Brotzu Lotion For Hair Loss? Maybe, Maybe Not. (See Photos)

Rob Treatments 67 Comments

In 2016, an Italian surgeon made hair loss headlines after announcing the accidental discovery of a topical formula that showed promise in slowing, stopping, and even reversing hair loss. Its name? Brotzu Lotion — titled after the creator himself: then-81-year old Giovanni Brotzu.

What happened next is what always happens: hair loss forums went wild.

Hair loss sufferers began researching the ingredients in Brotzu Lotion’s patent. They organized group buys to source, compound, and self-distribute crude versions of the lotion ahead of Brotzu’s expected 2018 release.

Some hair loss sufferers even contacted Dr. Brotzu himself — who, in correspondence, suggested that the lotion could turn back the balding clock by 5 years… and that there are no reported side effects.

Nearly two years later, where do we stand?

Since then, excitement for Brotzu Lotion has fizzled, returned, died, and just recently… exploded. The question is: will Brotzu Lotion — set for a 2018 release in Europe — actually live up to the hype?

I’m cautiously optimistic, with caveats. Emphasis on caution and caveats. This article explains why.

We’ll uncover the science behind Brotzu Lotion — its ingredients, mechanisms of action, and 120-day study results. Then we’ll dive into Brotzu’s before-after hair regrowth photos — along with some photos people claim are from Brotzu Lotion, but really aren’t.

Finally, we’ll reveal which kinds of hair loss the lotion may help — pattern hair loss (androgenic alopecia) or autoimmune-related hair loss (alopecia areata and alopecia universalis) — and if you’re planning on trying Brotzu Lotion, where to set your hair regrowth expectations.

Brotzu Lotion: A Hair Loss Breakthrough… Or All Hype?

Brotzu Lotion is a topically-applied hair loss lotion expected to arrive in Europe in late-2018.

At first glance, this is no big deal. After all, there are dozens of lotions used to combat hair loss — from FDA-approved drugs like minoxidil (Rogaine) to less conventional topicals like emu oil, rosemary oil, or even topical finasteride (Propecia). So what makes Brotzu Lotion worth any attention?

Three things.

Firstly, its inventor claims that for most users, Brotzu should reverse balding by five years within 18 months of use. That’s a huge claim in the hair loss world — one not even Propecia makes.

Secondly, a few great before-after hair regrowth photos are already circulating online — spurring excitement for many hair loss sufferers.

Thirdly, its ingredients and the way the lotion works (its mechanisms of action) are novel — meaning we’ve yet to see a topical target hair loss this way before (at least one that’s made it to market).

Let’s take these one-by-one.

Who Is Giovanni Brotzu — The Inventor Of Brotzu Lotion?

Whenever we hear of a new hair loss treatment, we should look at the person behind the discovery. Are they reputable? Are they operating under a pseudonym? Are they actually just a marketer? Or are they a scientist, working alongside a research team, with published literature to back up their claims?

Oftentimes, this all we need to determine if a new hair loss “breakthrough” is all-hype or the real deal. And encouragingly, in this case, Brotzu Lotion’s inventor (Giovanni Brotzu) is no quack.

Dr. Brotzu is a retired vascular surgeon. He’s the holder of several provisional patents for surgical implants, and his late father — a pharmacologist — was once a candidate for the Nobel Prize.

So how does one go from vascular surgeon to hair loss lotion creator? According to Brotzu, by accident.

Dr. Brotzu’s team was trialing a drug to treat a complication of diabetes: vascular insufficiency in the legs (which can lead to limb loss). When they saw the drug improved vascularity and hair growth on subjects’ legs, they reformulated it into a topical — and tested it on a nurse with hair loss on her scalp.

The results were impressive enough for Dr. Brotzu to pilot more case studies and then create a patent around the formula… which grabbed the attention of the Fidia Pharma Group — a pharmaceutical company. That’s when Brotzu Lotion picked up attention on hair loss forums… and when people started asking for photo evidence.

They didn’t have to wait long. Within the year, photos started circulating — along with study results.

Brotzu Lotion — Early Results (Hair Regrowth Photos)

So far, Brotzu Lotion has been studied on two types of hair loss: autoimmune hair loss (like alopecia areata and alopecia universalis) and pattern hair loss (also known as androgenic alopecia).

Results: Brotzu Lotion For Autoimmune Hair Loss (Case Studies)

Initial case studies (i.e., single-person tests) with Brotzu Lotion show promise for an autoimmune condition called alopecia areatea. This is when a person loses hair, usually in patches, anywhere on the scalp (the sides, tops, and backs of the head — and even the eyebrows). In advanced stages, this leads to hair loss everywhere on the body (alopecia universalis).

In a 2016 presentation, Dr. Brotzu showcased Brotzu Lotion’s one-year hair regrowth results for a female child suffering from alopecia universalis. Here are her before-after photos:

That’s significant hair recovery — and for those with alopecia areata / universalis — incredible results.

Encouragingly, Dr. Brotzu’s patent cites more case studies (but no photos) and claims improvement for pretty much all of his subjects with autoimmune-related hair loss. In fact, he even presented more before-after photos of autoimmune hair loss subjects (here’s the link  — start at 10:30) at another conference. The takeaway? Similar results. See this screenshot:

Another near-full recovery from alopecia areata — and in 16 months.

What’s yet-to-be determined: how much hair regrowth alopecia areata / universalis sufferers can expect. So far, it looks like full recoveries are within the realm of possibilities.

But is the same true for pattern hair loss — a much more common type of hair loss? Can androgenic alopecia sufferers expect similar recoveries — or even to shave five years off the “balding clock”?

Unfortunately — at least so far — the data suggests probably not.

Brotzu Lotion For Pattern Hair Loss (A Clinical Study)

In April 2018, Dr. Brotzu presented preliminary study results of Brotzu Lotion for pattern hair loss.

As with any study, its design matters. So here’s a quick overview of the study design…

  • Subjects: 30 males, 30 females — all with androgenic alopecia
  • Treatment: 1mg of Brotzu Lotion, applied daily in balding regions
  • Duration: six months — with follow-ups at months 0, 1, 3, and 6

…And here’s what the team measured at each follow-up session:

  1. Scalp exam — to check for skin quality changes (i.e., side effects)
  2. Hair diameter — a surrogate for hair thickness
  3. Photographic analysis — to measure the total number of hairs, the percent of anagen hairs (hairs in their growth phase), and the percent of telogen hairs (hairs in their resting phase)

(Note: the investigators also measured hair fall during wash tests and tug tests. But for androgenic alopecia — these metrics are basically useless, so we won’t cover them).

Brotzu Lotion’s Six-Month Results For Androgenic Alopecia (And Photos)

After six months, here were the study’s findings:

  • Scalp exam — no changes (no side effects)
  • Hair diameter — no significant changes
  • Photographic analysis — an increase in anagen hairs (growth phase), a decrease in telogen hairs (resting phase), and no mention of the overall change in hair count

The two major takeaways are that 1) hair thickness did not change, and 2) while the ratio of hairs in the growth vs. resting phase improved, we still don’t know about the overall change in hair count (unless I missed it somewhere — which is possible, since the presentation was in Italian).

So how do these results translate into photographs?

Here are two subjects Dr. Brotzu highlighted in his presentation. First, a before-after photo of a male:

Next, a before-after photo of a female:

The takeaways? Very little regrowth for the male, and maybe slightly more regrowth for the female — though it’s hard to say. It seems like the female got her roots colored between photos, and in the “after” photo, her dyed blonde hair may just blend better into the scalp skin.

What Should We Make Of Brotzu’s Results For Pattern Hair Loss?

I’m not impressed, but I’m also not surprised.

When it comes to pattern hair loss, it’s hard to find a good treatment. In fact, most topicals / supplements on-the-market for androgenic alopecia (pattern hair loss) are either completely ineffective, or only demonstrate hair regrowth on paper (in a study) — with any marginal changes in hair count rarely translating to photos.

Long-story short: the above results are, sadly, ones we’ve come to expect for pattern hair loss.

But how is that possible? After all, people suffering from autoimmune-related hair loss showed major hair recoveries using Brotzu Lotion. Why aren’t we seeing the same results for pattern hair loss?

Well, autoimmune hair loss is not pattern hair loss. They’re entirely different conditions. And unfortunately, hair loss forums confuse the two all the time.

Autoimmune Hair Loss Is Not Pattern Hair Loss

Autoimmune hair loss presents as patchy hair loss anywhere on the scalp. Pattern hair loss presents as a receding hairline, a bald spot, or general “diffuse” thinning above the sides of the scalp.

