Nutrient Deficiencies And Hair Loss: A Master Breakdown

Rob Diet 155 Comments

If you’ve ever google’d, “The best supplements for hair growth”, you’ll find thousands of articles claiming hair loss is caused by a nutrient deficiency — from iron to iodine to vitamin B-12 — and if we supplement with these nutrients, we can reverse that deficiency, stop our hair loss, and maybe even see hair regrowth.

Sound too good to be true? Well, it probably is.

Truth: our nutritional status influences our degree of systemic inflammation, and thereby our propensity for weight gain, autoimmunity, atherosclerosis, and even disease development…

But does nutrition actually influence our chances of going bald?

The short-answer: it’s complicated. Why? Just look at the end-points.

On the one hand, chronic malnourishment (i.e., too little protein or micronutrients) is closely associated with hair thinning. That’s no surprise. Hair requires energy to grow. Food contains energy (nutrients). If we don’t eat enough food, our bodies reprioritize energy expenditure to essential functions — i.e., whatever is needed to survive. Pumping blood from our hearts is essential; growing hair isn’t. If we lack enough energy for both, we prioritize our hearts and stop growing hair. So at the extreme… nutrition does influence hair loss.

But if that’s true, then how can some nutrient deficient, morbidly obese men have zero hair loss? Why are some pro-athletes — despite working with full-time nutritionists — totally bald?

It’s tempting to say, “It’s because of our genes”, but that’s not entirely true. Yes, our genes influence our predisposition for hair loss. But genes alone can’t explain why the perceived incidence of hair loss is on-the-rise… or why one genetically identical twin can bald faster than his counterpart… or why people moving from the third world to the U.S. are now reporting hair loss — despite no familial history of it.

So… is our first-world diet partly to blame? Or a nutrient deficiency? And if so, what can we do about it?

This article uncovers evidence-based answers.

A Deep Dive Into Diet, Nutrient Deficiencies & Hair Loss

This is part one of a three-part investigative series on nutrition, dieting, and hair loss. The goal: to uncover (and answer) the biggest paradoxes in nutrition-hair loss research.

This is some of the most nuanced content on this site — and for good reason.

The connection between nutrition and hair loss is complex. For example, too little (or too much) of certain nutrients are linked to hair thinning. But contrary to what supplement companies say, fixing a nutrient deficiency is NOT as simple as taking a supplement like iron, biotin, or vitamin D. In many cases, it may make our hair loss worse. In some cases, it increases our chances of morbidity. We’ll uncover why.

First, we’ll reveal nutrient deficiencies and nutrient surpluses connected to hair loss. Then we’ll uncover the difference in nutrient-related hair thinning vs. androgenic alopecia — and why this misunderstanding is leading pattern hair loss sufferers to supplement unnecessarily (and even to our hair’s detriment).

Finally, we’ll answer one of the hardest questions in nutrition-hair loss research: can a nutrient deficiency cause (or even exacerbate) pattern hair loss? The answer isn’t what you’d expect.

[Note: if you have questions or thoughts, please don’t hesitate to reach out in the comments section.]

The Nutrition-Hair Loss Connection

Historians have long noted a relationship between poverty and brittle hair, but it wasn’t until the 20th century when scientists developed the tools to measure those anecdotes — specifically, the impact of wealth on food choice, and the impact of food choice on hair health.

Fast-forward to today: we now have thousands of studies linking vitamin and nutrient deficiencies to dozens of hair loss disorders. And unsurprisingly, most of our discoveries come from studying those who lack nutrition — aka, impoverished populations.

So what have we learned (so far)? For one, diet is 100% connected to hair loss. Diet determines our nutritional status, and our nutritional status determines our ability to grow hair.

Just see this 2010 review on nutrition and hair which reveals that, among other nutrient deficiencies, a…

  • Zinc deficiency is linked to diffuse or patchy hair loss — often all over the scalp
  • Iron deficiency is associated with diffuse hair loss, and mainly in women
  • Selenium deficiency is associated with skin and hair pigment changes, as well as scalp hair loss
  • Vitamin A deficiency is linked to phrynoderma — a condition where hair follicles produce too much protein called keratin, which leads to raised skin bumps and (sometimes) hair thinning
  • Vitamin B complex deficiencies (B-3, B-6, B-7, B-12) are linked to hair disorders in women
  • Essential fatty acid deficiency is linked to hair lightening and diffuse scalp or eyebrow hair loss

And encouragingly, that same review reveals that correcting these nutrient deficiencies can often lead to hair regrowth, and sometimes even full hair recovery.

But don’t get too excited. If we’re going to extrapolate these findings to our own hair loss, context is key.

Because when we look closely at the papers cited in that review, we realize…

  1. The correlations on nutrient deficiencies and hair loss were made using data on malnourished impoverished populations, and mostly children — i.e., people who lacked access to food (energy).
  2. In most cases, hair loss from a nutrient deficiency does not resemble pattern hair loss.

These distinctions are important. Why? Because pattern hair loss — also known as androgenic alopecia — accounts for 95% of hair loss cases in men… and it’s not exactly the same as nutrition-related hair loss.

Androgenic Alopecia (Pattern Hair Loss) Is Not The Same As Hair Loss From A Nutrient Deficiency

Here are the key differences.

Pattern hair loss is extremely common — affecting up to 50% of women and 80% of men throughout a lifetime. In men, pattern hair loss often starts as a receding hairline or vertex thinning. In women, it usually starts as even hair thinning across the top of the scalp. Primarily, it’s a hormonally-driven condition. It doesn’t occur in men who can’t produce the hormone DHT, which is why it only develops after puberty and not in children. Finally, pattern hair loss leads to scarring — also known as fibrosis — which is what makes the hair loss permanent (unless you can reverse the scar tissue in balding scalps).

Conversely, hair loss from malnourishment — i.e., a nutrient deficiency — is rare in the first world. It usually presents as increased shedding, brittler hair, diffuse thinning, scalp skin irritability, and hair loss in clumps or patches. It isn’t primarily hormonally-driven — which is why so many nutrition-hair loss studies are done on children, not adults — i.e., before sex hormones kick in. And in general, hair loss from malnourishment doesn’t lead to scarring — which means once we address the nutrient deficiency, we often see hair regrowth.

Finally — for a nutrient deficiency to actually cause nutrient-related hair loss, the deficiency has to be incredibly prolonged, and incredibly severe. That’s why nutrition-hair loss studies use subjects from impoverished populations — because they’ve usually suffered a lifetime of malnourishment.

To summarize: each condition is different in causes (pathology) and appearance (morphology), so we can’t apply treatments in nutrition-related hair loss to pattern hair loss. It’s like applying treatments in type I diabetes to type II diabetes. While it’s still hair loss (or diabetes), it’s still an apples-to-oranges comparison.

How Nutritional Supplement Companies Exploit These Definitions

Unfortunately, most supplement companies mischaracterize the findings on nutrients and hair growth. They read a study, see the term “hair loss”, and broadly assume its findings apply to 100% of hair loss sufferers.

Unfortunately, this sort of misguidance rarely helps us… and can even make our hair loss worse.

Exhibit A: Supplementing With Biotin For Hair Loss

Biotin, also known as vitamin B-7, is one of the most popular nutritional supplements for women suffering from hair loss. Why? Because studies show that a biotin deficiency is associated with brittle nails and hair… at least, in malnourished children.

So… how does biotin stack up as a hair loss supplement in the first world? Not well.

For instance, this study on biotin supplementation for women complaining of hair loss found that…

“…Treating women complaining of hair loss in an indiscriminate manner with oral biotin supplementation is to be rejected unless biotin deficiency and its significance for the complaint of hair loss in an individual has been demonstrated. …At the same time, potential additional causes of hair loss, for example, androgenetic alopecia, other nutritional deficiencies, and endocrine disorders, must systematically be addressed and treated as needed.”

And of the women with severe biotin deficiencies in that study (38%), biotin supplementation only helped marginally, and usually for hair loss conditions that weren’t characterized as androgenic alopecia. That implies that even for women with a biotin deficiency, a lack of biotin didn’t drive most of their hair loss.

This biotin-hair loss review comes to similar conclusions — and reiterates that we should rule out the more likely causes of female hair loss (like androgenic alopecia) before trying biotin at all.

Unfortunately, when it comes to nutrition and hair loss, biotin supplements are just the tip of the iceberg.

Exhibit B: Nutritional Supplements That Worsen Hair Loss

While low selenium is linked to hair fall, over-supplementation of selenium is associated with hair loss. The same is true for vitamin A — which is why one side effect of Accutane (a synthetic derivative of vitamin A) is thinning hair. Ironically, many hair loss supplements contain both selenium and vitamin A — despite the evidence that deficiencies in the first world are extremely rare.

Moreover, several chronic conditions can occur alongside hair thinning. As a defense mechanism to these chronic conditions, our bodies often will adapt by forcing a nutrient deficiency. In these cases, taking a supplement to correct our “perceived” nutrient deficiency can literally kill us. And unfortunately, many hair loss supplements contain these nutrients. [More on this later.]

Knowing this, it’s no surprise that a 2017 review on nutrient supplementation for hair loss concluded that…

“…some supplements carry the risk of worsening hair loss or the risk of toxicity.”

The bottom line: if we don’t know why we’re losing our hair, and we don’t test for a nutrient deficiency, we might be doing more harm than good.

Is Pattern Hair Loss Connected To A Nutrient Deficiency?

In the U.S., hair loss exclusively due to a nutrient deficiency is rare. At the same time, pattern hair loss is a common condition, and in forums and natural health blogs, it’s widely assumed that most Americans have a nutrient deficiency.

But is that actually true? And if most Americans do have a nutrient deficiency… is it associative or causative to pattern hair loss?

These are big questions, and to get answers, we need to do some digging. First we need to find out how common pattern hair loss is, how common nutrient deficiencies are, and our likelihood of having both.

Then we need to uncover if people with pattern hair loss suffer disproportionately from a nutrient deficiency… and if so, if the relationship is mere coincidence or something more.

I know it may seem unnecessary to go so far backward to answer this question, but please bear with me. It’s important to question widespread scientific dogma (for example, the idea that we should “ice” our injuries)… because oftentimes, the dogma turns out to be wrong.

Pattern Hair Loss: Prevalence In The U.S.? High.

In the U.S., pattern hair loss (androgenic alopecia) is estimated to affect 80 million of 250 million adults nationwide. That’s 32% of adult men and women — which is lower than I expected.

But if we dive deeper into the data, that percent is probably understated.

For instance, androgenic alopecia incidence tends increase ten percentage points for every decade of life — so 20% of males suffer from hair loss at 20 years old, 30% by 30, etc. And some researchers believe the percent of caucasian men who will suffer from androgenic alopecia, if they live long enough, is 100%  (America is ~75% caucasian). Even for non-caucasians, this first-world survey (on Singaporeans) found that by 80 years old, 100% of Singapore men were balding. And a few hair loss researchers have gone on the record to say that by the time hair loss is noticeable, we’ve already lost 30-50% of our hair.

Taking this into account, it’s more likely 50%+ of U.S. adults have some degree of pattern hair loss, and that almost all American men will experience some pattern hair loss if they live long enough.

And what about a nutrient deficiency? Are these as common in the first world as pattern hair loss?

The truth: it’s unclear.

