite yet.
I currently do a nightly routine with the following:
10,000mcg of biotin
1000mg of pumpkin seed oil in capsule taken orally
400mg of saw palmetto in capsule taken orally
200 mg of ecklonia cava in capsule taken orally
Plus rosemary, peppermint, coconut oil, and pumpkin seed oil applied topically to my hairline before I go to sleep. I store the supplements and oils in the refrigerator to help prevent the oils from turning into fatty acids.
I’m on day 17, and I’m fairly convinced i’ve seen a reduction in daily hairloss and shedding, and reduction in hairloss during application. I’ve seen a few small wispy hairs at the front of my hairline, but it’s not easy to tell if they are new hairs, or just old hairs that are thinning and next to go. Some nights i’ll notice 5-8 hairs on my fingers after applying oils/shampoos and some nights it’s up to 10-15 hairs. Even though I’m convinced of this, I’m still paranoid that I’m still receding. I cannot tell definitively, and am about to consider adding rogaine to this regimen.
Am I naive and too eager to be expecting results after just a few weeks? What is your opinion on this system and how can I improve it? I’ve considered derma-rolling and massaging during application of the oils.
Thanks again!
Hey, I normally don’t do this but your post reminds me of myself. I had hairloss that started from 24 years of age and by 26 it got so bad I was wearing a hat to hide my receding hairline. So, during that time I tried basically everything you could ever imagine for about 2-3 years. I ate spoonfuls of pumpkin oil, flaxeed oil, rubbed it on my head, consumed tons of eklonia kava cuz of that immortalhair guy pumping that crap, I tried all kinds of vitamins and antioxidants, i juiced garlic and put it on my head with a shower cap at night, even rubbed urine on my head (yes I know, I was desperate). I can tell you that all of it was basically a waste of money and possibly to a detriment of my health considering all the vitamin supplements I was taking.
Now, I don’t worry about losing my hair since I have been steadily growing it back for around a year now (I just turned 31). What worked? Well I quit masturbating for 2 years straight, and as soon as I stopped that, so did my hairloss, and it became a thicker because of that. People say there is no connection, but some of us probably cannot afford to masturbate freely like othres who have different DHT levels (which is one part of the equation). Anyway, I have been massing my scalp for almost a year, but only have been doing it properly for around the last 6 months. The first 6 months I only did pinch and press and only on the front hairline. Now I do all 3 regions and also stretching the scalp as well.
Here is the amazing part: I am regrowing hairs at exactly where my hairline was when I was 20. The hairs grow, fall out, grow a little bigger, fall out, over and over again. It may take a really long time, but I definitely went from insecure to feeling good about my hair and almost have regained my original hairline, which I will as soon as these hairs get as thick as the rest of the others (as they have been slowly). I am also dermastamping every week along the front hairline. So, anyway, I have a ton of new hairs all over my new hairline, some super thin, some thick, but they are sprouting and becoming thicker over time. So this stuff WORKS.
Now, I just want to say that you should focus on living an anti-inflammatory lifestyle (food, low-stress,, etc), don’t masturbate (this makes a huge different IMO), do the massages correctly, try dermastamp/dermarolling, and that’s probably the best course of action. Also quit washing your hair with shampoo. My hair is so much better without it.
Anyway I just related so much to your post since you mentioned all those supplements hoping they’d be the miracle you’re hoping for. You’re better off eating a whole foods diet and reducing anything that stresses your body and just focusing on the massages/dermarolling.
Good luck and don’t waste your money!
And I want to emphasize that my hairloss has been improving from around age 28 to now, from the time I stopped masturbating and especially from the time i starting doing the massages/dermastamp (that’s when I saw the new hair growth). It’s real and it works. I just wish I had known this sooner.
Hey Alan — thanks a ton for sharing your story / perspective. And congratulations on your success so far!
Hey Brandon — day 17 is a little early to see definitive results. I’d set a benchmark of 3-6 months. Massaging and/or dermarolling could certainly help in conjunction with the topicals — they tend to be synergistic with most topicals and through a variety of mechanisms.
Best,
Rob
Anyone experiencing curliness and stiffness of hair while doing the massages? I’ve dialed it down to 3 min every other day and my hair still feels stiff (I have good thyroid, healthy lifestyle and diet, started applying essential oils). I’m going to try to lower massaging to once per week, I do not know if that would reduce hair loss? And does anyone else experience this?
Thank you!
Congrats Rob! It’s been a pleasure reading and discussing with you. Not sure if this has been mentioned already but the galea part of the theory would also help to explain why some individuals (even non-aga males) will suffer hair loss when they suffer from high stress for some period of time.
Thanks Raxory! I appreciate the kind words.
I have a question for the more experienced users of this method. I am currently at the 8/9 month mark and the area around my crown / vertex is slowly giving in, meaning that I can go deeper into the tissue while massaging. I keep my head shaved in order to pinch/press/pull correctly and I have noticed that i can actually see the “borders” ( I mean sort of ridges that outline the typical horseshoe pattern) of the areas that are more easily pinchable versus those that are tighter. Tissue that is “outside” of those borders and closer to the sides of my scalp has become very easily pinchable and has very dense hair. Tissue that is “inside of those” borders is still tighter and has less dense hair giving the impression of diffuse thinning. After I heard my scalp crack once, the ridge on the left has become less “deep” and the tissue seems more even compared to the right. Could this mean, that my galea is slowly becoming detached from the underlying tissue layers?
Can anybody relate to this “geography” of the scalp? Maybe users like Paz, or even Rob himself?
Kind Regards, Michael
Hey Michael,
Morphological changes to the scalp are sometimes reported by readers — a few of them being newfound “smoothness” to the scalp ridges, meaning a more uniform / rounded scalp versus the typical scalp ridging you see in cases of MPB. This isn’t necessary for regrowth — as people who have and haven’t reported this, have still seen regrowth. Are the changes to the left ridge also accompanied by increased elasticity?