Autoimmune hair loss is when the body confuses its own hair follicles as foreign invaders. Pattern hair loss is the result of an interplay between genetics, hormones, and skin remodeling (fibrosis).

Autoimmune hair loss accounts for less than 5% of hair loss cases. But pattern hair loss? 95% of cases.

While both conditions are linked to inflammation, but only pattern hair loss leads to scarring. And while both conditions result in hair loss, their pathologies — and thereby treatments — vary wildly.

The bottom line: we should never assume treatments for alopecia areata will translate to androgenic alopecia (pattern hair loss). It’s making an apples-to-oranges comparison.

So… Should We Dismiss Brotzu Lotion For Pattern Hair Loss Entirely? No

Firstly, we need to keep in mind that hair loss treatments take a long time to work.

For reference, studies show that finasteride (Propecia) takes two years before reaching full efficacy. Minoxidil (Rogaine) takes 6-12 months. And Dr. Brotzu himself said that the lotion needs 18 months for the full effect.

Brotzu Lotion’s study was only six months long. Maybe a six-month study wasn’t long enough to see significant results. We won’t know until Fidia Pharma releases more data.

Secondly, the Brotzu family continues to release more androgenic alopecia before-after photos… and some of these photos do show significant hair recovery.

In fact, following backlash in one hair loss forum, Dr. Brotzu’s son registered a username (and chimed in) to defend his father’s lotion — and with a new case study. His response, translated: “Statistics are used in medical congresses, photos are used in advertising.”

He then shared photos of a better responder — a male using Brotzu Lotion for two months

…and to me, these results are significant, and worth sharing. Which makes me wonder why Dr. Brotzu didn’t share more photos like this during his presentation.

Brotzu Lotion: Key Takeaways From Study Results (So Far)

In any case, we have enough information to draw a few conclusions:

  1. Brotzu Lotion, on average, may work well for autoimmune-related hair loss
  2. Brotzu Lotion, on average, may only marginally improve pattern hair loss in six months
  3. Brotzu Lotion, for a small percentage of pattern hair loss sufferers, may work amazingly

And while I have reservations about Brotzu Lotion reversing our baldness “clock” by five years, I also find the lotion’s mechanisms of action to be novel, fascinating, and a step in the right direction for hair loss treatments.

In fact, the way the lotion works is almost like minoxidil (Rogaine) meets a topical finasteride (Propecia) — but through different mechanisms, and without the side effects (so far).

And to understand how, we need to understand Brotzu Lotion’s ingredients. [Note: the following section gets a bit technical, and if you’re not interested, there’s a summary of everything at the bottom of this article.]

Brotzu Lotion’s Ingredients

According to its patent, Brotzu Lotion primarily consists of three ingredients:

  • Propionyl-L-Carnitine — an amino acid (protein)
  • S-Equol — a non-steroidal estrogen derived from soy
  • Dihomo-Gamma-Linoleic Acid (DGLA) — an omega six fatty acid

This is already a bit of a mouthful. So let’s break down each ingredient, rationalize why they’re included, and explain how all of them — when combined — may be synergistic for our hair.

How Brotzu Lotion’s Ingredients May Help Regrow Hair

Ingredient #1: Propionyl-L-Carnitine

When it comes to any hair loss topical — whether it’s minoxidil (Rogaine) or rosemary essential oilpenetration and metabolism of the “active ingredients” are key to a topical’s success.

For instance, if a hair loss topical ingredient helps regrow hair, but its ingredients can’t penetrate the top layer of our scalp skin, it’s useless. It won’t reach all the way down to our hair follicle dermal papilla cells — the place the ingredients must reach in order for the lotion to work.

And if that same ingredient penetrates our scalp skin, but it can’t be metabolized (absorbed) by our hair follicle cells, then it’s still useless. We need our scalp tissues to absorb (and use) those ingredients. Otherwise, they’ll just sit there indefinitely.

In the topical world, there’s a name for substances that help with penetration and/or metabolism: carriers. For example, minoxidil’s carrier (among many) is a substance known as propylene glycol. It helps minoxidil penetrate and absorb into the skin, which is why manufacturers add it to minoxidil to manufacture Rogaine.

Brotzu Lotion’s equivalent to a “carrier” is an ingredient called propionyl-l-carnitine.

Propionyl-l-carnitine is a protein. It’s also a derivative of l-carnitine. It’s associated with antioxidant activity  and, importantly, the improved transportation of fatty acids to cells…

…which is exactly why it’s used in Dr. Brotzu’s formula. Propionyl-l-carnitine increases the metabolism of a certain fatty acid ingredient (keep reading), and it also improves the metabolism of its two main ingredients.

So what are Brotzu Lotions main ingredients? A plant-derived compound that helps reduce DHT, and a fat-derived substance that improves blood flow: S-equol and dihomo-gamma-linoleic acid (DGLA).

Ingredient #2: S-Equol

S-equol is a compound derived from soy. It’s part of a class of chemicals called isoflavones. Specifically, it’s a phytochemical (a chemical from a plant). Even more specifically, it’s a phytoestrogen — a plant estrogen that looks structurally like human estrogen, but when we ingest it, it has a much weaker effect.

How Might S-Equol Improve Hair Growth? It Decreases Androgen Activity (DHT)

Research suggests that S-equol may help reduce a hormone known as dihydrotestosterone, or DHT.

Dihydrotestosterone (or DHT) is a hormone made from testosterone. It’s also suspected to play a major role in pattern hair loss. Why? Because 1) DHT is elevated in balding scalp tissues, and 2) men who can’t produce DHT (due to castration or a genetic deficiency) never go bald.

As a result, many hair loss treatments target to reduce scalp tissue DHT. And while DHT certainly isn’t the only factor in AGA, the evidence is clear: if we reduce DHT to castration levels (for example, with dutasteride), we can usually stop pattern hair loss progression for most men.

S-equol is one compound that may help reduce DHT levels, and thereby help fight hair loss.

One study showed that men supplementing with soy isoflavones showed increased serum equol and decreased serum DHT. If the same relationship holds true for a lotion with s-equol and scalp tissue DHT, then s-equol might help lower scalp DHT, and make for a great ingredient in a hair loss-fighting topical.

In fact, one hair loss sufferer active on some hair loss forums claims to show photographic improvements from combining mechanical stimulation (PDO needle threads) and his own homemade equol topical. See these photos (they’re often confused as before-after photos for Brotzu Lotion, but they aren’t):

(source)

Going into the science behind how S-equol reduces DHT is out-of-scope for this article. If you’d like a more in-depth analysis, feel free check out part one of this Master Guide For Reducing DHT. It covers the science behind S-equol, and every major “angle of attack” for reducing DHT for the purpose of improving hair loss.

We can think of topical S-equol like a topical finasteride (Propecia). While S-equol and finasteride work through different mechanisms, they both help reduce DHT levels.

According to Dr. Brotzu, S-equol makes Brotzu Lotion 80% more effective — likely due to its synergies with the lotion’s final (and critical) ingredient: a fatty acid known as dihomo-gamma-linoleic acid (DGLA).

Ingredient #3: Dihomo-Gamma-Linoleic Acid (DGLA)

DGLA is a type of polyunsaturated fat, and specifically, an omega six fatty acid.

Omega six fatty acids have a bad reputation in certain hair loss circles (like Ray Peat). For years, I wrote off most omega six fatty acids as “generally problematic”. But a reevaluation of the literature suggests that certain omega six fatty acids may be beneficial not only for our health, but also for our hair.

DGLA may be one of the good guys. There’s an overwhelming amount of evidence supporting its benefits.

For starters, people who are DGLA-deficient tend to develop significantly more inflammatory-based conditions — like diabetes, atopic dermatitis, rheumatoid arthritis, cancer and cardiovascular disease.

This is probably because DGLA tends to exert broad anti-inflammatory effects. It also helps slow cell growth, and some researchers even think DGLA could enhance the effectiveness of certain cancer treatments.

…But How Might DGLA Improve Hair Growth?

Interestingly, DGLA’s anti-inflammatory, anti-tumor benefits are attributed less so to the fatty acid itself… and more so to what DGLA turns into inside our bodies: something called prostaglandins

…and interestingly, prostaglandins and hair loss are closely connected.

The Prostaglandin-DGLA-Hair Loss Connection

Prostaglandins are substances our bodies make from polyunsaturated fats (omega 3’s and 6’s). They help our tissues recover from injuries and infections. And there are so many prostaglandins (prostaglandin D2 (PGD2), prostaglandin E1 (PGE1), prostaglandin F3 (PGF3), etc.) that scientists need a lettering-numbering system built around their molecular structures to keep track of them all.