Nutrient Deficiency: Prevalence In The U.S.? It’s Debated!

Defining a nutrient deficiency is hard — because it’s entirely dependent on where we set “healthy” nutrient thresholds (where we draw a line between “normal” and deficient)… and what we actually measure (circulating nutrients in the blood, or tissue nutrients — like balding scalp skin tissues).

The best data we have on population-level nutrient status comes from the Center For Disease Control (CDC). But the CDC’s reports are far from perfect, and resultantly, are up for interpretation.

For instance, while a 2012 report from the CDC found that less than 10% of Americans have a nutrient deficiency, that same report…

  1. …doesn’t measure all vitamins and nutrients, and…
  2. …uses American reference ranges to determine nutritional status, rather than functional medicine ranges (which are much stricter) or other country’s ranges. For example, Japan’s threshold for a vitamin B-12 deficiency is in the middle of  “normal” in U.S. reference charts. If the CDC had used Japanese ranges to test for vitamin B-12, the majority of Americans would be vitamin B-12 deficient.

And if we look at our nutrient status as a function of what we eat (our diets), things look way worse.

Data summarized by the U.S. Department Of Agriculture shows that 56% of Americans aren’t eating enough magnesium, and 93% aren’t eating enough vitamin E to meet basic metabolic requirements.

(source)

Even worse, this analysis on the diets of seventy American athletes found that 100% aren’t eating enough nutrients to meet their recommended daily allowances (RDA) — especially in terms of zinc, iodine, vitamin D, vitamin E, and overall calorie intake. That’s right. Not a single athlete was meeting their RDA.

The “RDA” is the minimum amount of a nutrient required for general “good health”. In other words, it’s the minimum standard to ensure we’re getting enough nutrients to function — rather than the amount needed for a true therapeutic dose.

Why Aren’t We Meeting Our RDA’s Anymore?

Unfortunately, our dietary choices aren’t entirely to blame for missing our RDA’s. In the past 100 years, we’ve seen a drastic decline in the nutritional profiles of fruits and vegetables — a phenomenon known as soil nutrient depletion.

Nutrient depletion is the mainly due to poor practices in farmland management (i.e., no crop rotation, forced higher crop yields, etc.). Its effects on food quality is drastic. Just see this table from Mineral Depletion of Foods 1940-2002 — which summarizes the 60+ years of data on the declining nutritional quality of fruits and vegetables (among other things):

(source)

Weighing The Evidence: Is The First World Actually Nutrient Deficient?

Again, that 2012 CDC report suggests that less than 10% of Americans are nutrient deficient. But that same report 1) uses conventional reference ranges to determine Americans’ nutrient statuses, and 2) only measures a select group of vitamins and nutrients.

At the same time, food quality and dietary analyses suggest that 93% of Americans don’t eat enough vitamin E, 100% of American athletes are meeting at least one RDA, and nutrient soil depletion trends in the first world are making fruits and vegetables half as nutritious as they were sixty years ago.

This suggests one of two things…

  1. The CDC report is wrong, and most Americans are actually nutrient deficient, or…
  2. The CDC report is right, and Americans are meeting their nutritional needs outside of their diets

That second point isn’t out of the realm of possibilities. About 70% of Americans take some sort of nutritional supplement, which may offset the difference between dietary nutrient ingestion and actual nutritional status. Our gut microbiome may also help. Gut bacteria can produce, synthesize, and assimilate micronutrients like vitamin B-12 and vitamin K, and may offset some nutrient deficiencies in our diets.

But nutritional supplements and gut flora probably can’t explain the entire gap between the CDC’s findings (i.e., less than 10% of Americans have a nutrient deficiency) and the reality of our diets (i.e., nearly 100% of us don’t meet our RDA’s). My guess? It’s likely the CDC report severely understates just how nutrient-deficient we are. It doesn’t measure all the right variables, or the right reference ranges.

The bottom line: we’re all probably nutrient deficient. Most Americans are likely sub-clinically or clinically deficient in at least one nutrient — regardless of whether they’re losing hair.

But Does A Nutrient Deficiency Cause Androgenic Alopecia?

We’ve now established that a nutrient deficiency and pattern hair loss are, at a minimum, associative. One possible explanation: it’s simply because both conditions are so common.

These types of associations happen all the time, and they don’t imply causation. For instance, ice cream sales are associated with shark attacks. Ice cream sales increase on warm sunny days, and on warm sunny days, people go to the beach and swim. But ice cream sales don’t cause shark attacks.

Is the same true for a nutrient deficiency androgenic alopecia? Is this a case of association, not causation?

To find out, we need to uncover if people with androgenic alopecia suffer disproportionately from nutrient deficiencies. So let’s look at the research.

Do People With Pattern Hair Loss Have More Nutrient Deficiencies?

This Indian study found that more than 90% of androgenic alopecia subjects were deficient in histidine (an essential amino acid) and alanine (a non-essential amino acid). Moreover, in men with pattern hair loss, more than 10% had a zinc deficiency… and almost 30% had a copper deficiency.

Unfortunately, that study didn’t include age-matched, non-balding controls — which means we can’t say if those deficiencies are more pronounced than in Indians who aren’t balding. And while studies in India suggest these nutrient deficiencies are more extreme than the general population, we can’t make an apples-to-oranges comparison and feel good about it.

But maybe we don’t have to. Because here’s where things get interesting.

This Turkish study showed men with androgenic alopecia do have low zinc and copper levels… and that those levels are statistically significantly worse than non-balding counterparts.

That’s a big revelation. It implies people with pattern hair loss may sufferer disproportionately more from nutrient deficiencies. The question is… Why?

And this is where things get very complicated.

Can A Nutrient Deficiency Exacerbate Pattern Hair Loss?

Potentially. And here’s why.

There are varying severities of nutrient deficiencies. For instance, you can be barely deficient… or severely deficient. And interestingly, our symptoms of a deficiency change based on its severity — from no symptoms at all to a full-blown bodily shutdown.

So let’s look at the end-points of nutrient deficiencies (severely deficient versus barely deficient), and compare which conditions are associated with each category.

At the severe end of the spectrum (extreme deficiency), we see conditions like scurvy (the near-full absence of vitamin C), rickets (the near-full absence of vitamin D), or nutrient-related hair loss (the near-full absence of zinc, selenium, protein, and many other nutrients). [Again, American diets are far from perfect, but they often provides enough nutrients to avoid extreme deficiencies. So in the U.S., hair loss exclusively from a nutrient deficiency is rare].

At the less severe end of the spectrum (just barely deficient), we see conditions like hypothyroidism, hyperparathyroidism, small intestinal bacterial overgrowth, and polycystic ovarian syndrome.

So let’s graph this out. The green text represents conditions associated with less pronounced nutrient deficiencies; the red text represents conditions from extreme nutrient deficiencies.

Now… what is so surprising about the above chart?

Those conditions in green are all associated with pattern hair loss… and the conditions in green occur alongside just mild nutrient deficiencies.

That’s right. Mild nutrient deficiencies are correlated with the chronic conditions most commonly linked to androgenic alopecia. And when we dive deeper, we begin to understand how just the slightest nutrient deficiency might exacerbate pattern hair loss.

The Link Between Nutrients, Chronic Conditions, & Androgenic Alopecia

First, here’s how each of these conditions associated back to androgenic alopecia.

One of the first signs of polycystic ovarian syndrome (PCOS) is female pattern hair loss. Interestingly,  PCOS is associated with slight (but significant) deficiencies in vitamin B-12, C, D, and calcium.

One of the first signs of hypothyroidism is hair thinning (often diffuse and similar in pattern to androgenic alopecia). Hypothyroidism is also linked to an iodine and selenium deficiency.

A small intestinal bacterial overgrowth (SIBO) leads to deficiencies in many trace elements and B-vitamins. It’s also a condition present in nearly every female pattern hair loss sufferer with whom I’ve worked.

Hyperparathyroidism is linked to both low vitamin D levels and diffuse thinning across the entire scalp — and is nearly identical to the pattern in female pattern hair loss.

Which Came First: The Nutrient Deficiency, The Condition, Or The Hair Loss?

It’s hard to say. At this point, separating cause and effect depends on the person and the condition.

Here are just two examples to highlight how complicated things get.

PCOS

PCOS is associated with a wide range of nutrient deficiencies. Oftentimes, symptoms (like hair loss) improve by correcting those nutrient deficiencies. So it’s possible that for some women, PCOS symptoms are partially rooted in a nutrient deficiency (i.e., deficiency first, condition second).

But in some cases (and likely, the majority of cases), PCOS-associated nutrient deficiencies are actually due to a compounding condition: a small intestinal bacterial overgrowth (SIBO). In this scenario, PCOS is secondary to SIBO — as are the nutrient deficiencies (i.e., condition first, deficiency second).

Hyperparathyroidism

Hyperparathyroidism can occur when a tumor forms on a parathyroid gland — interfering with our ability to produce parathyroid hormone. When our bodies can’t regulate parathyroid hormone, we also have trouble regulating blood calcium levels — and serum calcium increases.

As an adaptive response, our bodies will lower vitamin D levels — since too much vitamin D in the presence of high calcium can lead to arterial calcification. In this case — it’s tumor first, condition second, and an adaptive nutrient deficiency third.

Can Nutritional Supplements Improve These Conditions (And Our Hair)?

We should never assume yes. And when we go down the list, we realize that in many cases, a nutritional supplement will either be useless, or dangerous.

PCOS

If your PCOS is, in part, due to not eating enough of the right nutrients — then nutritional supplements can often improve your symptoms (and in some instances, stop hair loss).

But if your PCOS is compounded with a SIBO infection (as is often the case), it’s likely that your nutrient deficiency isn’t only due to not eating enough. Rather, the deficiency is due to bacteria (or yeast) getting to the nutrients you ingest before your small intestine can assimilate them. In this case, a nutritional supplement might actually just encourage the overgrowth of more bacteria. Instead, you should first opt for a SIBO treatment, then address the nutrient deficiency after you’re clear.

Hypothyroidism

The causes of hypothyroidism are multi-faceted and not typically due to nutrition alone. Having said that, hypothyroidism is most often associated with an iodine deficiency. Knowing this, many people choose to supplement with iodine — in hopes of improving their symptoms. Sometimes, this helps.

But ironically, whether iodine will help actually depends on your type of hypothyroidism. If you have the most common form of hypothyroidism in women — hashimotos thyroiditis — supplemental iodine may actually make your condition worse. And this study found that ironically, iodine restriction reversed hashimotos in 78% of subjects.

The bottom line: if you have hypothyroidism, you probably also have an iodine deficiency. But if you supplement with iodine, you might actually worsen your condition.

Hyperparathyroidism

In secondary hyperparathyroidism, our bodies lose the ability to regulate calcium levels in the blood, and as a response, our bodies force a vitamin D deficiency — because high vitamin D in the presence of calcium leads to arterial calcification (a precursor and cause of heart disease).

In this case, if you supplement with vitamin D (even in small amounts), you’re acting against your body’s defense mechanisms… and in doing so, increasing your serum vitamin D in the presence of calcium and exacerbating your rate of vascular calcification.

That can literally kill you.

The bottom line: if you have diffuse hair thinning across the scalp and a vitamin D deficiency, don’t fall into the trap of blindly supplementing with vitamin D.