Best,
Rob
Hey Rob,
Thank you for your reply. Since my last post, my scalp has continued cracking several times, allowing me to go deeper into the tissue that is the center of my crown really. Interestingly enough there seems to have been a certain order of areas that gave in one after another. When I first started the massage routine i could barely pinch any of the areas advised by Rob, excluding the sides which were always easily pinchable. First, my hairline (especially on the left) started to increase in elasticity, then my ridges slowly started to give in, allowing me to do deeper and deeper towards the middle of my vertex/crown.
Then some heavy cracks occured around the hairline (again first on the left side) and the past two weeks the right side of my vertex has massively increased in elasticity after several cracks.
If I now compare the overall elasticity of my scalp with the state it was in 9 months ago, it seems like a night and days difference. As for regrowth, I am pretty sure that the hair density (especiallyaround the ridges) has periodically increased with scalp elasticity, even though my hairline is still pretty weak since I stopped minoxidil four months ago.
I tend to say that scalp cracks and increasing elasticity always occur several weeks or months before any hair regrowth is actually visible. This seems especially true for me since my regrowth always starts with weak vellus hair that thicken up over several hair cycles.
Sorry for the kind of long post but I felt like explaining my situation in detail, hopefully inspiring other users.
Best,
Michael
Hey Michael! This is all great news, and congratulations! I’m looking forward to your continued progress — please keep me posted!
Best,
Rob
Hi Rob,
My name is Andre, I purchased your $49 package today but I haven’t received anything yet. I thought I could have access to the book instantly after the payment. Please get back to me, thank you.
Hey Andre! I couldn’t find your email address in the customer list — which means the purchase likely didn’t go through, or you may have used a different email address. I’ll follow up in an email now.
Best,
Rob
Hi rob,
Does low Ferritin and have a major role in hair loss as that produces keratin which is the main ingredient that grows hair follicles ?
How does skull bone growth effect hair loss?
I have read that the immune system attacks the good cells in the body so is that true and how do you stop your immune system from doing this?
How is massaging the hair alone have to do with hairloss as I have read the journal and it doesn’t explain that relationship towards what is happening to cells inside the body?
Hey Enrique,
1. Low ferritin can sometimes be correlated with hair loss, especially in women — but we often need a full iron panel (not just ferritin) for a clearer diagnosis.
2. Skull bone growth may contribute the chronic scalp tension associated with MPB. It may also just be symptomatic — more research needs to be done here.
3. This sounds like you’re describing autoimmunity — which is pretty complicated and often begins with gut dysbiosis. Stopping it is dependent on what’s causing it for each individual.
4. Massaging can promote gene expressions / growth factors associated with the hair growth cycle, improve transcutaneous blood flow / oxygen levels, and potentially relieve scalp tension if the massaging is focused on releasing chronic muscular tension surrounding the galea aponeurotica.
Hi, is there a post from Rob anywhere on all the relevant tests that you need to do to figuring out the root cause of your hair loss?
For example checking your liver and testing its enzyme functions or your thyroid and checking TSH, T3, T4 etc.
I understand you need to test before you assume you have a hormone imbalance for example.
If there is such a post that would be most helpful, if not there should be one.
Thanks.
Hey Mark,
I don’t have a compiled list of relevant tests for determining the causes of hair loss. Unfortunately, it’s often such a localized issue that blood tests won’t give us an accurate picture. However, during Skype calls, if someone is presenting with symptoms of PCOS, SIBO, hypothyroidism, hyperparathyroidism, estrogen dominance, etc. — I will recommend specific testing since those issues can compound with / exacerbate hair thinning, and resolving them is top priority before moving onto hair loss-specific treatments. I’ll work on putting a post together!
Best,
Rob
Hey Rob,
First off thank you for all of your research and time spent. I just discovered your site this week and I am excited about the process and results you and others have seen. I started your routine this week. Im 23 years old still have quite a bit of hair but I have deffinitly seen miniaturization. I have been on minox for 1.5 years and because of the facial side effects I am looking to stop indeffiniatly. I saw positive effects from it but the progress has subsided for the most part and I am left with just the side effects.
My question is, from your experience is there a way of safely getting off minoxidil where I wont loose a lot of hair from a massive shed?
I am currently using 1ml of the foam x2 per day. The sides are dark eye circles, wrinkles on forehead and eyes and abnormal heartbeat. Thanks
Hey Zach,
Thanks for the kind words. Transitioning off minoxidil is a challenge — and the reality is that everyone seems to react differently. The expectation should always be a shed. But sometimes this can be mitigated with a slow weaning off the topical. If you’re applying the foam 14x per week (twice per day), try lowering your usage by 1x per week, so that by the end of a 14-week period, you’re off it entirely. If you begin to shed drastically at any stage, take note of it and consider holding at a slightly higher dose, or continuing forward. It’s hard to say who will / won’t undergo a shed, and who will / won’t recover from one. I certainly shed when I quit, but I was lucky enough to see a recovery down the line.
Best,
Rob
Rob,
I really admire your intellect and web site. The article on transgender individuals regaining hair matched the non-conclusive, cataloging research that I had done. I feel as though I have insight that could be helpful. Like many on your site, I have tried various and sundry ways to maintain my hair, from vitamins to minoxidil to surgery, then to Proscar but stopping to have a family and then going on Dutasteride after my children were born. Polysorbate actually seemed beneficial which was the infomercial rage in the mid-80s. Most people would say that I have a normal head of hair for a 53 year old. I can part my hair but I have some recession in the front and a bald spot that is visible depending on the light but that sometimes looks decently full. My side-patterns (fringe regions) remain intact and high. Many balding men go deep into the fringe area, so I hope that I am not complaining too much. When you start balding young, you think of yourself that way, even if hair loss stabilizes. I am still trying for more and better hair and research upon oneself is a tradition going way back.
Estrogen is not regulated in any serious way. This completely differs from testosterone for which one can serve serious time for possession without a prescription. Estrogen may grow hair but it does not make you good at sports so the powers that be largely ignore it.