In general, different prostaglandins exert different effects. Some prostaglandins are pro-inflammatory; others are anti-inflammatory; others are both.

And interestingly, certain prostaglandins linked to chronic inflammation are also linked to pattern hair loss. Here’s how.

The “Bad” Prostaglandin: Prostaglandin D2 (PGD2)

Prostaglandin D2 (PGD2) is a pro-inflammatory prostaglandin, and studies show that PGD2 is chronically elevated in balding scalps. For unknown reasons, PGD2 seems to stop hair follicle stem cells from becoming progenitor cells — a critical step in hair follicle development (and the hair cycle). The end-result: a decrease in hair lengthening in mice and humans — or in other words — hair shortening.

This is typically one of the first signs of pattern hair loss: slower-growing hair. And once that hair disappears and fibrosis (scar tissue) sets in, it becomes a lot harder to regrow. This is why PGD2-reducing drugs like Setitpiprant are currently undergoing hair loss trials for FDA-approval. The hope: if we can reduce the presence of this “bad” prostaglandin, maybe we can regrow some of the hair that was lost.

But interestingly, not all prostaglandins are bad. In fact, some prostaglandins are considered “pro-hair” — mainly because of their anti-inflammatory properties. And just how researchers are developing drugs to decrease the “bad” PGD2, they’re also developing drugs to increase the “good” prostaglandins.

Enter prostaglandin E1 (PGE1): a prostaglandin that reduces inflammation, expresses near healthy hair follicle sites, and is also the current target (and attention) of a few pharmaceutical companies trying to create a new hair loss treatment… including Brotzu.

The “Good” Prostaglandin: Prostaglandin E1 (PGE1)

That fatty acid in Brotzu’s formula — DGLA — is a precursor to PGE1. In other words, DGLA is what our bodies use to make PGE1. The more DGLA, the more PGE1, the better our chances for healthier hair.

DGLA Increases PGE1, Which May Improve Our Hair

According to Dr. Brotzu’s patent, prostaglandin (PGE1) may help our hair in three ways:

  1. PGE1 decreases DHT — it inhibits the enzymes that convert free testosterone into DHT
  2. PGE1 is a vasodilator — it increases blood flow
  3. PGE1 increases angiogenesis — it encourages the formation of new blood vessels

In fact, Dr. Brotzu argues that PGE1 may improve microcirculation better than minoxidil (Rogaine). In this interview, he states that PGE1 stimulates not just one — but both — types of cells that interact to form our blood vessels: endothelial cells (the inner lining of our vessel walls), and pericytes (the smooth muscle “surface” of our blood cells). According to Dr. Brotzu, minoxidil (Rogaine) only affect pericyte cells — making it less effective.

Should We Try To Make Our Own Brotzu Lotion? No.

Brotzu Lotion isn’t yet slated for a US release, and as a result, some hair loss sufferers are trying to organize group buys to make the topical at home.

But while Dr. Brotzu’s patent theoretically gives you everything needed to make the Brotzu Lotion, there’s still a lot that can go wrong with the DIY approach.

Here are the two biggest problems.

Problem #1: DGLA Isn’t Widely Available

DGLA is only found in trace amounts in mammals. It also isn’t commercially available in the US (to my knowledge). That means that you can’t buy it. You can, however, buy gamma-linoleic acid (GLA). And GLA is the precursor to DGLA.

GLA is abundant in plants, human breastmilk, and herbs like borage (and thereby borage oil). And humans seem to convert GLA into DGLA in a dose-dependent manner — meaning that if we eat more GLA, we’ll make more DGLA, and theoretically, we’ll make more PGE1.

You might be thinking, “If GLA turns into DGLA, and DGLA turns into PGE1 — then what difference does it make? Why can’t I just buy GLA to increase my PGE1 levels?”

Well, inside our bodies, DGLA can turn into one of two things: arachidonic acid, or prostaglandin E1. See this chart below — which represents the different metabolic pathways polyunsaturated fats take in our bodies.

As you can see, what happens to a polyunsaturated fat depends on its molecular structure (omega 3, omega 6, etc.) — and the source of the polyunsaturated fat (i.e., if it’s plant-derived, shellfish-derived).

What’s relevant below: the orange boxes (and their flowcharts).

(source)

Keep in mind: Dr. Brotzu’s lotion is formulated to encourage the conversion of DGLA into PGE1. But if we blindly supplement with GLA — hoping it will all convert into DGLA — this may not always happen.

In fact, some percentage of GLA will become something called arachidonic acid — which is the precursor to the “bad” prostaglandin PGD2.

In other words, taking DGLA blindly or without the right adjuncts may increase both PGE1 and PGD2, which may have a neutral or negative overall effect on our hair.

Interestingly, among human populations, the following factors of GLA consumption vary wildly:

  1. Our ability to convert GLA into DGLA
  2. The percent of DGLA we convert into PGE1
  3. The percent of DGLA we convert into arachidonic acid

…and to make matters more confusing, those percentages also change depending on which part of the body we’re studying!

Researchers believe that the above is mostly determined by our genes — and specifically, our expression of genes that help produce the enzymes required to convert GLA into DGLA, and DGLA into all of its byproducts.

Interestingly, this may also be the reason why a small percentage of Brotzu Lotion testers are seeing amazing results — and in just a couple of months. They may have the genes needed to better metabolize the topical — which might explain why their hair regrowth is dramatically better than most other users.

Problem #2: Stability

The ratios of Brotzu Lotion’s ingredients matter, and anecdotes from both Dr. Brotzu and hair loss forum “group buys” suggest that it’s very hard to keep the formula stable.

In fact, some speculate this could be why it’s taking longer than expected for Pharma Fidia to release Brotzu Lotion in Europe. It seems like every few months — the latest expected release date passes.

Brotzu Lotion For Hair Loss: Key Takeaways

Brotzu Lotion contains S-equol, DGLA, and propionyl-l-carnitine. Together and in the right ratios…

  • S-equol helps reduce free testosterone (and thereby DHT)
  • DGLA turns into PGE1, which helps increase blood flow and reduce DHT
  • Propionyl-l-carnitine enhances the penetration and metabolism of both S-equol and DGLA

In a way, we can think of Brotzu Lotion like a safer topical finasteride + minoxidil. After all, finasteride (Propecia) reduces DHT. Minoxidil (Rogaine) increases blood flow and may increase PGE. And Brotzu Lotion? It decreases DHT, improves blood flow, and increases PGE1 — but through entirely different mechanisms than finasteride and minoxidil… and without any reported side effects (so far).

Brotzu Lotion shows significant promise for autoimmune hair loss conditions like alopecia areata — probably because it targets inflammatory biomarkers involved in the early stages of alopecia areata onset.

Brotzu Lotion also shows some potential for pattern hair loss (androgenic alopecia), but nothing worth getting too excited about. A six-month study shows the lotion helps stop pattern hair loss, with only marginal visual improvements to hair growth. Any claims of “reversing the balding clock by five years” have yet to be proven.

Having said that — there seem to be a few pattern hair loss sufferers who respond very well to the formula. These users likely have the right genes / gene expression to metabolize high amounts of DGLA into PGE1, and as a result, get more out of the topical’s mechanisms of action. In addition, these users may also have suffered from rapid-onset AGA (aggressive pattern hair loss in a few months or years). In rapid-onset AGA, balding areas are more so affected by PGD2-induced hair shortening, and less so affected by scar tissue development (since that happens later). As such, a rebalancing of prostaglandin expression in balding tissues (which is what Brotzu Lotion helps to do) may be all these users need to see hair recoveries — since scarring has yet to settle in for them.

Scarring is also likely why Brotzu Lotion works better for alopecia areata than androgenic alopecia. Alopecia areata isn’t typically a scarring form of hair loss, whereas androgenic alopecia is a scarring form of hair loss — and potentially mediated by a combination of genetics, chronic tension, androgens, and chronic inflammation.

Questions? Comments? Thinking of trying Brotzu Lotion when it’s available? Feel free to leave a comment below. I do my best to get back to everyone.

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Comments 67

  1. Hi Rob,

    Fascinating information regarding the Brozu lotion, but i do have a question, you mentioned at the top about how you need certain carriers to penetrate the skin, would you say then that rosemary oil or pumpkin seed oil needs a carrier? If so which one?