Instead, first test for hyperparathyroidism. All that’s required is a serum reading of your PTH, calcium, and vitamin D. If things come back normal, feel free to supplement. If you come back with high calcium, low vitamin D, and/or out-of-range PTH — you probably have hyperparathyroidism, and you should seek treatment for that first, and under no circumstances supplement with vitamin D.

Anemia

Many women with hair loss also have an iron deficiency. And oftentimes, if these women get more iron into the body (either through dieting or supplements), they see improvements in their hair loss.

Having said that, anemia isn’t always due to low iron. There’s actually a case where our bodies will force low iron stores as a defense mechanism. This is especially true in low-grade, asymptomatic blood infections.

Here’s a gist of what happens:

Pathogenic bacteria feed off iron to survive. And if a pathogen enters our blood stream, our bodies will respond by lowering iron stores in an attempt to reduce the proliferation of that bacteria. This is a condition known as anemia of inflammation — and health professionals who don’t run both iron and ferritin panels on their “anemic” patients miss it all the time. The end-result: the recommendation to supplement with iron, the proliferation of the pathogen, and oftentimes the death of the patient.

Once again — the takeaway is that if you’re presenting with hair loss and an iron deficiency, you absolutely have to run the right diagnostic tests before supplementing. [Note: an article about iron and hair loss is coming soon.]

Final Thoughts: The Nutrition-Hair Loss Connection

The connection between nutrients and pattern hair loss is incredibly complicated, and it’s unclear just how far we can implicate poor nutrition with androgenic alopecia. Even still, here’s what we know:

Nutrient-related hair loss occurs under extreme nutrient deficiencies. This is uncommon in the first world, and it’s different than pattern hair loss (which accounts for 90%+ hair loss cases in the first world).

Despite this, supplement companies continuously misinterpret hair loss studies on malnourished populations — implying that if biotin can regrow hair on a starving child suffering from a lifelong biotin deficiency, then supplementing with biotin must help hair loss for people who can actually afford to supplement (i.e., the first world). This couldn’t be further from the truth.

It’s difficult to separate association versus causation when it comes to nutrient deficiencies and pattern hair loss — because both are so widespread. Having said that, evidence suggests people with androgenic alopecia tend to suffer disproportionately from nutrient deficiencies — particularly in terms of amino acids, zinc, and copper.

Interestingly, less severe nutrient deficiencies are linked to other conditions associated with pattern hair loss: PCOS, hypothyroidism, hyperparathyroidism, a SIBO infection, and even anemia. In some cases, nutritional supplementation may help improve the condition and marginally improve hair loss outcomes.

But I can’t stress this enough: this is a case-by-case basis. Hair loss sufferers who want to take a nutritional supplement should first test for a nutrient deficiency, and then the chronic conditions associated with whatever deficiencies they present — and before they supplement. Failure to do so may make waste money, waste time, worsen hair loss outcomes, and even increase morbidity.

What’s Next

In part two of this series, we’ll dive beyond nutrients to investigate the benefits and pitfalls of all major diets — from veganism to paleo — and their potential impact on our hair. We’ll also reveal a major finding from a 2017 survey on readers — a connection between dieting and hair regrowth — and why it’s relevant. Finally, we’ll uncover the limitations of any diet for reversing pattern hair loss — all due to androgenic alopecia’s location and isolation.

The third and final installment of this three-part series will reveal actionable advice: the best nutritional and dieting practices for anyone interested in slowing, stopping, and reversing hair loss. Here’s a hint: it’s not any specific diet, nutrient, or supplement regimen… but it is something that most of us aren’t doing.

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Stop Googling "How To Regrow Hair" Until 3AM

Instead, just sign up for my 10-day course on natural hair recovery.

You'll get access to my before-after photos, the science behind the DHT paradox, hair loss mistakes to avoid, reader-submitted photos, and more.

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Comments 155

  1. Excellent job. In a world where journalistic standards have plunged to the point that the average article is as typo-ridden as a D. Trump tweet- even those from respected news sources- it’s refreshing to see this level of professionalism. Obviously, you did a staggering amount of research, and the conclusions you draw are well-argued.

    Now, let’s talk glycation. What is it exactly? Basically, sugar-induced, cellular inflammation. It can make you go grey prematurely. It can make your hair thin. I kicked high glycemic carbs recently (today is Day 28) and it seems that my hair has stopped shedding. I have a feeling this is the missing piece of my hair loss puzzle.

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      Author

      Thanks Adrian! What was it that brought about your interest in glycation? It’s something to which I haven’t studied well enough to speak about — though I’ve heard of a number of people who’ve gone on all-meat diets — or extremely low-carb diets (which should drastically reduce glycation potential) — and seeing major improvements in nearly all autoimmune symptoms, skin disorders, etc. It’s certainly possible this could be a major piece to what’s triggering your shedding — as I know your hairline has pretty much remained stable for the last couple years, and the sheds seem to be the problem.

      Best,
      Rob

      1. On second thought, I’m wondering if glycation is actually the issue. I discovered the term while researching the connection between sugar and hairloss, as it was obvious that I was/am totally addicted to sugar. Real talk: most grown men don’t remove the stuf from TWO Double Stuf Oreo cookies, sandwich it between two Chips Ahoy, dunk it in milk and then actually eat it. This is the stuff of eighth grade sleepovers. After hitting rock bottom, I began to wonder how my addiction might be fueling my hairloss. Flash forward a month: I have cut the high glycemic carbs, fruit and sweets. Sure enough, my hair has stopped shedding. Hopefully it’ll start growing back

      2. Just realized that last response said absolutely nothing. What I meant to say is that I think the issue might have more to do with insulin resistance and the ensuing hormonal wreckage. Without getting too graphic, let’s just say my procreative impulse have intensified dramatically since the sugar cessation.

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      Author
  2. Hey Rob, I’m 16 years old and I’m already receding slightly and thinning slightly on top. I don’t have much money and I’m too young for the FDA approved meds. Is there any way you could send me a list of affordable things I should do to stop my hair loss such as massages or saw palmetto…. This is really causing me problems. Please help me.

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      Author

      Hey James — you can certainly try microneedling or massaging. Any supplement like saw palmetto typically only works as long as you use it — which means $30+ per month out of your pocket. At the same time, I wouldn’t recommend taking any DHT-reducing supplements at such a young age. You’re going to continue to physically develop over the course of the next decade. Keep your hormone levels naturally, and instead, opt for better dietary / lifestyle choices to improve overall hormone production.

  3. Hey Rob,

    It is said that this post was published in June 19th yet I just see this article today. Any error when publishing this post?

    Anyway, looking forward for the next post!

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      Author

      Hey Reza! I privately published the post (no one could see it), and once I finished it, made it public (just a few days ago). That’s probably the discrepancy 🙂

  4. Hi Rob , Great article .

    The only conclusion i can draw in regards to demographic changes and movement is the radical change in diet and stress.

    You mentioned modern manufacturing of food process which i totally believe is a causative. Along with
    higher stress leading to cardiovascular issues and thyroid problems.

    I believe heart health is related more than we think. There is a disease related to the heart in which a persons entire face can be covered in hair.

    Il try and find the study.

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      Hey Paz — the data certainly implicates a relationship between heart disease and AGA. In fact, a study to uncover gene targets for AGA was just recently published — and the genes were identified by correlating AGA to coronary heart disease.

      https://www.jidonline.org/article/S0022-202X(17)32131-0/fulltext

      I also agree with your comments about stress + diet. Environmental factors seem to accelerate AGA, and even in twin studies. Everything seems to be inter-connected.

      Best,
      Rob

  5. Hi Rob
    I split my entire scalp into three parts and massage it one part every time. Two sessions of massage 20 minutes a day. Noon and night at a distance of 12 hours from each other،and this cycle is repeated. If I follow precisely the 12-hour intervals between massages, then I have 36 hours time for recovery,do you think this is a little time to recover or is it enough?
    Thanks

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  7. Unbelievable piece of work rob! I just want to say thank you for the hard work and continued interest in this subject for all of us who desperately need help with our hair loss.

    P.S: I can see one of these days you’ll end up with your own high end clinic and a nobel prize!

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      Thanks Dan! That’s very kind. A nobel prize isn’t in the foreseeable future, but I do have a couple more papers almost ready for publication! I look forward to sharing the findings with you and everyone else, so that we can all continue to make steps forward in health and in hair.

  8. Hey rob,

    I purchased your Ebook and have been doing the massages for past couple months or so, and essentially have cut out gluten, dairy, and grains from my diet. I shaved my hair pretty short, so it’s unclear whether or not it’s making a difference. I want to start testing out different types of diets, however. What do you think is the best way to approach that? Do I get certain nutrient levels tested first? If so, which ones? And, what would you reccommend as the first couple of diet types to go on, and for how long to test them out? Thanks!

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      Hey Sean,

      I plan on writing more about this soon — but it all depends on your budget. In my opinion, the best way to do this is to do a complete blood panel that includes vitamin D, zinc, copper, a full iron panel, b-12, and a thyroid panel — then test a diet for 3 months, then retest the same panels and see any differences. I’d also journal / track diet changes alongside daily energy, skin, hair, mood, and bowel movement qualities — to see if you can identify any potential dietary allergens that you might be consuming on a regular basis, or that may be having a lagged effect.

      Another route is to just test for food sensitivities, and then build a diet around that.

      Best,
      Rob

  9. Thanks for the answer, I figured it might be bad to mess with my DHT levels at a young age. However, my diet is pretty good already, but I’ll keep working to improve it. I also read your article on shampoos and conditioners, and I’ve quit using them completely in the last month. However, I’ve been considering buying a shampoo like Nizoral or Lipogaine with ketoconazole. I feel like it might help if I reduce scalp DTH with a shampoo in union with scalp massages and microneedling. But my question is would this trigger excess sebum production like normal shampoos do. Also, would using oils with microneedling be effective? Sorry for more questions and thanks

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      As long as you’re not shampooing in excess (every day, and sometimes multiple times per day), and you’re sticking to shampooing at maximum 2-3 times per week, then any additional sebum production shouldn’t have that drastic of an effect on the quality of your hair.

      You can certainly try oils with microneedling! There are a few articles on the site that talk about this:

      https://perfecthairhealth.com/does-rosemary-oil-help-fight-hair-loss/

      https://perfecthairhealth.com/why-most-hair-loss-topicals-fail-to-regrow-hair/

  10. Hi Rob!

    First at all, thanks for your really great work, Rob!!

    This is Victor from Spain. In the past i asked fot the difference between dermaroller and dermapen and you always surpise me with your extremely well reasoned answers. Now I wat to ask you twoo questions:

    1.- I bought your book last year and i have had quite exit in my crown area but not in the temples. Lastly i have change massaging for dermaroller and it has been quite good. At less it seems i have stopped my hair loss, but i am thinking in doing a hair transplant in my temples area. How much time after the transplant do you think i have to wait to apply dermaroller again?? Do you thinks a transplant is a bad idea? It is the only real way i see to see new hair growing in my temples again!

    2.- Lastly i have been using a product called Zymessence to fight fibrosis and chronic inflammation. The creator says it has been used against scleroderma with good results. Do you thinks it can be useful???
    https://drwongsessentials.com/zymessence-systemic-enzymes-blend/

    3.- In past you said you are going to write about autophagy and hair loss. Do you think fasting could be useful against chronic inflammation and fibrosis??