Amazon sells a pretty potent estradiol/estriol blend for $19 that I have used since about 2013 when I became disappointed when it was evident that not even dutasteride was growing any hair back, as opposed to maintaining it. You can do the math but because it is a three quarters estriol/one quarter estradiol lotion, my calculations based upon the ratios and relative strengths of estriol and estradiol indicated that, roughly, one four ounce pump canister if used equally for seven days, would be equivalent to 6 to 8 mg of estradiol orally. Many transgender patients take 2 to 4 mg of estradiol orally each day, so you actually can get a big dose from transdermals.
When I could get my hands on it, I opted for Estrogel, which is pure estradiol, but which can require a prescription but mg for mg, there probably is not a lot of difference in terms of price/mgs of estradiol. Here is the Amazon version. https://www.amazon.com/gp/product/B003LYDBCG
/ref=oh_aui_detailpage_o02_s00?ie=UTF8&psc=1
I have bought it on eBay as well. Sometimes Estrogel has been available on eBay. The Indian connection for obtaining prescription drugs has gotten more difficult and Amazon has the Bi-estro to my door in two days. I wish that it were solely estradiol but it is still at my door in two days so it is hard to complain.
So, without wasting too much of your time, does the Bi-estro work to grow hair? My answer is that it is still not clear to me whether it helps regrow hair or not. I firmly believe that it does/will but I am still taking dutasteride and I believe that most people (or scientists) would say that I am losing my hair extremely slowly rather than regaining it. I started balding at 18 in 1983 but minoxidil came out soon after that so I have had help that previous generations have not. My father is 80 and has Ronald Reagan hair and my mother has impossibly good hair for an 80 year old so the genetics is complicated. Both of my siblings, one male and one female have similar struggles with hair loss to mine, not overt baldness but more generalized thinning.
So I have kept pushing the estrogen. I feel as though there has to be a connection. I had terrible dermatitis, which would erupt into sores all over my head and estrogen cleared it up. I started using estrogen on my face which was blotchy, oily and difficult to shave without bleeding and irritation and all of that has cleared up. Estrogen does great things to skin in general.
So I have insight into the side effects of topical estrogen both on the head, face and two other control areas. Honestly, in my opinion, the side effects of estrogen, if someone is not actively trying to transition to the female sex, are pretty mild. I have never had any side effects from Proscar or dutasteride and I firmly believe that neither of those drugs have significant sides for many or most people.
First of all, yes, topical estrogen goes systemic. It seems to improve hair quality, which is often overlooked by the balding population, immediately. Let’s face it. There are millions of people with full heads of hair of frizzy hair that is difficult to style or comb and that does not look good or blow in the breeze well. For people like me, a significant increase in hair quality, even if the numbers don’t increase makes a big difference. I believe that the vast majority of men could benefit from topical estrogen at low risk. You start slow and you don’t push the dosage if gyno is a big deal to you and you monitor your erections and that is about it, at least in my case.
Your penis will not shrink and unless you push the dosage, you may still get erections without trouble and if not, viagra works for people in this situation. The testicle definitely shrink but can rebound if hormones are stopped.
Yes. I have gyno which does not matter that much to me, but even to those who fear it, gyno is far, far better than the scalp and facial conditions that I had due to dermatitis. On many, if not most men, the breast tissue will not be particularly prominent because men have fairly wide chests which flattens the tissue out. This is why most transgender women who want to be passable get breast implants. Otherwise the breast growth can be managed. If I had to choose between the head of hair that I had at 17 but with gyno, then that is an easy choice for me. Sexual side-effects are reversible. Yes, if you hit the estrogen heavy, you won’t want sex for a few days but is that such a tragedy?
The topicals also tie in to the massage idea. It takes quite a few pumps and many minutes of massage to consume several mgs of estrogen lotion. Thus, in a sense, it forces scalp massage. Since I just came across your transgender article, I recommitted to the attempt with estrogen by using more and combining it with increased massage. I do think that topical administration may take larger amounts than does oral administration.
A lot of things are happening now with respect to gender. Many of us are ashamed to admit that our attachment to our past hair might be indicative of binary or non-binary transgender issues. These concepts barely existed prior to Jenner in the public eye. Thus, now one can use estrogen to attempt to get the hairline that one wants. There is no need to become female or to want to become female. In my experience, most, if not all of the effects of estrogen, even after being used together with dutasteride off and on for years, are reversible and fairly quickly reversible. Yes, the testicles rebound and fast. The breasts decrease and with weight loss decrease even more, although there is an unalterable change in some of the core breast tissue. That change is a positive to me regardless of whether I identify as male or female. When I went off estrogen, I began fighting dermatitis again.
I read a lot about depression and estrogen, and estrogen changing one’s though processes. I don’t believe that it is true, except that it clinically makes a person less aggressive but this effect is subtle, if true.
In the past, the powers that be, refused to prescribe hormones to non-binary transsexuals. You had to sign something saying that you intended to change your sex in order to receive prescribed hormones. This appears much less true now. People should do some research and speak to their doctors and evaluate the risks of therapies using flutamide or spironolactone or estrogen.
Having finally upped the topical dosage of the Bi-estro products to one seventh of the canister per seven days, I think that I am seeing effects but people also have to realize that hair regrowth is not like grass growing on a lawn. We all look at our temples for little hairs. Maybe, but what is really happening is that the longer hairs are staying put longer and shaft diameters are increasing. I feel so bad for these guys desperately looking for little vellus hairs in the mirror and complaining about sheds. Every single guy on the various hair loss forums says the same thing: “Just started Treatment X yesterday but I am worried because I am doing an immediate shed.” Sorry, it is not a shed. You are still going bald. I know that there is some basis for the notion of shedding after some period of time when using certain remedies but I am firmly convinced that a “shed” is for the vast majority of us, a simple euphemism for “damn, it isn’t working.” The companies all love pushing the “shed” idea. Keep using it. Maybe it will work later if you buy more.