    1. Post
      Author

      Hey Sarah,

      Great question! And for the most part, yes. Essential oil (like rosemary) should be 1) diluted, and 2) always paired with a carrier. In many cases, fat-based oils make great carriers — like emu, jojoba, olive oil, etc. — because their molecular structure helps improve penetration. In fact, most rosemary oil-based creams you can find in stores (like Whole Foods) will already have that rosemary compounded with a fat and/or other carriers.

      With that said, pumpkin seed oil is sort of like its own carrier! So in general, you wouldn’t need a carrier oil with pumpkin seed oil. In fact, there are a few readers here using pumpkin seed oil as a carrier for rosemary oil.

      I hope this helps.

      Best,
      Rob

      1. Post
        Author
  2. Hi
    Rob and sarah

    Im one of those who use rosemary and pumpkin seed oil, twice weekly with rosemary shampoo wash out next morning.

    I dilute the rosemary by 3 drops into one table spoon of pumpkin seed oil. Been doing this since around January along with massages for excellent results.

    About the article rob.

    1. Without the loosening of scalp tissue which increases vasculation and blood flow . And allowing carbon dioxide, and preventing plaque build up.

    2 . Without decreasing estrogen and prolactin

    3. Without sorting out thyroid.

    A person i believe cannot see results of reversing androgenic alopecia.

    The cream in question only does 20 percent of the required treatment.

    Im taking alot of inspiration from danny roddy and yourself. An a internal systematic approach with couple external treatments do the trick.

    Thanks

    1. Post
      Author

      Thanks for commenting Paz. And yes, the lotion falls under the category of a standard hair loss treatment option — a life-long commitment (to keep results), and a target at the inflammatory (but not structural) level. The first things to tackle are likely chronic scalp tension; next would be the inflammatory cascade (PGD2, DHT); and finally, the last things to target are the results of that inflammatory cascade (increased TGFB-1 which leads to fibrosis + calcification in the blood vessels supporting the follicles).

      The lotion starts further upstream than most other topicals — which is good — but it’s still not targeting what causes the inflammation in the first place.

      Best,
      Rob

    2. Hey Paz,

      what kind of pumpkin seed oil do you use for this? Probably not the edible oil, right? 😉 This is something I might try soon. I’ve made the mistake of using rosemary oil undiluted and irregularly.

      From what kind of alopecia do you suffer if I may ask?

  3. Hi,

    Completely off topic here, but i’ve been doing research on prostate health and i have a feeling an enlarged prostate links with hair loss.

    I havent looked at studies for this but its interesting how as men get older their prostates are likely to enlarge in fact for men age 80 and over they are almost always enlarged and as we can see men also lose hair as they get older

    Im going through some prostate health issues myself as well as hair loss, so ive been looking at treatments to calm the inflamation and on a Diet approach a mediterranean/whole food plant based diet is the best for reversing prostate issues, apparently animal meats give rise to inflamation.
    Also what was interesting was the treatment approach for reducing an enlarged/inflamed prostate was reducing DHT levels using Saw Palmetto or having more soy in diet that seems to be very popular in helping the prostate as well as hair loss.

    Also maybe this could be why men who live the meditteranean lifestyle and in asia dont bald as much as in the west because they keep their prostate health in check.

    I dont know but its worth looking at prostate health in regards to hair loss, they pose similar treatments like the original use for finasteride was to heal an inflamed prostate ect.

    1. Post
      Author

      Hey Mark,

      Your intuition is correct! In fact, finasteride (Propecia), which inhibits the enzyme type II 5-alpha reductase, was originally created to treat prostate conditions closely linked with high prostatic DHT levels. In other words, finasteride was first intended to reduce DHT in the prostate, and improve symptoms of men with enlarged prostates.

      It was only by coincidence that later on, researchers also found that the type II 5 alpha reductase enzyme was the same enzyme used to convert free testosterone into DHT in balding scalp tissues.

      Saw palmetto works to reduce DHT levels as well, which is why it’s sometimes recommended as a less aggressive, alternative treatment to BPH.

      Best,
      Rob

  4. Hmm so Brotzu uses S-Equol.
    Rob i remember you mentioning S-Equol in the DHT Master series, i have been trying to find this S-Equol as a supplement but having no real luck, i understand as well that you’ll need the gene to metabolize it but its worth trying anyway.

    With that said does anyone know of where to get hold of S-Equol?

    1. Post
      Author

      Hey Daniel,

      A percentage of us can produce S-equol from the bacteria inside our large intestine. If you’re looking for summaries of the literature, this site is a great resource:

      http://s-equol.com/index.html

      It helps to keep in mind that equol comes in two forms: S-equol, and R-equol. And if you’re interested in supplementing, you can also supplement with things further upstream, like substances that eventually become equol (soy isoflavones) or produce equol (bacteria).

      https://academic.oup.com/jn/article/136/4/946/4664303

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2834330/

      In terms of soy isoflavones — you could try looking for isoflavone supplements with daidzein or genistein. There are a lot out there.

      In terms of bacteria — you could try looking for a supplement that contains Lactococcus 20-92 (see https://www.ncbi.nlm.nih.gov/pubmed/22286043).

      It’s important to keep in mind that while equol isn’t nearly as powerful as most human-produced estrogens, it still is a phytoestrogen, and thereby still has estrogen-like effects when taken in very high dosages. Usually therapeutic dosages aren’t that high, and generally for men lead to a reduction in DHT without most side effects. But just keep it in mind if you decide to supplement orally.

      Best,
      Rob

  5. Another excellent article Rob! I truly do believe that hair regrowth is very possible under certain scalp conditions and if your metabolism is in good shape.

    I agree with you that fibrosis is a large issue in hair loss, but I think that the loss of the subcutaneous fat layer of the scalp is what really causes the hypoxic environment for the hair follicle.

    Is there evidence in your scalp massages helping replenish the subcutaneous fat layer under the scalp? Also, what oils or lards do you believe are most effective in replenish the fat layer under the scalp to become plump and oxygenated again?

    Thank you so much for the quality research.

    1. Post
      Author

      Hey Mike,

      Thanks for reading!

      I don’t want to discount the importance of subcutaneous fat erosion in pattern hair loss, because it’s certainly there. The question has always been… is it associative to the scarring, or causative?

      Interestingly, a new study by George Cotsarelis of prostaglandin D2 fame, along with over a dozen other investigators, demonstrates that in wound healing, hair follicles and fat develop separately but not independently. In fact, the hair follicle has to develop first, and then the follicle signals to the fat tissue:

      http://science.sciencemag.org/content/early/2017/01/04/science.aai8792

      And from an interview with Dr. Cotsarelis…

      ““Essentially, we can manipulate wound healing so that it leads to skin regeneration rather than scarring,” said George Cotsarelis, MD, the chair of the Department of Dermatology and the Milton Bixler Hartzell Professor of Dermatology at Penn, and the principal investigator of the project. “The secret is to regenerate hair follicles first. After that, the fat will regenerate in response to the signals from those follicles.””

      https://www.pennmedicine.org/news/news-releases/2017/january/using-fat-to-help-wounds-heal-without-scars

      When I published my paper on a hypothetical pathogenesis model, I wrote that subcutaneous fat erosion and hair follicle miniaturization were two consequences of fibrosis / calcification — which Cotsarelis’ paper supports. But interestingly, it seems like if we remove that scar tissue and regenerate the hair follicles, the subcutaneous fat should also return — and that moving in the opposite direction of loss (regrowth), hair follicles come first, then adipose tissue.

      So it’s complicated! But if any treatment theoretically helps improve the health / size of our hair follicles — and remove scar tissue — it should also improve subcutaneous fat. Maybe some people with regrowth can chime in about whether that fatty layer feels thicker. It might be tough to differentiate from skin elasticity.

      In terms of oils — what have you tried? I’m not sure the equation is as simple as a fat-based topical increasing the subcutaneous fat layer — but at the same time, any topical with hair-promoting properties should technically help improve our lost subcutaneous fat layer. That means any topical that helps reduce DHT and TGFB-1, or halt/reverse fibrosis, should be top-of-mind.

      Best,
      Rob

  6. Hi Rob/ Paz

    Excellent article Rob, had heard of this a few years back but suspicious when approval was being pushed out.

    Paz read about pumpkin seed oil with Rosemary and will add to my regime. Just wondering does it work on hairline. I stopped massages a few months back due to an injury and feel that my hairline has become lighter.
    Reading about saw palmetto in another comment, I had issues with this herb and think readers should read side effects carefully before choosing this treatment.
    Rob, i’ll drop you a mail soon and keep up the good work.