    Thanks a lot Sir!!

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      Hey Victor,

      Thanks for the kind words. In terms of how much time to wait after a transplant to start dermarolling — I would ask your surgeon about this. I would assume that a few months is likely required, but there’s actually very little research into this — and it’s entirely possible that not waiting at all might not impact the results of the transplant. But I’m sure your surgeon will have a better idea of how his or her dermarolling patients have responded in this respect.

      You can certainly try the Zymessence supplement! In general, I like Dr. Wong’s research and writings. While I think that AGA’s inflammation is structurally-mediated (and not systemically-mediated) — and therefore I think there will only be marginal benefit from the supplement — I also believe that if you want to try something, you should absolutely self-experiment. I recommend tracking your skin / hair / mood / bowel movement quality changes daily as you start supplementing, to see if you see any positive effect, and for how long until things begin to return to baseline. As a side-note — things will almost always return to baseline with supplementation. As we end up taking more exogenous enzymes through supplementation, our bodies eventually reduce endogenous production of those enzymes to even things out. That normally leads to a temporary increase in benefit, and then a slow return to baseline in the coming months following supplementation continuance.

      RE: autophagy article–

      Yes! This is still on my radar, as is the article about greying hair. These two topics are so incredibly complicated that it’s almost like learning an entirely new field. As a result, I’ve started both articles but am nowhere near finished with either — as I’m still combing through the research and have been side-tracked by various other AGAa-related topics. I certainly think localized autophagy might be THE critical thing that gets everyone to full hair recoveries.

      Best,
      Rob

  11. My hair loss started when the endocrinologist that I switched to so i did not have to drive so far left my Hashimoto’s Hypothyroidism out of level. My TSH went low and my T4 went high. As you know with Hashimoto’s Hypothyroidism the levels fluctuate. So since July of last year up until about 4 mths ago my levels were out of range. Now with that being said it triggered my already extremely high immune system (Mast cells) when my thyroid was out of range which triggered seborrheic dermatitis and Chronic TE. I have always been deficient in Vitamin D but did not find out until 2010 after my grandson was born with Cystic Fibrosis. My vitamin D was then checked and it was 7. Then my labs were sent to Mayo and found out that I have a mutation to my CF carrier gene which caused me to have chronic pancreatitis and gastrointestinal CF. Also, I have 5 heart conditions one being Long QT Syndrome which can block any ion channels at any given time and cause a fatal arrhythmia and/or death. Now, back in 2016 I literally lost 3 electrolytes, Calcium, Magnesium, and Potassium. I have to take all 3 replacement therapy twice a day and also have to take high amounts of vitamin D. With CF you tend not to be able to absorb fat-soluble vitamins. I had stopped taking my prescribed vitamin D (which was dumb) but I am now taking it again and added Biotin and my hair is getting better and very quickly. So there are other things that trigger hair loss. I know most is on the basis of generally healthy people but there are more illnesses that do cause hair loss that trips up vitamins in your body. My calcium replacement is masking my hyperparathyroidism but the vitamin D supplement is not having any negative affect on anything taken with my calcium, potassium, and magnesium. To date ( I go to a major medical university) no one understands or has ever seen anyone literally lose 3 electrolytes and never come back. They have seen some drop a little low but come back to normal. I guess I am a rare one.

  12. I think the problem is hair loss is complex and probably has multiple causes.

    For men, particularly white men, androgen signaling issues seem to be the major cause. This could be caused, for example, by the body producing higher levels of DHT to counteract falling testosterone levels leading to higher 5AR activity which causes more localized Androgen receptor activation and increased oxidative stress due to more enzyme activity. This is why Finasteride/Duasteride is so successful for white men in particular because they disable the enzyme inside the follicle itself–though they also target the enzyme elsewhere. As you said, our lifestyles and deficiencies could exacerbate the hormone dysfunction and the increase localized Androgen production to combat Androgen insufficiency and/or inflammation which eventually leads to androgenic alopecia. This localized inflammation then can cause Prostaglandin imbalances among other things. Eventually leading to fibrosis, shrinking of the follicle and stem cells changing from follicles to skin.

    The current treatments: DHT inhibitors (Finasteride/Duasteride) Prostaglandin modulators (Minoxidil, PG analogs such as Latisse and drugs being studied such as Seti) preservation of follicular energy production (topical caffeine) and growth factor inducers (dermarolling, PRP) are all going to help keep what we have and grow hair–however hair loss should not feel INEVITABLE…for some men it surely is. Hair loss has been around for millenium. But for others it most likely is precipitated by something else.

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      Hey James — great thoughts, and I agree! We certainly have a slew of treatment / therapy options that all target different aspects of the pattern hair loss equation. Uncovering which combinations or mono-therapies that will 1) be the most effective, and 2) minimize the chance of side effects, is all person-specific. Nutrient deficiencies have the potential to exacerbate hair loss for some individuals, but sometimes they’re just symptoms of other underlying conditions.

      Best,
      Rob

  13. Hi Rob!
    I am Tsveta from Bulgaria. 2 years ago i have been diagnosed with FFA. Before to be diagnosed i lost my eyebrous and my body hair. After that , probably 1 year later hairline has receded , I’ve lost inch and half from my sideburns. My forehead is rapidly progressing . Sometimes, my scalp is itching and then hair falls a lot. Sometimes it seems to stop for 2-3 months and then pick up again. Now i noticed that eyelasches are thinned. I am not using any medications. My Derm prescribe me Dermovate and ELIDEL cream to applay on the skalp, Menoxidyl 5%, but i stiil wonder what to do .
    Best Regards:
    Tsveta

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      Hey Tsveta,

      Thanks for reaching out. With hair loss that also encroaches into the body / face, generally autoimmunity is suspected. Have you looked into running stool analyses to determine microflora composition and inflammation, digestion/absorption, and immunological parameters?

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  14. Good article, Rob, thanks! I’m looking forward to parts II and III.

    There is a typo, “PCOS is associated with slight (but significant) deficiencies in vitamin B-12, C, D, and cobalamin” looks like it should be “PCOS is associated with slight (but significant) deficiencies in vitamin B-12, C, D, and calcium”.

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  15. Great stuff Rob. I’ve been taking high dosage biotin for the last year, can’t say it’s helped at all. I fell for it! Was just about to buy collagen tablets too because they also sound so great in the write ups from the companies selling them, guess that’s not such a good idea either. There’s no magic bullet by the sounds of it, I’ll stick to healthy eating, massaging, and dermarolling until further notice. Cheers

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      Thanks Richard. Nutritional supplements are certainly helpful for some people, but it just seems like the majority of us aren’t going to see benefit. Certainly cutting back will help save money!

      In any case, I like to think of collagen supplementation as generally helpful. It’s high in glycine, and glycine is associated with life extension in mouse models, and in humans, inflammation resolution. This review is great, if you have access to the full article:

      https://www.ncbi.nlm.nih.gov/pubmed/12589194

      The good news is that if you have regular access to bone broths / stocks , you generally don’t need to buy supplemental collagen. Even still, hydrolyzed collagen is generally the only thing I (occasionally) supplement with nowadays — maybe once or twice a week.

      Best,
      Rob

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  16. Rob, thanks for the phenomenal commitment and work!

    A list of physicians who follow along and are willing to investigate these underlying pathologies would be so invaluable for the future. Oftentimes, requesting all this testing becomes impossible with uninformed and/or unsympathetic medical professionals. hence the ensuing financial burden makes all this a moot point for many of us.

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      Hey Jaya,

      Thank you — and I agree! I’m working on putting together a list of symptom-specific lab tests that people should consider getting. The next step is to pair those tests with a list of physicians that operate within insurance policies but also understand that patient best-practices for diagnosis / prevention have evolved since their residency. It’s going to be a longer process, and unfortunately, most of us (myself included) will likely have to pay for tests out-of-pocket, and work with functional medicine practitioners who even offer the tests in the first place. We clearly need a revamping of the healthcare system.

      Best,
      Rob

  17. Hi Rob
    I hope you be ok. I had a questions about hair rinsing, I completely follow your advice and did not use any shampoos to wash hair. I use only warm water and I usually use cold water to wash the hair at the end of the bath. Dear Rob i wanna know how many minutes do you wash your hair every days? My scalp is very greasy after massage ,so that when I wash my head scalp and i do scrubbing my fingers get something like white fat under my nails,Is this the sebum? Do you also use nails for scrubbing to clean the scalp when you wash?

    Thanks&regards

  18. Dear Rob !

    I have found something like this :

    The liver processes fats and hormones among other things. If the liver has low levels of a certain essential ‘coenzyme’ called coenzyme A, sebum levels can increase to above normal levels. Coenzyme A breaks fat down. But if coenzyme A levels are low and/or the liver is working inefficiently, the body has no choice but to secrete fats in sebum through the skin.

    What do you think about this ? Is this information correct ? If it is, then how can we elevate this coenzyme levels in our body ? how can we have a healthy liver to stop hair loss and have new regrowth ?

    Thanks in advance

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      Hey Jordan — I wrote about this in this article:

      https://perfecthairhealth.com/p-acnes-bacteria-may-cause-hair-loss-heres-what-to-do-about-it/

      To quote an excerpt: “OG is topically applied and works by inhibiting an enzyme called acetyl coenzyme-A carboxylase — which is needed to synthesize the fatty acids inside sebum. With less acetyl coenzyme-A carboxylase present, less sebum fatty acids are secreted to the skin, and thereby fewer p. acnes can colonize that skin.”

      So you can reduce acetyl coenzyme-A carboxylase both systemically (orally) and locally (topically). However, I think this approach can be a little short-sighted for sebum regulation. Acetyl coenzyme-A carboxylase is an enzyme that helps to regulate skin and hair lubrication via fatty acid secretion through sebum. Rather than target to reduce its presence in absolute terms, I think a better approach is to try to optimize the microbial composition of our skin and gut. Doing so should reduce the inflammatory byproducts of the microorganisms, and resultantly, improve sebum regulation.

  19. Hey Rob,

    great read

    Im really looking forward to the next entry though focusing on diet. When will this be online?

    Regards

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      Hey Rich! Thanks. I’m working on it! My hope is that part two will be available in the next couple of weeks. I might have an article out before that too.

  20. Rob, another great article. However, any update on the grey hair article you mentioned you had thought about working on? Thanks for all your efforts.

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      Hey Fernando — thanks for following up about this, and I apologize for not having that article up yet. The grey hair equation is so complicated that I’m apprehensive to write about it just yet. I think one of the challenges is that as I better understand the problem, I don’t yet have any viable solutions / treatments that I’ve uncovered. Anecdotally, I’ve seen juicing diets improve hair color in a few people. However, the effect is pretty marginal, and I’ve yet to see major reversals from grey hair with any therapy / diet / etc. (aside from coloring). With that said, I’ve seen significant grey hair reversal due to accidental wounding — where someone inadvertently injures a large part of their scalp, and throughout the healing process, happens to recover a lot of hair color. I’m still working on researching the mechanisms, and contacting the investigators involved in these case studies to see if the patients could’ve been on certain medications that modulated their recovery toward pro-hair pathways. There’s some speculation certain arthritis medications could do this during injury.