So, as you have indicated in your article, we know that many transgender and non-binary transgender people using female hormones and androgen blockers experience great improvements in their hair. I am going to try adding oral estrogen, flutamide or spironolactone to the estrogen and 1 mg of dutasteride mix. It takes a lot of effort to massage the topical estrogen daily. Luckily, due to your site, I don’t mind massaging for minutes and minutes and minutes to attempt to validate the massage idea.
As an aside, I believe in Nizoral and Dutasteride and I find pretty much the rest of the male-oriented hair loss mixtures to be either ineffective or not worth the trouble. Most are costly For what it costs and having to use it everyday, I don’t believe that minoxidil is worth the trouble. I think that the piece of the puzzle that differentiates me from the transgender people that you highlighted in your article is that my testosterone levels continue high and that might be hindering break-out growth. The literature on female baldness remedies references this need to move testosterone levels down to help regrowth.
By adding something to lower testosterone, that may be the last puzzle piece. It may also be that by upping the topical estrogen to the max, more or less, that that will lower the testosterone. Even though I have decided to be/become non-binary transgender, I still worry about libido and strength so I don’t want to lower my testosterone levels more than I have to. I hope to provide some input to anyone with questions. A lot of these guys seem to think that they are going to spontaneously combust if they touch estrogen. I think that the so-called side effects of estrogen are generally mild, unless the dosage is pushed and that what side effects do occur, for many people are an improvement, such as a decrease in acne, dandruff or oily skin or less body hair or much more sensitive skin and breasts and an improvement in hair quality. The soles of my feet used to be like tough leather they were so cross-linked and rough. Now they are smooth and pliable. That is all estrogen.
I really appreciate your site and your approach and I sincerely hope (and think) that you are right about most of your contentions and I share many of them.
Yours truly,
William Loeffler
Hey William,
Thanks for taking the time to read the content on this site, and for taking the time to write out your comments. I really appreciate it.
I’m still researching whether, for most binary men, how drastic of an effect topical estrogens could have from transdermal systemic absorption. The evidence suggests that estrogen (less so serum estrogen, and more so estrogen in skin tissues) appears to be pro-hair for both genders, and is involved in the stimulation of secondary hair for men and women (even without DHT). The exception is estrogen dominance in younger men (high serum estrogen / elevated estrogen metabolites — which is linked to inflammation). The questions that remain: what’s the mechanism of action? Is it estrogen specifically, or something further downstream? And what are the risks / side effects at each potential dosage / delivery?
Since I don’t yet have answers to the above, I can’t give you a concrete opinion on using Bi-estro for the treatment of MPB in the general population of men. But your perspective helps tremendously. It seems like it’s helping you, and if you’re comfortable with its related effects, then I hope it continues to help. Please keep me updated with your progress. I look forward to hearing more!
Best,
Rob
Hi Rob,
Congratulations on publishing the paper. I read it and it is fantastic. I wanted to ask about a line in your book. You essentially state sebum production down-regulates when people stop shampooing their hair. My father has highly advanced MPB (almost slick bald), he never shampoos, and has an extremely oily scalp. I am a NW3, I shampoo daily, have an oily scalp, but not to the extremely oily level he does.
This seems a strong indication to me that ending the use of shampoo does not (necessarily) lead to lowered sebum production, at least in my family. Knowing that sebum is one of the many secondary causitive factors in MPB (I still believe, like you, that tension causing inflammation is the main cause) I would like to remove as much trapped and surface sebum as much as possible, and then remove it from the scalp.. the only way to do this, it seems, is to apply your massages then to shampoo daily and let the surfactants wash it away. I use a shampoo that contains caffeine and salicylic acid to get some additional benefit here. I know that if I did not shampoo, the level of oil on the scalp would be too much, especially with my genetics. Do you see a problem with me using shampoo and expecting regrowth? I otherwise follow everything in your book.
Thank you for your comments!
Hey Steve,
Great questions! I think I should clarify that while quitting shampoo can help normalize sebum production and improve the health of our scalp, it almost never makes the difference between regrowth / no regrowth. The second thing worth clarifying is that there’s sometimes a lengthy adjustment period when someone stops shampooing — where their scalp will overproduce sebum for a month or two until finally settling back to a normative production rate. At least that’s what I’ve found is true for myself and many other readers.
If you’re only using shampoo a few times per week, there’s likely nothing wrong with using your caffeine + salicylic acid shampoo. So feel free to keep using it!
Best,
Rob
Thanks Rob!
We should understand why these lines are happening. Then we can have a better picture of it. I have seen a lot of people with these kind of lines.
https://cdn1.thr.com/sites/default/files/2014/08/ed_harris.jpg
Do you have any idea Rob, or other folks?
Hey Mert — it’s either skull bone growth, the loss of subcutaneous fat in the layers residing over the balding regions, or both!
It’s interesting that those lines often act as the dividing point for balding scalps. Hair below the line; no hair above.
Hi Rob,
Your article is VERY interesting. I just bought the book and video bundle. I also suffer from hair loss and inflammed scalp. My scalp is tight and very close to the galea, I believe is in the way of merging.
I have 2 questions:
1. What do you think of non-balding people who has a very tight scalp but it seems that it doesn’t affect them over the years?
2. What is you opinion on taking Propecia for a couple of years while sticking to your regimen? I assume that once the scalp is loose and blood is flowing naturally, once we stop Propecia hair loss should not come back.
Keep up with the good work
Hey Matt! Thanks for your support. To answer your question — a tight scalp is just one of several factors associated with MPB. It’s likely the interplay of genetics + androgens that create a tight scalp in the first place, but even if that is the case, we still need to have a predisposition to “read” that tightness as inflammation, and then respond to that inflammation with DHT-induced transforming growth factor beta 1 — which leads to scarring. Not everyone will have that same cascade, and for some, the problem will stop at just a tight scalp. After all, we all use different toolkits to respond to inflammation.