    Best wishes
    Alan.

  7. Hi Rob!

    I’d like to ask you some question for my “massage trip”:

    1) I’ve got a general thinning pattern, do you suggest me to try the combo coconut oil + head massages?

    2) I’ve always had graisy and oily hair, so since 10 years I’m used to have a shower once a day using completely natural product, do you anyway suggest me to eliminate them from my routine?

    3) in this last months i use aloe gel as a carrier for rosemary oil in order to fight a strong seborrhoeic dermatite on my head, may i keep going to use these or i should stop using them for their healing properties that could hinder the massage efficacy?

    Thanks so much Rob! I hope to have some improvement and to make a contribute for your research and work!

    1. Post
      Author

      Hey Frinz — thanks for reaching out. I sent you an email a few days back about this. Could you confirm that you received it?

      Best,
      Rob

      1. Hi Rob! I didn’t receive anything yet. May you try to send it back again?
        Thanks so much!

      2. Post
        Author

        Hey Frez — thanks for the update! I’ve replied to your emails. Please let me know if you’ve received my responses. In the past few months I’ve had email deliverability problems where, during my reply emails, an email will get dropped by the sender but neither I nor the sender will receive a notification about it. It turns out a few high-volume spammers were spoofing my domain in emails, which lowered my sending reputation. Now I’ve taken measures to make it harder for spammers to do that, and even if they still do it, it shouldn’t hurt my sending reputation as it did in the past.

        Best,
        Rob

      3. I might have been affected by that, too. Haven’t heard from you in a long time, but not sure if you ever found the time to reply. 🙂

      4. Post
        Author

        Hey Manuel — I’ll be sure to resend anything I’ve sent to you today. Let me know if you don’t see anything!

      5. Hey Rob,

        sorry, just saw this. Unfortunately, I didn’t get any email from you. Seems like something’s not working right. I also checked my spam folder.

      6. Post
        Author
    1. Post
      Author

      Hey Akash,

      Thanks — I’ll be sure to add that treatment as part of another article covering stem cells and hair loss!

      Best,
      Rob

      1. Hey Rob,

        great article. Finally a new one, thanks a lot. 🙂

        I sent you a link a couple weeks ago regarding a treatment which also uses stem cells along with a peptide. Might be interesting to cover that one, too.

        Best,
        Manuel

      2. Post
        Author

        Thanks Manuel! I’ll be sure to include it in the stem cell article. I finally have some downtime and am in a position to research and write a few more articles over the coming months. I look forward to sharing the findings with everyone. Also — a forum is coming! So be on the lookout for that.

        Best,
        Rob

  8. Hi Rob!

    I’ve read your book and I have a few questions over Diet i’d love to have your opinion on.

    1. Whats your take on nuts and seeds (Like Pumpkin seeds or hemp seeds, considering omega 6/omega 3 balance) do you have them in your diet and how often do you use cooking fat is it with every meal?

    2. Whats your take on Intermittent Fasting in regards to adding it in your lifestyle? (for hair health)

    3. Whats your take on adding in soy proteins like organic tempeh or Tofu for a protein variant instead of eating meat everyday? (Something i want to cut back on)

    I recently visited a trichologist and he did a hair health analysis using a microscope, what he showed me is how much gunk and dirt was clogging my scalp, it was really nasty looking! Of course it was through a microscope but he said i need to shampoo as i told him i hadn’t shampooed in 4 months and he mentioned how he knows about the ‘No-Pooing’ movement and says its generally a bad idea, so for now he advised i used a scalp exfoliate like nioxin which ive used now, my hair is much cleaner after using.

    So im a bit unsure if no shampooing really is a good thing, i can understand the need to avoid the harmful chemicals in commercial shampoos, but my hair does get greasy if i dont use it and it does smell a bit too (something my friend pointed out), so perhaps we could still use healthier organic shampoos like with argan oil in it?

    Heres a link of the ‘healthier’ DHT blocking shampoo i’d like to use:
    https://artnaturals.com/artnaturals-argan-oil-shampoo-hair-growth-treatment-stimulates-cell-renewal-and-healthy-growth-16-fl-oz-473-ml-32-00.html

    Lastly i’m looking forward to your new update on the book, im excited to see what new things you’ve added! Good luck for the launch as well as the launch for the forum, hope these articles dont get closed down, theres some valuable info here in the comments too, anyway thanks Rob, all the best!

    1. Post
      Author

      Hey Ben,

      Thanks for your support. To answer your questions–

      RE: pumpkin seeds in the diet–

      The answer (while I understand this is annoying) is that it’s different for every individual, and that the only way to know for sure is to either 1) do a cross-reactivity blood test (usually these cost $300+), or 2) do a substitution diet. In the latter, you’d need to remove nuts and seeds from your diet for at least a month, track your mood, sleep, skin quality, hair quality, and bowel movements on a daily basis, and then substitute back in the nuts and seeds — and see if any barometers change. The cross-reactivity test is really the best way to go — but unfortunately it’s cost-prohibitive. For instance, from my test I discovered that while I don’t have any allergens / autoimmunity to dairy by itself, if I ingest dairy alongside gluten or rice proteins, my autoimmune and inflammatory biomarkers go up.

      This — alongside the idea to lower total lectin consumption — is why I generally recommend against most nuts and seeds. An exception might be seed oils — i.e., pumpkin seed oil. See this article:

      https://perfecthairhealth.com/pumpkin-seed-oil-hair-loss-study-what-you-didnt-know/

      RE: intermittent fasting–

      This is answered in the FAQ section in the book (with studies to back it up). I’ve experimented with several variations of intermittent fasting, and what I find is that in fasting periods greater than 14-16 hours, I start showing signs of hypothyroidism. I naturally fall into a 12-14 hour fast daily — since I don’t usually eat breakfast, and instead a big lunch and dinner. This works well for me, but anything longer, I start to get problems. I don’t think that intermittent fasting moves the needle very far in terms of hair regrowth, but I do think long fasting periods have the potential to significantly hurt our hair.

      RE: soy proteins–

      In general, I’d avoid this. While phytoestrogens from plants like soy are only a fraction of the strength of endogenous, human-made estrogens — they still can lead to estrogenic effects in the male body if ingested for years and in excess. A little here and there isn’t going to hurt. If you’re looking for an alternative protein source, consider supplementing with hydrolyzed collagen.

      RE: no shampoo–

      Sebum build-up is endogenously produced — meaning it’s made deep within the sebaceous glands. While no-shampooers certainly might be some dirt here or there on the scalp, the real issue is sebum overproduction — of which shampoo can only temporarily remove the sebum build-up, but not address the root of the issue. Usually sebum overproduction is closely linked to a micronutrient deficiency (which is why accutane (a synthetic vitamin A derivative) shrinks sebaceous glands) or even chronic stress / inflammation. In any case, shampooing every once in a while isn’t going to hurt much at all — and no-shampooing rarely makes the difference between regrowth / no regrowth. It just improves the health of your scalp skin.

      These articles / comment sections won’t get shut down! And thanks again for your support.

      Best,
      Rob

      1. haha I was wondering why you were not replying anymore . I understand now .

        Gilbert , Paris .

    1. Post
      Author

      Hey Reza!

      Thanks for sharing. I think it’s great to get any discussion started that leads to the idea of multi-targeting (rather than mono-targeting) to treat pattern hair loss. While I disagree with some aspects of Nutrafol’s research in terms of the pathology of AGA, it’s clear they’re trying to provide a viable alternative to finasteride — and with scientifically-studied ingredients. It’s good to see this happening!

  9. Hi Rob
    I massage my scalp with a lot of force، and during the massage, 8 to 10 hair is shedding? Is this normal? Usually after the massage my scalp is red for a few minutes، You experienced something like that?

    1. Keysi

      Shedding some hair is completely normal and often bound to happen when you massage the scalp. 10 hairs, being well within the limits Rob had described in the book, is nothing to worry about as I see it.
      I myself lose a minimum of 50 hairs every massage, which is very worrying. I can’t run my fingers trough my hair without unintentionally pulling out a few hairs every time. I have no idea what this condition be or how I can stop it. It’s like the hair just doesn’t want to stick to the scalp.

      1. Post
        Author
    2. Post
      Author

      Hey Keysi,

      8-10 hairs doesn’t sound out-of-range, but it really all depends on each individual. There are guidelines to shedding in the book. The big takeaway is that shedding induced from massages should never lead to visibly thinner hair, and that you don’t need to shed to see regrowth.