      In summary — when I started that grey hair article several months ago, I had inaccurately signaled to you (and others) that it would be done relatively soon. As I’ve uncovered more paradoxes in the literature, I’ve realized that I underestimated its complexity. I feel like I’m learning an entirely new subject in addition to AGA. But I do want to let you know it’s still top-of-mind, and I’m still working on it!

      Best,
      Rob

  21. Hey Rob
    I have lost the density above my to crown maybe due to stress or nurturing deficiency but when I got right dirty it speed falling out will that hair grow back by teaching the right dirty and oiling.
    I have lost in past 5 months
    Thanks

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      Hi Akash — I’m having a bit of trouble understanding your question / comment. Are you saying that after changing your diet, your hair fell out at an accelerated rate? Did you confirm your hair loss was stress- or nutrient-related? To/from which diet did you transition?

  22. Hey Rob, thanks for all this great information. I’ve been slowly losing hair since 2015 yet it seems that within the past 6 months its gotten much worse. Coincidentally this has been the time during which I started working a mentally and physically stressful job and not eating sufficiently to make up for the energy expenditure.

    What I’ve found most alarming though is that during this same period of time it seems the front and back areas of my skull have actually expanded to the point of looking almost deformed (cone headed) from certain angles (embarrassing to say the least). It’s clearly these expanded areas which present the worst hair fall and thinning. I feel slight pressure and numbness to the touch in these areas. If an expanding skull does indeed cause hair loss how can this be reversed? Are cases of significant skull expansion ultimately hopeless since the extra bone can’t be eliminated?

    1. Dima

      Robs book recommends scalp excersizes which help against expansion, he has the on video in the book.

      I more inclined to believe that the medical industry knows about expansion and skull growth, after CT scan evidence.

      However this then means that hairloss cannot be medically reversed completely by drugs, pills or surgery alone. And the industry cannot sell it.

      Regards

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      Hey Dima,

      It’s possible that as the subcutaneous fat layer that cushions the hair follicles erodes (this is a symptom that coincides with hair thinning), that simultaneously, people become more aware of the contours of their own scalp — since they can feel the ridges / bones more with less of a fat cushion. Conversely, you may also be noticing slight changes to bone structure. There are stages where our scalp sutures close — and many of them happen into adulthood.

      In general, skull expansion is likely informed by genetics just as much as it is muscle contraction along the perimeter of the scalp. At a certain point, cause-and-effect become difficult to delineate. In any case, we’ve seen a full hair recovery (by accident) from a 78-year old, totally bald man who accidentally burned his scalp, and throughout the healing process, regrew his entire juvenile hairline. If we assume that skull expansion, muscular contraction, genetics, etc. all contributed to his hair thinning — then at the end of the day, maybe solutions outside of trying to remodel skull bone can help recover hair. So I wouldn’t feel hopeless at all. We just need the research to catch up to the case studies.

      Best,
      Rob

  23. Hi Rob
    Is it necessary to hear the cracks sound during massage, after two months I heard this sound only one time during massage?
    thank you for the useful information

    1. Hi sasan.

      I hear these all the time. Especially where skin became more elastic.
      Especially at the front temple’s.

      Now interestingly, the four areas associated with skull expansion are the front two patrial bones and the back two of the vertex.

      This is where hairloss takes most activity.

      In my experience I believe this to be a sign of progress. However don’t pain yourself in these massages, you should feel throbbing which is good.

      Regards

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      Hey Sasan — in general, that shouldn’t be necessary (although noises are sometimes reported). Typically, any cracking noises are actually the result of edema (swelling), not necessarily bone movement (as that would hurt way more). If the sounds persist, that’s more of an indication that you may need to allow more time between massages for healing, or to just reduce your intensity.

  24. Rob – a little off topic but in light of your article here, do you recommend *against* calcium and VitD supplementation due to risks of increasing atherosclerosis? I’m talking about for a general, otherwise healthy person.

    Also, how do you feel about Vitamin K2 MK7 form. There is a lot of interesting information going around about MK7’s effect on the reversal of atherosclerosis. There are ideas it could help MPB as it may reverse vascular calcification in the scalp. At least in theory.

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      Hey Steve — yes! In general, I recommend against vitamin D supplementation even for healthy individuals. This article here explains a bit more:

      https://perfecthairhealth.com/vitamin-d-deficiency-does-it-cause-hair-loss/

      There are a few cases where vitamin D supplementation is potentially great — particularly for people in winter months who suffer from seasonal affective disorder and who are nutrient replete everywhere else except vitamin D.

      RE: MK7–

      We’ve seen MK7 reverse Warfarin-induced calcification in rat models. However, the calcification in this case was induced from a medication, and MK7’s applicability to calcification induced from localized inflammation / tension (i.e., MPB) is questionable at best. I’ve never seen a case where MK7 moved the needle in terms of improving hair loss outcomes. Having said that, it’s certainly something that doesn’t hurt to supplement with on occasion. I used to do it a couple times per week for a year or so. If you find benefit from using it, please feel free to keep going! I haven’t seen any cases where it’s actually had a negative impact either.

      Best,
      Rob

  25. Hi Steve. The Vitamin D3 that I’ve taken for the last couple of years has K2 in it, figured that was a pretty standard thing these days? Not sure it’s working, just one of many ingredients in the hairloss cocktail I suppose. The pills I take have 25mcg Vitamin D, and 90mcg K2. It just says for general wellbeing and bone health, nothing hair related. Hairloss is why I take it off course, hopefully it’s helping a bit

  26. Brilliant article, Rob. I’m excited to see what comes next in this series, most of all what to do with excessive shedding.
    I don’t know if you remember my condition: MBP, except, as of now, after exactly one year with the massages (and a disheartening amount of shed, typically more than 60 hair strands, with each massage) I haven’t seen any signs of regrowth, except for lighter density atop my head. I literally can’t touch my hair or scalp without losing at least three hairs. I don’t know what’s causing this. I’ve checked my nutrient values, I don’t have any food allergies AFAIK, and my diet is pretty much within the limits of what is described in your book.
    I just can’t see myself getting any effect out of your techniques if I can’t get this shedding under control.

    Ben

  27. Hi Benjamin

    Just read your post and just curious.

    60 hair per massage is abnormally high. After one year. Id expect you to be completely bald.

    Are you doing these massages correctly, I expect shedding but that’s a very high number after a year.

    In this case I would strongly think that your thyroid, or lifestyle is causing the shed. Are you stressed ?

    Have you noticed any positives at least ? And what is the quality of the shed are these thick hairs , straight ect.

    Regards

    Paz

    1. Hey Paz

      Me too. I honestly don’t understand why I’m not bald already. Interestingly, the other night I combed my hair a few times and an unbelievable amound of hairs fell out/got caught in the comb. I almost threw up from how uncomfortable that was.
      What I noticed though, was that I found the most amount from the sides and the back; the areas that MPB normally don’t affect. I also didn’t lose as much from the massage after I combed it, which means that it most likely doesn’t have anything to do with my massage technique or the massage itself. My shedded hairs are just falling out throughout the day and night and getting stuck in my hair. I still shed a lot of hair though, more than the normal 100 a day.

      As for my lifestyle, I live generally on a low-carb diet – little to no grain stuff. I’ve also just started lifting. In my fourth month now. I’m sure have a little depression, and generally low energy so I plan on checking on how my thyroid is faring.
      I’m also wondering if there is something that I eat that is causing this, or if my scalp’s outer environment is too dry or something, since I do have a lot of dandruff too, as I don’t shampoo my hair that often.

      As for my individual hairs’ qualities, they vary greatly. I tend to see that there is a general exclamation mark shape toward the root on most of the hairs if they are longer. If they are shorter they tend to be thicker and darker in colour toward the root. They are almost always straight. My hair tends to curl a little bit from the sides and the back though.

      Overallafter one year with the massages, I see that the density atop my head is getting lower, as is my crown area. My temples are still just as big, and the hairline is getting weaker.

      Thank you for you attention.

      Ben

      1. Ben

        I think that is thyroid or autoimmune related. Losing hair form sides and back seems to indicate that. But again that’s my guess. Also you mentioned low energy , which is a give away to thyroid problems.

        My honest guess is check Vitimin D, thyroid health and maybe even gut health.
        I recently read that hair is so reliant on Vitimin D that its so often overlooked.

        I doubt you just have normal MPB.

        regards

        Paz

      2. Hey Paz.

        Just to clarify, I’m not losing as much hair from my sides as I do from the top and front of my head. I’m a lot less dense at the typical balding areas of MPB. My hairline follows a painfully obvious “M” pattern.

        I’m not worried too much for my vit D levels. My doctor said I should actually hold back on any supplements. I’ll try to check my thyroid when I can.

        Thank you

        Ben

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        Hey Ben,

        Shedding-related disorders can be hard to diagnose. Sometimes, it’s just a function of the number of hairs someone has (the greater the density, the more hairs daily that are likely to be shed — like a dog). But when someone’s anagen to catagen ratio typically enters below 90% — meaning you have over 10% of hairs in the resting phase of a cycle — that typically is outside of the norm, suggesting an issue.

        I’d agree with Paz to check for systemic issues, particularly based on the additional symptoms you provided. One test that is absolutely worth the price of admission: a Comprehensive Stool Analysis / Parasitology x3:

        https://www.doctorsdata.com/comprehensive-stool-analysis-w-parasitology-x3/

        This gives us insights into our gut’s microbial colonies as well as inflammatory, absorption, and immunological biomarkers. Resultantly, it can give us insights as to whether you might be experiencing autoimmunity or consistently ingesting some sort of allergen, and as a consequence, could have higher markings of systemic inflammation that may contribute to periphery-related disorders (like excessive hair shedding).

        If you go down this path, let us know. By the time your test results are back, there should be a community / forum here where you can post the results and we can all take a look and comment to provide additional insight. Otherwise, just email me and I’m more than happy to take a look.

        Best,
        Rob

      4. Hello, Paz and Rob.

        Checked my oral temperatures (under the tongue) over the course of a day and got these results:
        Morning: 9:40am – 36.0C (96.8F)
        Evening: 5:00pm – 36.5C (97.7F)
        Nighttime: 11:45pm – 36.4C (97.52F)

        Overall seems to be about 97.2F, so I wonder if this is low enough to conclude it a thyroid problem?

  28. Hey Rob, what is your thought on fasting to reduce inflammation?

    It can be used to induce autophagy as well, which is beneficial for recycling unnecessary broken cells.

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      Hey Reza,

      This is covered in the book’s FAQ’s! In general, there’s potential for some benefit for overall health. However, it’s unclear just how well this will translate to hair health. I think autophagy might be a critical mechanism for full hair recoveries — though the effect needs to be localized to AGA-affected scalp tissues (and it’s hard to control for this).

  29. Hi guys
    Pls someone help me.I had a questions about hair rinsing, I completely follow rob advice and did not use any shampoos to wash hair. I use only warm water and I usually use cold water to wash the hair at the end of the bath. I wanna know how many minutes wash my hair every days? My scalp is very greasy after massage ,so that when I wash my head scalp and i do scrubbing my fingers get something like white fat under my nails,Is this the sebum?is this safe to use nails for scrubbing and clean the scalp when we washing?
    And i usually after wash my hair my scalp produces dry dandruff

    1. Hi Keysi

      Personally speaking I did the same as you . I wash my hair everyday in the shower with hot / then warm and finally cold rinse.