RE: Propecia–
It all depends on your comfortability with 5-AR inhibitors, and reducing your own DHT to castration levels. Propecia is currently the best-studied and most effective drug to stop (and partially reverse) hair loss. For a small percentage of men, it causes sexual dysfunction. It also requires lifelong use, and when you stop, you lose anything you retained within 3-12 months. It’s unclear if doing the massages + Propecia for a couple years, then transitioning off Propecia, will result in the same amount of hair fall. For some men, it’s led to a significant shed. For others, not so much.
Best,
Rob
Hi Rob! Many thanks for your reply.
Could yo please share some clarification on “reducing your own DHT to castration levels” from your previous response? My research led me to the actual % of DHT inhibited by Propecia being as much as 60-70%, which is not enough to chemically castrate a person.
I believe there are 3 million users of Propecia in the US only (including famous celebrities). In fact a co-worker of mine took it for 3 years in the early 2000’s, then stopped and his hair fall has stabilized ever since (he actually looks the same to after right quitting). Of course this varies from person to person and our specific circumnstances in life, there is no doubt.
On the other hand, I have just started with the proper massages from your videos (I was doing something similar, but not identical), and after 2.5 months of 2.4 months of my improvised technique + 0.1 months of your technique my scalp feels:
ON THE POSITIVE SIDE
1. Less hot/warm
2. Much more flexible
3. Much less tight
ON THE NEGATIVE SIDE:
1. Hair fall is still very high (abnormal)
2. Hair still “hurts” (when I gently pull or move strains in different directions)
My main concern is that if I keep trying this method, perhaps in 6-8 months it would be too late to take Propecia. I’m kind at a critical breakpoint I believe.
Anyways, just wanted to share my experience and thoughts on what’s hapening to me, and (perhaps) hear some thoughts.
Thanks again, and keep up with this project
Cheers
Hey Matt,
It depends on the finasteride dosage and what exactly you’re measuring (serum DHT, tissue DHT, etc.). Here’s a study that should help clarify the comparison:
https://onlinelibrary.wiley.com/doi/abs/10.1002/jcb.240501225
RE: concerns–
I can’t legally advise you to take (or not take) any drugs. The reality is that Propecia + mechanical stimulation has been demonstrated to be synergistic (meaning in terms of hair regrowth, the sum is greater than the parts), and the majority of people don’t experience major symptoms from finasteride — at least the ones quantified in studies. But there are downsides. This article may help:
https://perfecthairhealth.com/natural-dht-blockers-vs-finasteride-they-all-cause-sexual-side-effects/
Best,
Rob
Rob, been a while since any updates. Might we be expecting some new insights/research anytime soon? I know you must be busy. Just curious what’s going on behind on the scenes. Always appreciate your hard work!
Hey Alan — I’m just exiting another busy period at my regular job, and I’m going to spend the next few months working on research / updating the site. I’m hoping to finish a new article within the coming weeks!
Hi, does anyone know specifically why its harder to restore the ‘hairline’ at the front (Temples) than it is elsewhere on the head.
Whats going on underneath specifically in that region that makes it harder to grow back?
Hey Kieran,
It’s hard to say, but it might have something to do with the tension and positioning of the temples versus the vertex.
The temples overlie the front edges of the galea, where the galea stops and connects with the scalp’s forehead muscles. The vertex overlies no end-points of the galea, and where vertex thinning starts, that thinning doesn’t directly overlie any muscles (at least at first).
Two-dimensional models show that both the temples and vertex are the highest points of tension in scalp skin. But I’ve always wondered if the temples’ proximity to its GA-connected muscles might explain why people sometimes have a harder time regrowing hair versus the vertex.
Just a thought!
Best,
Rob
Hi Rob, during your years of research did you ever come across any information, anecdotal even, that may suggest how to prevent greying? Just thought I’d ask. Thanks man.
Hey Steve — there have been a few anecdotes (and even photos), and all basically surrounding juicing diets (believe it or not!). Interesting stuff. I haven’t fully vetted the sources or the science yet, so I can’t say. This is actually something I’ve been researching for a while — and have yet to find the answers I’m looking for.
Dear Rob,
discussing the fact that the % of AGA occurence in a masculine population having same sage is approximatively equivalent to the age in this population ( e.g. 50% of mens aged of 50 years have more or less signs of AGA) :
– assuming that at 20 years olds, 80% of mens DO NOT have AGA because they have a greater capital to absorb external stressors : e.g. : mechanical skull/galea/muscle initial condition (e.g. thicker subcutaneous adipose tissues+ larger free space between skull bone and skin) + biological initial condition (e.g. Testo/Estro level + low adrenal response to stress).
– in these 80% mens, when getting older at 50years old, an additional ‘batch’ of mens will have AGA, having consumed their resistance or buffering capital as well.
— > do we know for mens aged of 70-80 years old without AGA : what specific mechanical and biological conditions are far different from others ? (this putting appart, when possible, the special life or environmental conditions that could have either protected or damaged in too much extent this capital).. ?
we all have images of a friend, lazy, heavy smoker, eating lot’s of junk food but keeping lately plenty of hair.
We also all noticed that some mens having significantly more wrinkles on the front-head (even relaxed) have no AGA, probaly sign of a big structural scalp capital (thick layers+ few tension).
we all know the low occurence of AGA in Inuit population, having a thick scalp, (of brown adipose tissue? in scalp to whistand the cold) + stocking energy and their high omega3 fat diet.
If you are aware Rob of some Epidemiology studies on scalp structure, could you share it please ?
Best Rgds,
Ginger
Hey Ginger — great question, and unfortunately, I’m unaware of any studies measuring scalp structure and tension within the galea aponeurotica, measured over time, alongside AGA onset. There are some hypotheses that the tension resides from posture / development, which then translocate to muscle development / bone development, and finally galea-related tension. This would explain why some people, no matter how unhealthy they are, don’t seem to develop AGA — and why it’s likely polygenetic.