      Best,
      Rob

  10. Thank u benjamin

    Use a towel during pinching/ deep massage to reduce hair loss>>,trust me the force of your fingers will be increased, and the control of your hands will improve on the scalp.just do it

  11. Hi all

    Been doing the massages 2 years this October.

    The nutrofol interview is very good and has been posted before. An interesting thing they mention is that if your hair is thinning , and you can see it. ….. It means that you have lost 50 percent already.
    Amazing I know.

    The mitochondria system health is important. Reducing inflammation, and estrogen dominance.

    with Massages.

    Your aim should be to loosen the skin and make it more elastic. This should be the goal. Not regrowth .

    If your scalp skin becomes more elastic, it will allow more blood flow, and improve vasculation.
    breaking down fibrosis tissue. The knock on effect of this should be regrowth of dormant follicles.

    Alot of people are just concerned with regrowth results and worried about shedding 4-5 months into the regimen.

    It takes time, measure your progress with elasticity.

    I personally noticed alot of dirt , grease and flaky scalp skin when i started out . I also had sebum overproduction.

    This disappeared around month 4-8 and Never returned. What did return were healthier hairs.

    However your hair cycle system in my belief is attacked, and DHT has been known to damage gene expression, which is why we get shorter weaker miniaturized hairs.

    However when we massage and increase blood flow and vasculation, DHT is no longer stuck to the hair follicle. Which is why I no longer notice large bulbs at the end of my hair during shedding.

    Now interestingly in India, the blood circulation and vasculation theory has been known for centuries.
    And even Medical professionals are recommending circulation excersizes . It seems evident that DHT blocks nutrient flow, and thus weakens follicles.

    And Rob in his theory interestingly points out how DHT arrives there in the first place.

    Thanks

  12. Hi Paz
    You mentioned a good point. ” no longer notice large bulbs at the end of my hair during shedding.” Yes, I absolutely agree with that. I started deep and intense massage for almost two months , and it’s a pleasure for me to not see these yellow bulbs at the end of hair shedding. What is the meaning of these yellow bulbs at the ends of the hair? Is this the same hair follicle that is yellow?

    1. Post
      Author

      Hey Keysi,

      What you’re describing is known as “exogen” shedding. Studies suggest that it’s independent of the hair cycle, and relatively normal.

      Best,
      Rob

  13. Brian

    Nearly 2 years , ive had thickening of what was thin hair , slow regrowth at temples.

    And hair cycle growing and working again.

    This takes time and dedication. My situation was different, i had diffused pattern loss, which produced curly short hair.

    Keysi.

    I think the bulbs were a combination of blocked dirt , im guessing. From lack of circulation and blood flow.

    1. Hi Paz,

      I am suffering from diffused pattern hair loss too and produced curling hair like you said. Why is my hair turning from straight to curling? Hormonal? DHT? I’m continuously losing hair its depressing.

      Been massaging for 7 months with healthy diet lifestyle etc. still no avail.

      I will do dermaroll + rosemary + wheatgrass juice + everything LOL.

      This hair loss is so demoralizing especially if you’re ugly like me. Life is already hard, add that with hair loss that’s = miserablesx10.

      Did you stop your hair loss? How?

      Thank you.

  14. Hey Rob,

    I showed your paper to Danny Roddy a while ago, and he said (I’m paraphrasing) that in his eyes you were omitting several important variables in terms of environment influences and energy metabolism. I.e. not mentioning the role of thyroid or cortisol or prolactin, and that without considering those (and other) factors, estrogen could for example be seen as positive for hair despite significant evidence to the contrary. (He also sent me a bunch of references as usual lol!)

    I wonder what you’re thoughts are on that? From having read your book I think a lot of your ideas are parallel to the peat/roddy angle as far as maintaining a healthy metabolism with pulse and temperature etc. Danny isn’t particularly focused on mechanical stimulation (massage) as a treatment for hair loss, although he doesn’t seem to be against it and even hypothesized that if massages work it’s probably because they reduce concentrations of prostaglandins d2 in the scalp (there is a study that showed that ”scratching” the scalp did just that, and since pd2 are elevated in balding scalps it’s probably part of the reason.)

    From what I could gather, those who successfully regrow hair do so by both fixing the metabolism AND physically manipulating the scalp. The results are sub par if they’re done independently.

    It seems like there’s a lot of potential for a synthesis of Danny Roddy’s research and yours. Danny’s recent article (Aristotle’s radiator) is especially great I thought with very specific recommendations to experiment with (e.g. thyroid, aspirin, red light, d3, k2, calcium, gelatin, saturated fats etc. ) Anyway I’d love to hear your thoughts!

    David

    (Btw, is the idea of having a forum still part of the plans?)

    1. Post
      Author

      Hey David,

      Thanks for reaching out. Would you mind sending over the references that Danny Roddy sent you? I didn’t intentionally omit any studies contradicting my paper — but it’s possible they exist, and if that’s the case, I’d like to read them.

      It’s also likely that I have read the studies Roddy has referenced, but disagree with the interpretation. A general note is that the evidence I’ve seen from the Roddy / Peat camp that indicts cortisol, thyroid, and prolactin in hair thinning tends to have the following issues:

      1) The studies are often in animal models — specifically, animals that are “molting” — which isn’t morphologically the same as pattern hair loss…

      2) To my knowledge, the Roddy / Peat camp like to group together most forms of hair loss as one — particularly when arguing in favor of thyroid/prolacting/cortisol as pathogenic to MPB. But there are significant morphological and pathological differences in every type of hair loss, so the causes / appearance of one aren’t always the causes / appearance of another (i.e., alopecia areata versus androgenic alopecia). This was one of the major mistakes Christopher Walker’s video made on MPB (which went viral), and that video is essentially a secondary interpretations of Danny Roddy’s book — so I’m apt to think Roddy is using the same references (see this comment: https://perfecthairhealth.com/l-reuteri-for-hair-loss-review/#comment-36434), and…

      3) Many of the studies used to argue the relationships between cortisol, thyroid, and prolactin are on serum (blood) markers — and they either don’t translate to balding scalp tissues, or they haven’t been studied.

      So I’d love to see the references if you have them.

      In terms of regrowth + diet / metabolism — there’s some data on this I’ll be able to share in the near-future! And a forum is still in the works!

      Best,
      Rob

      1. Hello Rob!

        I have replied to the e-Mail you sent me several weeks ago but still haven´t got an answer. You mentioned earlier that you had trouble properly receiving/sending e-mails. Is it possible that you never received my answer?

        Sincerely,

        Michael W

      2. Hey Rob,

        Of course, I’ve just emailed you the references Danny sent me.

        I honestly don’t even think there’s any major clash between your view and Danny’s, I just think he’s big on operating from the perspective of energy, which an emphasis on thyroid. And honestly I did the massages for a good 6 months at first some 2 years back with absolutely no signs of improvements, then the motivation went down the drain a little, and it’s only been since I’ve focused on getting my body temperature and pulse up (up from 95F and a pulse in the 50s) that serious improvements have become obvious, and focusing on the various important factors that Danny talks about often (and that Ray Peat wrote about a lot too): thyroid, sugars, red light, vitamin a,d,k,e, gelatin, calcium, magnesium, caffeine, aspirin, stimulating life, saturated fats etc.)

        There’s a lot of overlap with what you talk about in the book. With the massages (I like the scalp stretching a lot), I think there’s truly serious potential for a very broad approach. In Ray Peat’s ‘Energy, Structure and Carbon Dioxide: A Realistic View of the Organism’, he cites studies demonstrating that stretching or massaging a tissue stimulates its synthesis of ATP, and we already know about the benefits of lowering prostaglandins.

        I think at first I was really excited by the prospects of massages, especially after reading that (phony?) 2012 Hong Kong Study, but in my case the loss was always more diffuse and weird so I guess it makes sense that the massages wouldn’t get the job done before my health got a whole lot better.

        David

      3. Post
        Author

        Hey David,

        Thanks for following up about this. I also saw your email and will reply there. What’s interesting is that our survey data seems to suggest that the massages are marginally less effective for diffuse thinners versus frontal / temporal or vertex thinners — and that this effect may persist even as we control for cumulative massage time. This goes along with your anecdote. Interestingly, diffuse-related hair loss seems to overlap more with other conditions (like the ones outlined in the nutrition-hair loss article). In other words, diffuse thinning isn’t always AGA — and might be more related to other factors more closely linked to nutrition / autoimmunity / thyroid disorders. So in this case, I can totally see why following a Danny Roddy-inspired diet would improve things much better, or act synergistically with the massages.