      When i begun this journey my scalp was greasy and oily, however this begun to subside after about 4- 5 months.

      Your going to get a lot of dandruff and grease in your fingers when starting off, this is dead cells and material which most likely clogged your pores.

      Continue to shower as normal. Id use tips of my fingers but not my nails.

      Please comment when your scalp sebum levels become normal.

      Im sure Rob might respond with a more detailed answer.

      regards

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        Hey Keysi,

        It’s okay if you don’t adhere perfectly to no-shampooing. In general, most people find that after the adjustment period, no-shampoo helps to normalize sebum production and improve the overall health of the scalp skin. However, some people hate getting through that adjustment period (which can last a couple months).

        Resultantly, if you decide to shampoo once or twice per week, that shouldn’t make the difference between regrowth / no regrowth. In general, I’ve found that shampooing tends to only be problematic for people who shampoo chronically (everyday, and sometimes twice per day).

        Otherwise, I think Paz has left great advice.

        Best,
        Rob

    1. Post
      Author

      Hi there,

      I’m a bit confused. It seems like your articles cite the same references in my paper…

      http://www.medical-hypotheses.com/article/S0306-9877(17)31041-1/fulltext

      Even the ordering of information / citations in your second article seems to match what I wrote in my manuscript. For instance, your article states…

      “According to the current theory, hair follicles on top of the head show increased expression of the androgen receptor gene [13], i.e. the top of the head is more sensitive to androgens action than hair on the sides and back of the head. However, higher levels of androgen receptors are also found in follicles of beard, scrotum and pubis, reinforcing the paradox [14]. Genetics also suggests that the probability of male pattern hair loss is dependent on family history and age [15]. However, in case of identical male twins, one can bald significantly faster than his counterpart [16]. These together with many other unknowns bring the necessity to define a new model for the explanation of baldness.”

      My paper states…

      “AR density and AR coactivator activity in AGA-prone sites associated with genes shared among AGA sufferers [2, 12, 13, 14]. However, genetically identical twins demonstrate that while AGA has a genetic predisposition [15], one male twin can bald significantly faster than his counterpart [16], implying genes do not explain all unanswered questions in AGA pathology, and that at a minimum, epigenetics may also play a role.”

      Another example from your article:

      “Many studies have shown DHT plays an important role in inflammations, regulating its activity [29,30,31,32]. Could be this the explanation of why increased DHT levels are found in bald scalps? When the inflammation is long-term and chronic, it causes fibrosis and calcification. Indeed, miniaturization of hair follicles has been associated with deposits of densely packed collagen bundles in the follicular dermal sheath, called perifollicular fibrosis [33,34,35]. This further decreases the blood flow into the scalp, promoting ulterior cells death.”

      Those are essentially the same references / conclusions from my paper, and in my opinion, too similar phraseology for me to believe you had no knowledge of my manuscript while writing your articles. Here’s what my manuscript said:

      “Chronic inflammation may, in turn, increase androgen activity. Studies show that DHT modulates the inflammatory response during acute wound healing [64]. In prostate tissues, DHT is shown to exert broad anti-inflammatory effects [65]. One study demonstrated that the pro-inflammatory cytokine interleukin 1 (IL-1) increases androgen metabolism in chronically inflamed gingivitis tissues and the periodontal ligament [66]. This verifies that androgen activity can be a response to inflammation, and that tension-mediated inflammation may increase DHT, AR, and TGF-β1 in AGA by inducing ROS and other pro-inflammatory biomarkers.”

      “AGA is the result of chronic GA-transmitted scalp tension mediated by pubertal and post-pubertal skull bone growth and/or the overdevelopment and chronic contraction of muscles connected to the GA. This tension induces a pro-inflammatory cascade (increased ROS, COX-2 signaling, IL-1, TNF-α, etc.) which induces TGF-β1 alongside increased androgen activity (5-αR2, DHT, and AR), which furthers TGF-β1 expression in already-inflamed AGA-prone tissues. The concomitant presence of DHT and TGF-β1 mediates perifollicular fibrosis, dermal sheath thickening, and calcification of the capillary networks supporting AGA-prone hair follicles. These chronic, progressive conditions are the rate-limiting factors in AGA recovery. They restrict follicle growth space and decrease oxygen and nutrient supply to AGA-prone tissues – leading to tissue degradation, hair follicle miniaturization, and eventually pattern baldness.”

      At first glance, I don’t see significant enough of differences between the theories. Rather, it just seems like your articles are rewording my paper and their references, but forgo actually citing my paper. I find this frustrating. While I’m open to the idea that the hypothetical AGA pathogenesis model I proposed could be missing some pieces, please delineate where our models differ.

  30. TmdOcclusion

    I’ve read some of your articles and opinions and again very interesting material. But I agree with Rob, you need detail where the models do differ. Im noticing a lot of similar or identical material which you have published this month.

    However your articles do upon on a phenomenon which has once been mentioned before on this site comments, and that is to do with , in layman terms Neck posture.

    In short

    The Galea is connected to the neck muscles, and any tension or muscles tightening will cascade into
    vascular problems. Thus inciting the inflammatory response.

    There are numerous sources who have noted that they have regrown or thickened hair via correct posture practice.

    But I believe this all linked to the factors Robs paper discussed on post pubertal skull growth.
    The mechanisms remain identical. This can also be said of your article on cranial development. Which again can also be linked to Skull growth or posture.

    Regards

    1. When writing the second article on the blog I knew your paper and that’s why I’m writing here as well. However, when writing the first article I was completely unaware of your work. I found really interesting that many of my conclusions overlap with yours, but I don’t agree in some parts of your model, that’s why I haven’t cited you.

      In the following, I’m talking about the paper you have published, not about this blog that I’ll never have the time to read. It is my understanding that in your model mentioned in your paper you say that it is fibrosis and calcification that cause blood vessels compression. In my model it is the opposite, i.e. it is blood vessels compression that causes cells to die, with an inflammation response to clear out necrotic cells. When the inflammation is long term, then we have fibrosis and calcification that further compress blood vessels. Also, I spend a lot of time in studying and researching why the galea is compressed and I found some answers, i.e. a poor craniofacial development causes body compensations with muscular tension in the cervical area that propagates to the galea through the myofascia (I refer to the muscle chains and trigger points theory). This is something you never investigated and never mentioned in your paper. I’m free to discuss further by email with you, you have my email address.

      1. Post
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        I completely believe that we came to similar conclusions regarding AGA pathology, and even independently of each other. I also believe that any reasonable person who invests enough time into AGA research should come to these conclusions.

        However, from my perspective, it feels disingenuous that while writing your second article, you had knowledge of my paper, and that your article’s order of information is 1) very similar to the build I use in my paper, 2) uses similar / sometimes-identical phraseology, 3) cites the same sources (and often in the same order), but ironically, 4) doesn’t cite my paper — from my understanding, because of a small ordering element difference of opinions in the flowchart (reduced blood/oxygen first vs. fibrosis/calcification), and because you’ve elaborated more into what could mediate galea-related tension.

        What compounds my frustration is that you initiated this exchange in an article that is unrelated to my paper or a discussion about its theories. In my opinion, the most appropriate approach would’ve been to initiate a one-on-one email exchange. Even still, I’m allowing your links / comments. But to me, this allowance feels very one-sided: your links on my site and in the wrong place, while at the same time, ostensibly my source material and argumentative build in your linked articles — but with no citation in return.

        As I see it, the equivalent would be if I acknowledged that I had awareness of your second article, then decided to write a new article using similar argumentative ordering, phraseology, and even the same sources — but I changed the order of one element in the flowchart, elaborated a bit more on fascia’s role in tension storage, and then decided that this made the piece unique enough to not cite you.

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  31. Thank you very much for your guidance Rob and Paz

    I’m almost a month and a half that I take this massage process so seriously,now after doing any massage sessionmy my scalp gets less greasy and but still i have dry dandruff on my scalp.
    I have decided to continue without shampoo because I feel my hair becomes thicker and the hair loss is much less.

    Once again thank you for guidance

  32. Thats good news Keysi

    Means that your hair sebum production is beginning to normalise.

    Keep going and update everyone when you see a change.

  33. Paz ,
    Really? thats give me a lot of hope
    This is my massage program for each part
    10 minute pi******
    4 minute str****
    4 minute pr***
    6 minute extra pi******

    1. Keysi ,

      Personally ive done more of the time in Robs video , such as 3 min warm up, 6 min pinch, 6 min press, 5 stretch.

      But keep going if you believe it is working for you.

      John

      Ive done some research on NOFAP for the last year or so regards to Hairloss.

      Many believe that excessive fapping causes an increase in DHT, estrogen and prolactin, again excessive, which is twice or more daily.

      Many people have mentioned benefits in hair after being on NOFAP. But their are also cases of people shedding more.

      I believe this involves stress hormones. Again their are people on who have not noticed anything on nofap , while people who are excessive fapping have still a full head of hair after many years.

      But the later is rare i admit.

      Personally I believe that their are benefits to doing Nofap and balancing hormones is one of them.
      And importantly retaining certain minerals that are thought to be lost in ejaculation such as Zinc.

      If you are eating healthy, and dont fap often , then you are fine. However lets look at it more carefully.

      Two models indicate that DHT effect on hair is via inflammation. If Nofap reduces the conversion of serum T into serum DHT, then I do beleive it can have a positive effect scalp health. Due to sebum and androgen production. Greasy scalps are androgen related in my opinion, and anything which helps androgens function normally should help sebum, But this wont effect regrowth or hair health, as long as vascular properties, inflammation and fibrosis are not targeted.

      I do believe abstaining can help, but not abstaining for too long. Unless you have other issues , such as mental, or thyroid ect. In which their is plenty of people gaining benefits.

      But there has been no hard study or research on the relation between NOFAP and hair. It is majority opinions and advice from people who noticed differences or else.

      regards

  34. Hallo everybody. Please Rob search for NOFAP. Its embarrassing, i know, but 10 days with nofap and much much less greasy scalp. I dont need to shampoo my hair after massages.

    1. Post
      Author

      Hey Julián,

      You can certainly try it! Anything that effectively grips against the scalp skin, feels comfortable, and minimizes friction will likely be helpful in lieu of regular hand massages.

      Best,
      Rob

  35. Hello everyone
    Is it normal that a while after performing scalp massage, lots of white brownish flakes comes out of my head? Anyone has the same experience?

    1. Post
      Author

      Hey Indonesia,

      This is covered, in detail, inside the book and video. What you’re reporting is very common. In the book, search for “cradle cap” or “dandruff”.

      Best,
      Rob

  36. Hi Rob,

    I have been doing scalp massage and on a paleo diet for about 4 months now. I have a question about when single hairs fall out: I know shedding has to take place before regrowth, so does it mean that when a hair falls its root will then be growing one to replace?

    1. Post
      Author

      Hey Alex,

      This is covered in the book, but in general, we don’t need to see shedding for hair regrowth to occur. There are a few different examples of different regrowth observations (vellus to terminal, hair thickening, etc.) — and a couple photos for comparison. You should find them in the mechanical stimulation chapter!