I’m also unaware of any investigation teams even attempting to study this. I hope it gets more attention soon — since I think AGA gives us great insight into how our bodies handle chronic, localized inflammation (also explaining its link heart disease). As you mentioned, studying the 20% of 80-year olds with no AGA might be a great starting place.
Best,
Rob
Hi Rob,
I have read your study about ketosis and fasting.
But have you looked into autophagy ? and what are your thoughts around it in regards to hair loss and extended fast?
Hi Alforno,
I’m still exploring the connection between autophagy and hair loss — but I think there’s plenty of evidence to support the process as potentially necessary for hair regrowth — particularly at later stages of hair loss. Wounding / healing’s positive impact on hair growth may also, in part, be due to autophagy. Eventually I plan on writing an article about this!
Best,
Rob
Hi Rob, attempting to adhere to a non inflammatory diet in conjunction with mechanical stimulation etc. In short, so far so good. I know your preference is for room temp solid fats when cooking etc. What’s your take on cold pressed quality rapeseed? From cursory reading, it seems perhaps not the evil once purported to be. At least over this side of the pond, it’s homegrown, of good provenance, cheap etc many thanks
Hey BB,
Cold-pressed rapeseed oil is essentially just canola oil (both oils come from the same seed family, but have different percentages of euric acid). Its high polyunsaturated fat content will likely oxidize even at medium cooking temperatures, and it’s probably worth avoiding in general (although a little here or there probably won’t be the end of the world).
Best,
Rob
Hi, Rob! I’ve just sent you an email regarding my hair loss!
Hi I have a slight raised area/thick tissue on the top of my head near the suture would this technique thin that area and help hair thinning? I’m a femal with temporal thinning and diffuse thinning
Hey Kate — it all depends on each individual. On average, the data suggests the massages help most people improve their hair loss outcomes. In terms of thinning a thickened skin area — this isn’t necessarily the purpose of the massage, but some readers do report more elastic skin and a release in dandruff / sebum build-up, which can sometimes lead to a perceived change in thicker-skinned areas.
For women with FPHL — I usually recommend testing for SIBO, PCOS, etc. before undergoing any treatment regimen — since female pattern hair loss is more closely associated with these conditions and oftentimes, resolving them first is critical to success on any regimen.
Best,
Rob
Hey Rob,
I am very interested in purchasing your book. However, it is clear that you also publish so many articles based on new published research. Does your book take incorporate the new research and your expert opinion on this research? My ultimate concern is that if I invest into your book and read it, I will be reading a book that is somewhat outdated, and not taking into account the new research and your opinion which you discuss in depth within your articles. Looking forward to your thoughts.
Hi Rob,
Do you know at all why Androgenetic Alopecia causes scarring in the sense that the hair loss becomes permanent?
Thanks
Hey Roger — this is covered inside the paper and the book. It seems like the scarring is tension-mediated, and the result of chronic inflammation.
Best,
Rob
Hi Rob,
Im new here and reading your articles is inspiring, you certainly seem to have a nack for figuring difficult information out!
I was wondering if you’re able to explain then how Diffuse Unpatterned Hair Loss (DUPA) and telogen effluvium is formed based on the model you have pieced together, can these 2 hair loss be tackled with the info in your book? Or is it an entirely different mechanism thats going on all together?
I’m wondering how Diffuse thinning fits within your explanation of things.
Thanks Rob, all the best.
Hey Cedricc — for diffuse unpatterned hair loss, I’d suggest looking into testing for secondary hyperparathyroidism (do a serum test for PTH, calcium, and vitamin D levels). Anecdotally, DUPA seems be more correlated with an underlying nutrient deficiency / chronic condition that pattern hair loss. The book doesn’t cover treatments for DUPA specifically, but I’d start here.
As for diffuse thinning — when we reduce the model size of Von Mises 2d stress patterns to better emulate smaller / smoother heads, the tension points are more diffuse. It actually lines up really well for describing diffuse thinning in both women and some men! I’ll have more to share (hopefully) in the next manuscript.
All my best,
Rob
Hi Rob,
I’m about three and a half months in the massages and elasticity is increasing, however, I’m in a very stressful period in my life at the moment and this definitely affects muscle tightness.
For example after waking up or going to the gym the galea can be moved around easily (not as easy as the sides, but close), although at the end of the day, it’s usually far more stiff.
I’d be interested in finding a method to counteract that and applying heat/cold seems like a good approach.
You talked about cold showers for example in the book (as far as I remember, it’s been some time since I read it), but that it rarely if ever makes the difference between regrowth and no regrowth, it seems to have health benefits in general though (which I agree from personal experience, especially avoiding hot tubs etc. ).
Now what do you think about applying heat/ cold for a long period of time (20-30mins) to the scalp muscles specifically? As far as I know from reading articles online, heat seems to be the better choice for chronic tension.
I’d be interested in your (and other readers) thoughts/opinion on that.
Best,
Tim
Hey Tim — it’s certainly worth testing. I’ve noticed that during workouts / yoga classes / after showers, my scalp feels incredibly loose — only for that elasticity to tense in a time-dependent manner following those periods. It must have to do with hydration, vasodilation / constriction, and maybe changes to periphery temperatures.
If the heat is applied to the muscles connected to the galea aponeurotica (which surround the entire perimeter of the top of the scalp) — and even the neck — I think there’s potential for muscle relaxation (as you said). Let me know how this goes! I’m curious to hear your findings.
Hi Rob – I’ve been doing the massage technique for about 5 months having red the book. It definitely feels as though my scalp has improved though my hair does not seem to as of yet.
I have been taking minoxidil and finasteride for about 13 years and my hair has become rather diffuse.
Of the photos I have seen as yourself and others any hair loss that has been cured seems to have been very mild. Do you have experience with the massage technique improving hair for people with more extreme hair loss/bald patches?
Thanks
Hey Oliver!