        In terms of the 2012 Hong Kong study — our survey data suggests that the book’s massages improve hair loss in a time-dependent manner, with estimated minutes daily, months, and minutes daily x months of massaging all positively correlated with self-perceived hair changes. The data gets even more impressive for people who’ve been doing the massages for 18+ months. Having said that, we just don’t see the same results that the 2012 Hong Kong study realized for 100% of participants. Knowing what I know now about 1) the Hong Kong study’s journal reputation (OMNISCI is considered a predatory open-access journal — meaning they typically publish anything that comes their way for a fee), 2) how difficult it is to publish in a quality peer-reviewed journal, and 3) the Hong Kong study’s unrepeatable results in comparison to our current survey data — I think it’s safe to say that the HK study would’ve never passed real peer review, and that we shouldn’t come to expect full-hair recoveries from just massaging for 10 months.

        Having said that, I think the massages are an incredibly powerful regrowth tool. In fact, evidence in mechanotherapy / mechanotransduction studies from peer-reviewed journals all support this. So at the end of the day, while we shouldn’t believe that full regrowth is attainable in just 10 months for 100% of people, we also shouldn’t discount just how effective the massages can be when implemented under the right circumstances.

        On that note — I’ve got a lot more before-after photos to share with the site that demonstrate significant hair regrowth beyond what we normally see with finasteride / the big 3 — and all from massaging. While it certainly isn’t the magic bullet for everyone, we’re still seeing impressive regrowth and relatively high response rates (dependent on time). Understanding the differences between responders / non-responders is also helping to elucidate massaging’s most powerful mechanisms. I’m writing a manuscript that touches upon a lot of this soon, and I look forward to sharing it with you and everyone else when it (hopefully) gets published!

        Best,
        Rob

      4. Hi Rob, are you perhaps saying that the issue with scalp tension is more important than internal issues?

        Honestly though… I’ve been massaging for more than a year now. Admittedly Ive been skipping a couple of days lately but I do tend to come back in massaging my head as it has somewhat become a habit now.

        Still no improvements with my hair as my hairline is still weak. Last year, I thought I was achieving regrowth since I was looking at my hairline too much. Now, I realize that I probably have those mini hairs around my hairline even before I did the massage and they stay weak even up to this day.

        Admittedly, I wasn’t able to follow the diet 100% as I am in a relationship. But I’ve minimized PUFAs and try to follow it as much as I can. Cooking oil of choice is now Coconut oil.

        Anyhow, my point is. Just massaging the hair sadly… probably won’t do anything. I am sometimes on the verge of breaking up since Ive been doing it for so long and nothing seems to be happening.

        Diet might play a role as much as massaging in regrowing the hair.

  15. Hi Rob !

    Hope you are fine, Once you said that over production of sebum is due to deficiency of a macro nutrient, is it Vitamin A ? how much of it should we consume daily ? Is it important to supplement with it while doing the massages daily in order to regrow hairs or just the massage will remove all the excess sebum from the scalp ?
    Thanks in advance

    1. Post
      Author

      Hey Jordan,

      It’s tough to say! Our sebaceous gland size is generally determined during puberty, and is largely androgen-mediated (castrate studies help show this). For the most part, we can’t shrink sebaceous gland size post-puberty. But interesting, synthetic derivatives of retinol (a form of vitamin A), if taken in high doses, can significantly reduce sebum output. This was the basis for isotretinoin drugs like Accutane for acne. And they certainly work (though they’re often toxic to the liver, which is why we shouldn’t drink while taking them).

      In general, the data we have so far suggests no correlation with supplements or topicals AND hair regrowth from the massages. The massages should help reduce sebum output too — though it takes a few months!

      Best,
      Rob

  16. Dear Rob !

    Thanks for the reply, but what do you mean that in general the data we have, doesn’t suggests hair regrowth from massages ? As i know your program really basis on a massage technique for hair regrowth , isn’t it ? and maybe the diet also play a major role on this theory…

    1. Post
      Author

      Hey Jordan,

      To clarify, the survey data suggests that diet isn’t correlated with hair regrowth from the massages. That means that people eating different diets didn’t get different hair regrowth from the massages — implying that diet isn’t a primary factor in massage success. In other words, while the massages certainly improved perceived hair growth — specific diets + massages didn’t perform better than the massages alone.

      Best,
      Rob

  17. That’s amazing Rob will you publish this survey.

    So if mechanical repsonds better it means that tissue damage is higher on the list .

    How would this coincide with hair loss mpb being a systematic issue ?

    Am I right in saying that people with a better functioning thyroid and mitochondrial system will see quicker better results from massage s ?

    As thyroid= energy , which an organ like hair needs. And thyroid health and massage would be highly successful.

    Thanks

  18. Rob will this survey be published?

    It’s interesting. Does this mean that mpb is not an entirely systematic issue ??

    And is indeed less related to thyroid and general health.

    Thanks

    1. Hi Paz,

      You mentioned in your earliest post that you are suffering from diffused pattern hair loss. I am suffering from diffused pattern hair loss too and produced curling hair like you mentioned. Do you have a clue why your hair is curling? Hormonal? DHT? APKH? I’m continuously losing hair its depressing.

      Been massaging for 7 months + everything with healthy diet lifestyle etc., started dermaroll + rosemary + wheatgrass juice.. still waiting for positive results..

      Did you stop your hair loss? How?

      Thank you.

  19. Hi Joe .

    We need to set some parameters to know where you are.

    1. Do you have a oily scalp which is itchy ?
    2.if so , since your regimen has this stopped ?
    3. Are you shedding weak curly lifeless hair ?
    4. What is the state of your scalp tight ? Or elastic.

    What is the texture of your hair ?

    If you can answer those I can give you more tips.

    Otherwise, check your thyroid health. As thyroid and mitochondrial
    Activity is related to hair quality.

    We need to improve scalp health first.

    Look forward to your reply.

    Kind regards

    1. Hi Paz,

      Thank you for your response. To answer your questions:

      1) I’ve normalized my excessive sebum production. I stopped shampooing for my first 5 months. I now shampoo just once a week. My scalp is sometimes itchy – scale 2.5/10. I don’t think its too much of concern. I have some amount of dandruff that I’m trying to treat with nizoral once a week.
      2) Back in my first 1-2 months it was itchy due to excess sebum and no shampoo but after it being normalized I only occasionally/seldom get itchiness on scalp due to remaining flakes I may have. I am still treating the small amount of dandruff I have.
      3) Yes, I am shedding weak curly lifeless pubic looking hair.
      4) My scalp is elastic since doing the massages. I added dermarolling to see if it has positive results and sometimes rosemary+coconut oil.

      My hair feels and looks like a pubic hair. I don’t know if this was caused by DHT, Aquired Progressive Kinking of Hair (APKH), hormonal. etc.

      My doctor said I have a pretty good thyroid health. I haven’t discussed mitochondria, but I will ask. I feel pretty healthy. I live a healthy diet (meats, vegetables, fruits, sufficient vit d3, selenium, zinc, iron, copper, etc..) and lifestyle and I don’t have any other issues other than hair loss. I am concerned with the continuous hair loss and abnormal curling (pubic hair looking) since my hair used to be straight and it all looks dead and all over the place. I don’t know if this is due to DHT, Aquired Progressive Kinking of Hair (APKH), hormonal? Even after going to a dermatologist they said they have no idea why the curling other than hormonal. They pretty much have no clue and just goes with assumption.

      I appreciate your response. Thank you.

  20. Hi Joe.

    The good news is that your scalp sebum has gone to normal. And your itchiness has resided.

    I guess you are doing Rob s massages to the book , like section in three and twice daily ?

    Your scalp health is improving if sebum has gone to normal. before any change in hair, you need a healthy scalp.

    Ok next.

    I’m still skeptical about DHT role in mpb , but I believe it’s a symptom.

    Do the following.

    First I believe your doing too much to your scalp. Might be.

    You need to let it recover and rest.

    I stayed off any topical until month 14.

    I only introduced rosemary and pumpkin seed oil , with rosemary shampoo at month 14.

    Incorporate cold shower or rinse afte warm shower. Rob recommend cold shower, and they benefited me.
    Cold water also is good for the scalp.

    Now for dht.

    In your case I’d say try saw Palmetto and pumpkin see supplement.
    Also ashwanda and rhodiola, vitamin K2.

    Do this for a few weeks.

    Recheck your thyroid, and blood works.

    Lower stress which is important against prolactin and estrogen.

    Have you checked estrogen levels at all Joe ? .