      Best,
      Rob

  37. Hey Rob, I have a theory that I find interesting and that could correlate with your hair loss thoery (mine could be completely wrong though, I’m just throwing it out there). Have you ever thought that one of the reasons that hair loss mainly affects the top of the scalp is because when you sleep, the back and sides of your head are usually touching a pillow or something which keeps them moving. Also, when you talk or eat the sides of your head move. Both of these actions are a form of messaging and prevent and tear down fibrosis and calcification. Just a theory that I thought was interesting.

    1. Post
      Author

      Hey James,

      It’s an interesting idea. I think the big reasons why the sides of the scalps are (mostly) protected from AGA is because 1) these tissues have different capillary networks from the tops of the scalps, and 2) these tissues overly muscle rather than the galea aponeurotica — and are therefore not subjected to the same chronic tension generated from muscular contraction at the scalp’s sides versus tops.

      On a similar note, I’ve seen an AGA-pillow compression hypothesis around a few hair loss forums over the last few years. This is the idea that pillow compression restricts blood flow to the tops of the scalps, and thereby catalyzes or exacerbates AGA. While the hypothesis has a couple (loud) supporters, the evidence doesn’t seem to support its validity. Here are a few reasons:

      -Japanese men, on average, experience hair thinning ten years later than Western men. Paradoxically, Japanese men, on average, sleep on much harder surfaces and harder pillows — which would create harder compression against the sides of the scalp while head-resting. According to the hypothesis, this should exacerbate AGA — but in this population, it doesn’t.

      -The compression points for a pillow happen at the sides of the head. Baldness occurs at the top of the head and in regions above the galea. The blood vessels that support balding hair follicles run through the sides of the scalp which theoretically could be slightly compressed — even from a pillow — if pressed upon for a VERY long time with no adjustments in force or location. However, this isn’t how we sleep. No one sleeps entirely still, ever, unless they’re dead, in a coma, or have a related medical condition.

      -Proponents of the pillow compression theory often cite studies on pressure alopecia as evidence for its validity. However, pressure alopecia is not morphologically or pathologically the same as pattern hair loss. It’s something most commonly reported after cardiac surgeries, where head movement is typically immobilized due to anesthesia, and the patient cannot create micro-movements as they would during sleep. Over a series of hours with no movement at all, this causes tissue necrosis in the impacted areas, which leads to hair loss. But again, this is an event specific to the surgery itself. It’s not androgenic alopecia. And again, in normal sleep settings, you’re going to move around. Your body can’t help it. We have built-in adaptations to prevent this from happening outside of this setting.

      -Moreover, pressure alopecia is androgen independent. It happens in children as young as 9 and men as old as 73. It happens in women undergoing breast surgery. It happens in men receiving and giving a liver transplant. It also tends to happen at the site of the injury (side), rather than further up the scalp (top).

      -Pressure alopecia is definitely a real thing. Look at men who wear long socks to work everyday. They lose the hair around their ankles and lower shins. Look at men who wear glasses all the time. Many lose a bit of hair where their glasses press against the skull. But when you stop wearing high socks, and you stop wearing glasses, the hair almost always comes back. Again, this is androgen-independent, and while it might contribute to hair loss in general, these should be treated as a separate phenomenon.

      You can read more here:

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3500075/

      Best,
      Rob

  38. Hello Rob, thank you for sharing your article, great info. I was wondering, was is your take on organic silica (such as silicium G5 or other horsetail herb based remedies)? I’ve tried applying it to the scalp one or two times and it seems to make it much more elastic. On the other hand I read it can promote collagen production which is not what we want in terms of increasing fibrosis. But maybe the goods of it outweigh the bads?
    Here are two links that explain what it apparently does for hair loss:

    https://blog.viviscal.com/power-of-silica-for-hair-growth-the-complete-guide/

    https://www.orgonosilica.com/en/blog/entrada/orgono-silica-for-skin-hair-and-nails

    This is not meant to be an ad by any means, it’s just that it’s been almost the only info I could find about it.

    Thanks and best regards.

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      Author

      Hey Mario — fibrosis is disorganized and excessive collagen, whereas healthy collagen is perfectly cross-hatched, elastic, and has a healthy blood supply. So more “healthy” collagen is a good thing! 🙂

      If you think a supplement is helping, then by all means, keep taking it! Otherwise, I find 99% of them are useless for AGA, and of the supplements that improve hair loss — usually it’s person-specific (meaning the supplement may have inadvertently addressed a nutrient deficiency or improved a condition concomitant with the hair loss).

      Best,
      Rob

  39. Hello Rob, here a big fan of your studies and book from Spain!

    What is your opinion about long term dermarrolling use? There is the opinion that a long term use of dermarrolling will form a scar tissue because of the reduction of collagen production.

    Maybe a long term use builds scar tissue and the response gets less and less each treatment. If this is true, how do you think could this affect to the scalp?

    A link here: https://simplyhealthyskin.com/micro-needling/

    Thanks in advance!!

    1. Post
      Author

      Hey Sergio,

      Thanks for sharing the link. It’s an interesting perspective, and certainly one that goes against most of the research we have (so far) on microneedling and AGA outcomes. At the end of the day, we’ve seen at least one case study of a full AGA recovery from incidental, full-dermal burns. So wounding certainly has its role in hair recovery, somehow, and through mechanisms by which we’ve yet to entirely understand or elucidate. Research here is still in its infancy, and the reality is that it’s entirely possible that we take missteps before finding ourselves heading in the right direction. Is microneedling a misstep or a step toward progress? I think it’s a step in the right direction, but it’s hard to say with certainty. This sort of debate should be encouraged!

      Best,
      Rob

  40. Hi guys
    the right amount of pressure in massaging how much should be?my scalp would also be a little red directly after the massage

    1. Post
      Author

      Hey Keysi — the video is very explicit with the pressure and pounds of force to apply. If you need comparisons, I’d recommend pressing your hands against a weight scale — either at a grocery store or a personal scale at-home.

  41. Hello Rob.

    Received an email for avoiding nutritional supplements, i agree what you said there. Writing here something that everyone should get benefit from it. People having illnesses like hypothyroidism or hyperthyroidism will definitely lose their hairs and will have a bad impact on general health also. What to do to cure these illnesses ? well i have a good understanding of what happens in the body when the thyroid gland goes out of control and it sometimes goes under-active(hypothyroidism) or sometimes goes over-active(hyperthyroidism). Natural Treatment without dangerous surgery or drugs which cause very bad side effects: People with under-active(hypothyroidism) have definitely lower levels of mineral Zinc in the body & that’s why its thyroid gland can’t work in a normal speed. And people with over-active(hyperthyroidism) have definitely a mineral copper deficiency, if we get car as an example of these illnesses zinc is accelerator and copper is breaks for the thyroid gland. This is what i say from experience and i am very angry to these fool doctors which they’re still unable to cure such easy illnesses and they take actions like surgery to cut such an important gland from the body. Shame on them. Well proceeding to my topic with that being said : dosage should be adjusted to 40 mg of zinc per day or per patients tolerance and no more than 12 mg of copper for over-active(hyperthyroidism) patients. The key is to adjust those minerals back to the optimum value as they should. Remember that vitamins play a major role for utilizing minerals in the body.
    Vitamin B6 is vital for utilizing zinc in the body for [[under-active(hypothyroidism)]].
    Viamin B1,B2,B3 is vital for utilizing copper in the body for [[over-active(hyperthyroidism) ]]. people with hyperthyroidism should also use turmeric in their foods to avoid toxic environment and should use black pepper at the same time to increase turmeric absorption. This is a very strong study and very helpful all over the world for these patients.
    Hope Rob you will stay my post visible to others which is very useful. Anybody need more info let me know i can help with these 2 disgusting diseases. Me myself had hyperthyroidism and have successfully recovered from it very easily without any drugs or surgeries.
    Thanks.

  42. Hi Rob, Great article and work as usual. Wanted to ask for those who stop using minoxidil and start with your massage program, would they still be able to maintain the gains from minoxidil or not?

    1. Hey Tim,

      I hope you don’t mind if I jump in, but I’m someone who has used Rogaine foam for years. If it had kept working as advertised, I probably would’ve never searched for something else, but thankfully I came across Rob’s regimen. So as far as the actual “gains from minoxidil”, for me personally, if I had ever benefited from its use (which was very debatable), I feel like it had already run its course because my hair was continuing to thin. I didn’t have the guts to stop using it until I saw definite results from the massages which I did (around 6 months in). I was then hesitant about stopping Rogaine because I didn’t want to lose any growth I received from the massages. (What a predicament!) I’ve been weaning off of minoxidil for the past couple of months because I’ve heard too many anecdotes of people stopping cold turkey and losing significant ground. I can’t say that I’ve noticed any discernable difference in my hair (both in appearance and any increased shedding) and I take pictures on a fairly routine basis. I’m on my last can and will probably use it once per week until it runs out and then I really don’t anticipate using it any longer.

      Basically, I’ve been taking a very conservative (wimpy) approach with my discontinuation of minoxidil. Others (I believe Rob is one of them) decide to jump in head first and abruptly stop. I can’t tell you what to do, but if your someone who is looking to stop using minoxidil, at some point you just have to muster up the courage and take the plunge yourself!

      Best of luck.

      1. I’m in a similar predicament – was at first (many years back!) a great responder to minoxidil but slowly lost ground despite continued use. Two weeks without left me terrified – I shed/ thinned an incredible amount even in that short window of time. And so back on I went…

        I suspect there’s a correlation with the efficacy of its action/ extent of shed on cessation – i.e. good responders stand to lose the most. I suppose that stands to reason…To whit, if you never saw significant gains and/ or haven’t used it for an extended amount of time, your shed may be minimal. That said, it may be worth considering that, even if you never noted significant gains but used it for a prolonged time – say several years – it may have potentially maintained a significant amount of hair. Ultimately, without hard data on such things, I suspect it’s impossible to tell how an an individual will fare on quitting. (Rob, I think this could be an interesting point of study/ data collection for the benefit of future massagers?).

        Hypothesis – if one is to have extensive regrowth whilst massaging and in conjunction with application of minoxidil, and then, on cessation of minoxidil treatment shed extensively, it is fair to assume that there’s some other unknown action of minoxidil making follicles dependent upon it, i.e. it’s not just or is more than a vasodilator. Thoughts?

      2. Post
        Author

        Hey BB — great comments. This scenario is something of which I don’t have much data. To echo an earlier comment reply, there seems to be (with any supplement or medication) an efficacy-dependency relationship, where as the use of the medication/supplement increases, its efficacy decreases as our dependency on its effects simultaneously increases. This is especially true with antioxidant supplementation — where in the early stages, both exogenous (from the supplement) and endogenous (from the body) antioxidant status remains high… until the body adjusts to produce less and less endogenous antioxidants to reach the same overall production prior to supplementation.

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      Hey Tim,

      The effects of getting off minoxidil seem to vary for each individual. Minoxidil initiates the anagen stage of the hair cycle, and there’s a hypothesis that with continued use, our hair becomes somewhat dependent on minoxidil to maintain anagen, with minoxidil’s effectiveness lowering over time as the body adjusts. This is essentially the same dependency-degradation effect we see with any antioxidant supplement or medication — i.e., in the medium run, we achieve gains; in the long-run, we develop dependency and supplementation / medication has a weakened effect.