The survey data we have on massaging suggests that the massages improve hair loss outcomes in a time-dependent manner, and that results don’t change depending on age or AGA severity. However, it’s worth noting that while people who are NW5 have still reported significant effects, it goes without saying that recovering 5,000 hairs at NW5 might just move you to an NW4, whereas the same increase in hair count at NW2 might make your hair loss essentially unnoticeable. We have seen cases where people at NW5+ recover significant amounts of hair — but the time tables are typically longer. There’s one case photo on the site where someone massaged for 3 years to see an estimated 40% recovery of hair at the vertex.
Hair recovery from mechanical stimulation tends to be synergistic with finasteride / minoxidil — particularly dermarolling. So if you’re having no issues with either drug, I’d recommend adding in dermarolling once weekly to the routine!
Best,
Rob
I learn a lot with you. But there are things that do not completely fit me. Sorry for my English.
DHT
The function of DHT is simply to create the secondary masculine traits.
In the same way that DHT binds to receptors to signal the body to generate beard, remove fat from the belly or make the voice deeper, it could also intentionally weaken the follicles on the top of the head. Maybe it’s an ancestral genetic mutation.
Inflammation
If the theory of inflammation is correct, take a cocktail of powerful oral and topical anti-inflammatories (for example aspirin inhibits COX-2), in addition to antioxidants, should stop the baldness, but this doesn’t happen.
Scalp masage
It’s possible that massages simply stimulate growth signals locally and, because of this, the body strives to remove calcification and fibrosis by itself.
Aging
People while young have higher levels of signals that protect their follicles from deterioration (growth factors, pineal hormones, endogenous antioxidants, etc.). These could even protect them from their sensitivity to DHT until a certain age.
Hey Rob,
what do you think of this article https://www.hairgrowthsos.com/detumescence-therapy.html.
Its from Paul Taylor, does he have a point? Its about the flaws in choys study and the Detumescence therapy which you might find interesting.
Hey John,
It’s a GREAT article. For the record: I’m a fan of Paul Taylor. I also cited his paper in my hypothetical pathogenesis model.
Choy’s study certainly has problems. For one, I’ve tried several times to contact Choy without success. This is unusual — as true academics are almost always thrilled to discuss their research (I’ve always replied to other investigators contacting me about my paper). There are also issues in how Choy characterizes the scientific understanding of AGA pathology — as Paul Taylor mentioned in his article. So far, Choy’s study results have 1) far exceeded anything we’ve seen from any other hair loss treatment, and 2) have yet to be successfully repeated in the short 10-month time window he cites (while we’ve seen significant AGA recoveries from massaging alone, we’ve yet to see someone go from NW7 to a NW0 in ten months — which is what Choy states). Finally, the journal he published in — Omnisci — is renowned as a predatory journal (they’ve been known to do a pay-to-publish model, ostensibly skipping peer-review — for payment — for papers that would otherwise not pass it).
When I saw success from massaging throughout a 10-month time period (back in 2013), I believed Choy’s study results — since I’d seen a near-full AGA recovery in that window. However, I also wasn’t as far along in the balding process as other individuals. As I’ve continued to research and write about AGA — and as I’ve published in peer-reviewed journals (and been selected as a peer reviewer for other AGA manuscripts / studies) — I’ve come to accept that, more likely than not, we shouldn’t believe the results of Choy’s study.
But, to be absolutely clear: this is NOT to say that mechanical stimulation-based therapies like microneedling or massaging don’t work. These therapies DO work — and for the majority of people. Interestingly, the survey data we have on past readers suggests they probably work through different mechanisms than the ones outlined in Choy’s study. This is all discussed in greater details in my upcoming manuscript — which I’m hoping will be ready for sharing in the next couple months. So don’t let this derail any massage efforts. The data we have suggests that what is outlined in the book is working — and in a time-dependent manner (the results typically continue to improve as cumulative massage time increases).
Best,
Rob
Hi Rob and John.
Thanks for sharing that article, Paul Taylor is correct in everything he said. And Paul taylor also published his work on scalp expansion and the success of scalp mechanical stimulation way before the Choy study in 2012.
Its sometimes hard to believe that Paul came up with this theory back in 2007 I believe.
The Choy study should be pushed into the shadows, I dont believe the author has returned for an follow up work either. And personal experience and reading peoples feedback and progress on this site, proves that 10 months is not near enough time to see full results, again dependent on the status of balding.
And why has nobody who saw success in this study come out since 2012 ?
far too many holes.
Regards
Hey Rob,
I have been doing scalp pinching for a few months a year ago and it didnt do anything for me.My scalp is very thight so i cant pinch it very good.Recently i decided i will be doing scalp pressing using a wooden meat mallet.I press it on my scalp and do circular moves to loosen my scalp.It is really painfull because the mallet goes a lot deeper than my fingers can.When i press the mallet to my scalp it leaves ”holes ” on the scalp which return to normal after 10 minutes or so,its like there is clay under my scalp that takes any shape.(probably fibrosis).These holes dont happen on my non thinning areas.I can see these effects because i shave my head and i can see the scalp.My scalp stays red for a day after doing that.Do you think this is a good idea?Will it have the same effect as pinching with fingers?I feel like this is doing a lot more than using fingers.The mallet goes really deep in the scalp to the point of pain without penetrating the skin.I think this way it reaches scalp fibrosis and calcification better.There is a lot of dandruff left on my scalp after i use it.The wooden mallet i am using is usually sharper and with longer edges than the most metal ones.I have 2 kinds and the wooden one is going deeper into the scalp.I use the metal one which doesnt go as deep when my scalp is too sore for the wooden one.What do you think?(Excuse my english its not my first language.)
Hi Petar ,
It seems what you are doing may result in Injury . Please be careful.
Have you seen the massages in Robs Book ?
I strongly suggest that you follow the techniques in the Book. According to the right pressure ect.
However if you decide to continue with this mallet, then please do it to a pressure that wont hurt.
Personally I believe knuckles are better, and your scalp skin will get more elastic and easier to massage with time.
For best results you will need to do all three, and give them adequate time and recovery.
Hopefully Rob can give you a good answer.