    Stick with the massages , and ensure you can feel blood flow.

    I begun to notice these changes at month 4-5.

    Regrowth was at around 8-10 with thickening. But it takes a long time.

    You need to stick to it, but your explanation seems to indicate that diffused hair has trapped dht at follicle base which needs reducing via natural methods.

    Try dht blocking foods as well.

    Have you stopped/reduced grains ?

    I’m beginning to think that diffused hair loss is connected to autoimmune and thyroid, which can reduce sebecous fat layer.

    Quick question, were you u Der stress when you noticed diffused loss ?

    Thanks

    1. Hi Paz,

      Yes, I am doing Rob’s massages 2x daily 20min in sessions. I stopped in the last month after speaking with Rob and trying dermarolling. I was concerned with my curling of hair and thought it was caused by massaging so I shrank my massage routine down to 5min every other day in months 3-5 (but still losing hair at the same rate from months 1-2) and eventually started experimenting with dermarolling. I am doing dermarolling 1x per week for a month now to find any results, so far I don’t feel any changes in my hair loss. If dermarolling for some months alone does not stop my hair loss I will incorporate massaging again or both. My scalp remains elastic even for not massaging for a month now.

      Basically my rate of hair loss has been stagnant since month 2-3. I am 7 month in and wondering what I am missing.

      Yes, I also do cold showers most of the time.

      I workout 4-5x per week I feel pretty healthy high libido I don’t think my T/E ratios are out of balance. I have low body fat and pretty defined musculature.

      I am slowly stopping on grains. I still eat about 1-2 cups of cooked organic rice daily. I try to keep my calories 2000+ daily with all recommended nutrition for a 150lbs male.

      Yes, I would say that I was under stress when I experienced my diffused hair loss. I haven’t been in an extremely stressful environment in the last 4 years. I am working on living a more stress free lifestyle when I can and maybe do meditation etc to see if I get positive results.

      That’s where I’m at. Thank you.

  21. Hi Joe thanks for your information.

    I do believe a decent T/E ratio is important for general health.

    Its interesting how different people act to regimens. You said you stopped at month 7 with massages,
    and itching and oily scalp also stopped.

    About topicals. I previously said I was against topicals until the scalp had reduced its own over sebum production and begun to regulate correctly.
    You said you have tried topicals fat based it seems.

    I would personally look at pumpkin seed oil, which is a fat based topical full of zinc and DHT blocking
    properties. I diluted this oil with rosemary oil two drops or three on a table spoon worth .

    I do this on a twice weekly basis and then wash out in the morning with rosemary shampoo .

    Right now my hair sticks up, before it use to be limp and flat. Its getting its old strength back since January.

    I dont think curly hair is caused by massages. I believe this has to do with hair nutrition levels , for me it indicated that the hair is not nourished. I had curly hairs at the front and back which looked awful.
    They fell out , and i remember shedding back in oct 16 when doing the massages properly.

    Since then ive had sheds and hair thickening , sheds ect. its part of the hair cycle.

    Its possible that diffused hair loss is not caused by scalp expansion entirely. I believe were looking at Zinc , hormones, stress leves, and fat loss.

    I would treat your condition with continuation of massages or dermarolling.

    try the pumpkin seed oil. And maybe think about DHT natural blocking . Keep an eye out on hair shedding , and what quality of hair it is.

    How long are your workouts ? and do they involve heavy lifting for long periods .

    The key is time and patience, as you could see regrowth at month 8-9 , and i think people such as JD moyer didnt see greater growth until after month 7.

    best of luck Joe.

  22. Some time ago I tried a Coumestrol topical, a powerful phytoestrogen extracted from Red Clover, in an 25% ABV grain ethanol carrier. Rather than preserve hair, the estrogenic effect caused my MPB to increase dramatically.. I sticked with it for a month of daily use, then discontinued. It was literally the worst topical I’ve ever tried. No noticable systemic effects though. I also tried a different phytoestrogen that had a similar effect. I strongly warn against use of estrogenic compounds, and I feel very skeptical about this Brotzu lotion for male androgenetic alopecia use. Progesterone on the other hand, I’ve heard very positive things about. There was one guy who ground up contraceptive pills and added it to his shampoo which he claimed caused powerful regrowth. Personally, I’m not interested in trying anything hormonal anymore – I have the most faith in Rob’s protocols and massages which seem to have totally alleviated my MPB itch and frozen my hair loss (few months in so far). Forget topicals and focus on manual stimulation.

  23. Steve

    Estrogen is highly associated with causing MPB. I’m not remotely surprised that it caused you more harm than good.

    1. Dear Paz,

      On another article written by Rob you claimed that your hair loss reversal was full. In yet another article, if i remember correctly, you claimed that you only regrew very little at the temple area and a lot at vertex area. How is the regrowth then? Do you mean that your diffuse hair loss reversed fully where you still had hair and additionally your temple area that was completely bald has regrown only a little? I am a little confused and curious.

      I am a diffuse thinner as well and roughly 2 weeks away from the 1 year mark. So far: between month 7 and 10 I noticed several big cracks all over my scalp, same as you and Julian were describing in another article. The last few weeks there were no more big cracks but instead vertex area seems to be slightly cracking every time i do the massage there. Elasticity has increased drastically. I hope to see regrowth in 3 to 6 months as I believe that I might need a few more hair cycles until the vellus hairs turn terminal.

      How was regrowth for other people here? I find my hairline to have a lot of vellus hairs that I hope to turn terminal in the future. As for other areas of the scalp I find it difficult to spot regrowth of vellus hair so I believe that the thickening only becomes noticeable once there was actually regrowth of terminal hair.

      As for shedding: Daily shedding seems to have stopped. I do shed hair (between 15 and 30) when I do the massages but these appear very weakened so I believe they were meant to be lost anyway. I instead hope that healthier hair will replace it like it seems to have happened so far.

      I believe that it takes a long time until the scalp becomes entirely healthy again but so far the dedication seems to have been worth it.

      Sincerely,

      Michael

  24. Micheal

    My reversal meant the following

    -sebum production/ hair quality

    I had vellus hairs growing at around month 7-8 if I remember correctly.

    My temple’s begun to improve around month 9- 11 with small vellus hairs.

    I initially had better growth in one temple area than another. And then suddenly vellus hairs arrived.

    Right now they are thickening.

    I class reversal as

    1. Vellus hair in previous loss area’s. As it means dormant follicles are renergizing

    2. hair is beginning to thicken

    3. Sebum and scalp itch have stopped which indicates scalp health improvement.

    You cannot go bald without over- sebum production imho.

    Can you please link the articles where I commented please.

    The process is long. I will be two years in October. This includes vellus hair and thickening quality of hair.

    I’ll be honest, this process is not for people who don’t have patience. And seeing small improvement is encouraging.

    Regards

    Paz

  25. Dear Paz,

    To start off, I do not mean to critizise you or accuse you of contradictorial claims – I am just curious of your situation because it sounds simliar to my own. 🙂

    This is the article where Rob announced the publication of his medical paper. Here you claimed that your hair loss reversal was full but that the hair cycle is still out of balance: https://perfecthairhealth.com/update-2018-published-research-paper/#comments

    In this article you explain your situation and the cracking sounds and discuss your experience with Julian: https://perfecthairhealth.com/trans-hormone-replacement-therapy-hair-regrowth/#comments

    I just noticed that it is further above in the comment section of this very article where you say you had slight regrowth at temples and thickening of what was thin hair.

    So basically when you mean regrowth you mean growth of small vellus hair that fall out several times, regrow and finally turn terminal i.e. “thicken up” over time? This would fit my own observations as well.

    To Rob, why do you think that some people regrow terminal hair right away and other people only ever get vellus hair? My hairloss story began roughly 2 years ago, maybe 2 1/2 at best so I figured that the hair I lost over that period was not so weak that it has to start off with vellus first as it was terminal (but weakened) when it fell out quite “recently”… But it sure is complicated.

    Regards,

    Michael

  26. Micheal

    No worries that’s cool.

    Correct. If my hair is to thicken to normal standards right now I would be happy with the results.
    But this is the process of which it seems to take the longest.

    I also write to Rob that I felt I had recession on the widow’s peak , for it regrow slowly after several months.

    New hair takes ages to grow, only the past week or so I experienced further thickening and existing hair is growing. But it’s taken a year for me to reach this point.

    My observation has to be the disruption to the hair cycle is a huge factor. You could regrow hair , but it depends on the cycle, which I believe is individual.

    Regards

    Paz

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