Kind regards
Hey Petar,
It’s hard to say if using a wooden meat mallet in lieu of your hands for standardized scalp presses is a good idea. I’d recommend sticking to the recommendations in the book and video — since the data we have suggests that on average, that’s working for most people. Otherwise, I don’t have enough anecdotal data from readers to provide any insights on the wooden mallet.
Best,
Rob
Hi, Rob I’ve had some good success with this technique combined with weekly derma rolling and Nizoral. Now I also have a question since I can only find people experiencing this through anecdotal comments, after awhile into the massages I start hearing this odd crunching sound within my scalp. I’ve been unable to find any information about this and I’m highly curious what this is. My main assumption is that it’s fibrotic tissue being broken up. It fully goes away after some time massaging but comes back slowly. I’ve currently been using this as a way to gauge how long I should massage.
Hey John,
Thanks for reaching out. It’s a great question, and one that’s not always the easiest to answer. I think the evidence tends to suggest that the crunches we sometimes hear from massaging are more likely edema (swelling), and less likely the breaking up of fibrotic tissue. This is mainly because morphologically, fibrotic tissue doesn’t typically detach from healthy tissues and produce noise when manipulated. Rather, it’s the acute inflammation from the massages that promotes anagen-associated growth factors which then help attenuate / metabolize part of that fibrotic tissue as the skin remodels.
If the noise bothers you, you can certainly reduce your massage intensity, or take a few days off to see if anything improves. Otherwise, keep it up, and congrats on your progress so far! Have you been taking any photos?
Best,
Rob
Yes I’ve been taking pictures, I’ve been uploading them to an Imgur album, these were posted a month ago which is relevant for non-dated timestamps.
Overall – https://imgur.com/a/sbORLf9
Hairline – https://imgur.com/a/AARrnqD
Crown – https://imgur.com/a/2bEfC1g
Current Regime:
Derma Roller 1.5mm – weekly
Nizoral – weekly
Zinc Pyrithione – daily
Scalp Massage – daily (I try to aim for 5 minutes daily)
Scalp Exercise – whenever I remember to do it, based on Tom Hagerty
Fish Oil
The noise doesn’t bother me at all, I was just using it as a measure for how long to massage. Would you have any objective recommendations for the massages aside from an arbitrary number? I found massaging till the crunches stopped much easier than massage for X minutes.
One other objective recommendation — outside of the recommended minutes per session — is based around shedding rates (which vary depending on someone’s hair density, AGA progression, and massage technique/duration). For people who experience lots of shedding during the massages — to the point of visible hair loss after 1+ months of massaging — I recommend that those individuals taper their massage intensity so that by the end of a session, they shed no more than 10-15 hairs.
If that means the session only lasts 5 minutes, then that’s okay. But in these cases, the end-goal is to make it the 20 full minutes while shedding only 10-15 hairs. Again, this is just for individuals with lots of shedding that they can’t seem to get under control. If this isn’t your case, and you find benefit by massaging just until the crunches stop, then keep riding that wave until progress stops. At that point, please reach out and we can troubleshoot!
Best,
Rob
Hi John
Your not alone In hearing the noise.
It’s a common query from many people who have done the massages. And we also believe it’s to do with fibrosis tissue, or some of us do . But We definitely need a solid answer.
However the Symptom I’ve noticed is pliable scalp skin, which is good.
Regards
Hi Rob,
I bought you eBook and I wanna thank you because your method is working well for my boyfriend but I have a question: does it work also for women? I’m struggling with female pattern baldness and I would like to try it. Thank you.
Hi Rob,
I am incredibly enthusiastic with your studies and your commitment to reverse Hair Loss. It has completely changed my perception of hairloss and motivation to do something about it. I have been doing Tom Hagerty´s exercises for 14 months and the massages for 6 weeks now. With TH exercises, I was able to reduce hairloss significantly and even get a little regrowth visible on my temples. With the massages, it is too early to say if it is leading to any progress but I continue to see new terminal hair popping at my temples. I have a few questions that I haven´t been able to find the answer to:
1. If calcification could be partly due to pinching blood vessels, are the massages promoting calcification?
2. When I went hard with the massages, my scalp dried up (used to be very greasy), isn´t that bad for subcutaneous fat and hence bad for hair follicles?
3. In the paper, you mention a that once there is a dettachment of the APM from a hair follicle, hair loss may be permanent. Is there a rule of thumb to know how much of my hair follicles are dettached vs NW scale? It is clear that you can not have full regrowth if some follicles can not be reactivated.
4. You have mentioned several surveys with results and degree of progress, between people implementing the massages. Would it be possible for you to share the data?
Many thanks
Hey Rob, could I get you on a brief Skype call? I bought your ebook and have had mixed results. I just want to chat about my experience and ask a couple of questions.
I’ve been studying androgenic alopecia (AA) on the side while finishing a graduate degree in health informatics. One thing I can say regarding the variability in success with finasteride is that it is likely due to another factor that’s not often discussed in AA research. Cytochrome p-450 3A4 which is a major metabolic enzyme found in the liver, is also found in the skin. This 3A4 enzyme is responsible for metabolizing many compounds including testosterone. So, inhibition of 5a-reductase with finasteride or dutasteride is just one possible source of DHT. Perhaps, and this is just hypothesis, the inhibition of 5a-reductase works for some people because they may have a genetic variant that expresses less CYP3A4 in skin and/or liver, or are unknowingly taking other concomitant medications/natural health products that inhibit the 3A4 enzyme. Being on finasteride plus a 3A4 inhibitor could produce double-inhibition of DHT.
There are a ton of drugs and natural health products that can be used to inhibit CYP3A4 and have been known by pharmacists for years to be the biggest offenders of drug-drug interactions. So I wouldn’t encourage people to go out and seek these products as it can cause many complications if you are on these inhibitors and subsequently require immediate medical treatment.
Interestingly, some alternative AA treatments are also CYP3A4 inhibitors like ketoconazole and valproic acid.