      In any case, when you transition away from minoxidil, you’re bound to shed. Most readers report a significant shed coinciding with a weaning off minoxidil and the beginning of the massages. Personally, if you’re okay with minoxidil use and are seeing gains — I don’t think it’s problematic to continue using it alongside the massages, then slowly weaning off many months later — if you’re happy with your hair, and want to experiment with decreased dosages.

      Best,
      Rob

  43. Hi Ian and BB

    Back in early 2016 I also purchased minox and used it for around 3-5 months. I noticed it use to make my heart beat pace, and felt terrible on my head. I didnt get any puffy eyes as far as i can recall.

    I only used it on my Vertex though, because my fear was that it would shed. Then regrow, and if discontinued. I would lose all gains. At the time most forums or internet sources mentioned that it only worked on the vertex.

    However had this terrible night where I hadn’t cut my hair for some weeks, in order to cover up my thinning. And so I thought. Until a family member pointed out that my scalp could be seen. I shed crazy amounts, and thought it was minoxidil.

    I got off this chemical as soon as i became confident in the massage progression. But up until early 2017 i remained with it.

    And since then I am very glad I did. And even more so glad that I didnt take Fin.

    I do believe that this chemical is responsible for vasculation purposes. Evidence suggests that Rogaine was intended to help heart conditions, and the side effect was hair growth. However it does not seem to tackle calcification or fibrosis or relax any tension. This is why some people I remember posting that their gains were not strong thick hair follicles, but weaker looking.

    However People lose their gains if they leave Rogaine. This needs more research. Could it be that the particular area which rogaine is applied to has more vasculation, and any reduction in rogaine causes them to fall out ?

    But lets not forget , that Rogaine is also used for facial hair.

    I will research this area.

    Thanks , regards

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      Author
  44. Hi guys
    _Today was the second moon I did this operation.my hair becomes less greasy , but dry dandruff has risen to the scalp and the dandruff are always shredded in my hairs. you’ve also experienced this?
    _Why in most cases, after five months of massage, we see the first hair growth?
    _Is massage more than 20 minutes every turn better or 20 minute is enough?

    1. Hi Keysi

      I also experienced shedding with white bulbs which I thought was dandruff . In the first few months
      You will noticed your fingers are greasy, dandruff is expected along with maybe scalp crust.

      This is a sign that your scalp sebum is being pushed out , which may very well be clogging follicles.

      Some people dont even I see regrowth in five months from what I have read. Rob is the best man on this .
      I believe this is to do with hair cycle regeneration which is a painfully slow process. I believe it could be a cycle of three months to maybe four.

      Id stick to 20 minute twice daily. I believe people should do exactly as Rob has demonstrated in his videos for at least 8 months. And decide where they are at before adopting anything else.
      Otherwise you just wont know.

      patience and consistency is key.

      Good luck

      Regards

  45. Hi,

    What about anti inflammatory foods like turmeric? Are they benefitial for us when doing the massages? I’m talking about using them in our daily food.

    1. Post
      Author

      It’s hard to say! Anecdotally, I found that while simultaneously taking Meriva 500 (curcumin) alongside Thorne vitamin D/K2 drops, cod liver oil, and a B-12 supplement — my hair quality seemed to drastically decrease (higher shedding, thinner-feeling hair) and just within a two to three week window. Conversely, many people here have reported just the opposite. I ended up hopping off all supplements and seeing things return to baseline after a couple months. Everyone is different.

  46. Hi Paz I thank you very much for your answer and guidance.you mentioned this”This is a sign that your scalp sebum is being pushed out , which may very well be clogging follicles” so i wanna know sebum can block hair follicles?and this dry dandruff is the same sebum thats shed of my scalp.
    What does “Microneedling” doing is the same as pressing deep?
    Tnx

    1. Hi Keysi

      Sebum overload is usually androgenic in nature, and would be pushed out from pores to the hair and scalp. When you massage more sebum will be pushed due to the nature of mechanical stimulation.

      I personally in the first few months noticed my fingers being greasy after a massage. And traces of dandruff or dirt from topicals previously used were also witnessed. Your pores usually open and close depending on the nature of the surface. For example, hot water is known to open pours on scalp while cold does the opposite. Some hydrotherapy sites have commented how its beneficial to shower with warm water and then change to cold, as it helps clean the scalp. Also Cold water apparently is anti-inflammatory on the scalp , however more research is needed I believe.

      In regards to dermarolling or microneedling.

      This process is covered in Robs Book.

      A dermaroller has many small needles which cause acute wounding in the skin, which then signals a skin healing process and cell regeneration. Men and women also use this on their faces, as it has
      anti-ageing benefits.

      People have experienced success in using dermarollers for hairloss.

      However.

      Dermarollers do not press deep into the tissue, And anyone thinking of doing so must reconsider unless they want a very messy and bloody session. Not recommended. The idea of a dermaroller is to allow the roller to roll across the scalp skin with ease, as it is intended to do, while it makes micro punctures in the skin. This is also determined by the size of needles you are using, the bigger go deeper and cause more pain according to reports.

      One of the most successful therapies as mentioned in Robs book is dermaroller and rogaine together.

      Personally I believe one needs to assess their scalps and rate of hair loss. Massages are able to go deeper into the tissue and allow the skin to become more elastic, which is important.

      I avoided the dermaroller as I didnt have a patch of complete baldness, but more thinning hair. So using a dermaroller would of had an effect on my existing hairs.

      Some people do both. The importance is to assess yourself, and not overdo anything.

      If you do decide to both, then please note that you need to give the scalp a rest. Recovery time is very important.

      Hope this helps.

      Regards

  47. Rob, your site is without a doubt the most definitive source of hair loss related info on the net. Only thing it’s lacking is a post dedicated to dermarolling. I hope you’ll consider one.

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      Author
  48. Thank you paz

    I was surprised by your interesting information.regarding your answer I think that you prefer massage to dermaroller.

    Luckily, my dandruff is lower. I do not know, but I feel less, and after 70 days of the beginning of the massage, I only used twice the shampoo but very little

  49. Hi Rob,

    How do you feel about extending the rest period between massages to 24 hours per scalp section? I noticed in your book you stated the best responders are careful and prioritize recovery (even inc inversions) and they do not overload the scalp tissues with chronic inflammation. Occasionally I find that a scalp section is still slightly sore 36 hrs after that section had the last massage (when doing a section every 12 hrs). Extending rest periods to 24 hrs would give the same section of scalp 72 hrs to recover, vs 36 in the standard protocol. I am certain then it would not be sore at all. It would be fully recovered and ready to take the assault again.

    I guess it all depends if pounding a still sore area is a positive or negative for long term hair regrowth outcomes? Not sure what to think.

    Many thanks,
    Steve

    1. Hey Steve, I think you should heed the signs of pain for such an extended period of time – either you could try reduce the intensity of the massages, or follow your own intuition and extend the recovery period. You’re correct in noting the fundamental importance of recovery. Perhaps crosscheck how much pressure you typically exert using a scales, to correspond with the recommended forces in the book. Just speaking from my own experience thus far, hope this helps!

      1. Hi BB, thanks for the reply. Good thoughts. I did check with scales, the pressure I apply was within the upper limit of the poundages Rob suggested. 10 lb pinches, 20 lb presses (per hand). That’s actually a lot of downforce applied on soft tissues, imo. Maybe the scalp will adjust, but I want to be certain I am being effective enough to break down the fibrosis we all have. Steve

      2. Post
        Author

        Hey Steve — I agree with BB’s advice. If you need more recovery time, certainly feel free to take it. Results seem to be entirely time-dependent, with people reporting positive hair changes even while committing as little as 0-10 minutes daily — albeit for several years 🙂

  50. Hi Steve. Also noteworthy is consistency of effort in best responders. Ideally, as a regimen, I think it’s preferable to reduce pressure and stick with the recommended number of sessions, rather than applying maximum pressure over fewer sessions.

  51. Thanks Rob, and BB. So, consistency and time committed are the keys for best results. I have to remember it’s about stimulating long term remodelling of the scalp, rather than physically breaking the fibrosis down with maximum pressure each session. I will stick with the regime, and ease off the poundage a little when needed. Thanks again.

  52. Hi Rob

    I have been massaging my scalp for more than one month. I found that sometimes I shedded more hair. In your own experience, how many months did you have where you lost more hair?

    Besides, I found that the healthy scalp (where the hair is thick and dense) is milky white and looks thick, while the scalp of those balding regions have colour like your skin. Would hair regrow before the scalp of these regions revive and become milky white again?

    Anyway your work and researches on hair loss is very impressive. I am considering to purchase your ebook to learn a better diet for my hair.

    Best wishes,
    Ken

    1. Ken, the ebook (and video) is a must. They contain a great deal of information and instructions. I would not consider attempting massages blindly without first studying the book and video. The questions you ask about shedding are answered in there. To answer your other question, balding regions aren’t so white simply because they have tanned, there is less hair coverage to block the sun.

  53. I have gone over 4 pages of your articles, My question centers around your flowchart “The Master Hair Loss Flowchart” what tests can I request my dermatologist to do to check for scalp DHT/fibrosis and scalp calcification.

    1. Post
      Author

      Hey SK — it should be largely unnecessary to test for biopsies of DHT, fibrosis, or calcification in or under balding scalp tissues. These tests are really invasive, and if you’re balding, we can assume they’re probably present. First, I’d recommend going to a dermatologist to determine if you have classic AGA, diffuse thinning, or a non-scarring alopecia, etc. The difference will determine the best treatment modality.

      Best,
      Rob

  54. I’ve been following the method for about 5 months now, and after the first month or two saw some slowing of shedding and even thick small hairs replacing fallen ones, but I find if I go a day without eating regularly, the next day there is a lot of shedding. I no longer see signs of new growth, either. Is this something anyone else experiences? I feel like the progress I was originally making has been completely lost and am feeling discouraged, although I won’t stop. I know consistency is important, but should one day missed really make such a difference?

    1. Post
      Author

      Hey Richard,

      Are you suffering from AGA? If so, which type (frontal/temporal thinning, vertex, diffuse)? Do you have any issues concomitant with AGA — i.e., nutrient deficiencies, hypothyroidism, etc.? In general, months of progress shouldn’t be lost from one single day of under-eating. And a single day of under-eating — absent of massaging — shouldn’t accelerate AGA. This leads me to believe something else might be going on.

      1. Thanks for your reply, Rob,

        After looking closely at pictures taken at the beginning of August (which show signs of new growth) and some taken today, one month apart, I see that all of the new small hairs were gone. The only difference in this month from last is that I diverged from a vegan diet that I had been on all of this year and was eating an egg every day or every other day for the past few weeks. I believe this has to be the culprit: I was vegan from January through July, but at the end of July I had dairy and fried foods a few times at the end of the month, and then in August was having eggs as mentioned. I haven’t had any animal products in the last 3 days and notice the hair fall has been much less severe. I’m going to go back to 100% vegan for this month of September (heavily relying on pumpkin seeds, almonds, sunflower seeds, hemp hearts, soaked chia seeds, soaked flax seeds, avocados, a red onion a day, dark green and orange vegetables like sweet potatoes, zucchini, leeks and bok choy, garlic, fruits like apricots, dates, bananas, apples, etc as the daily core of my diet) to see if this makes a difference. It was the end of last year that I decided to go no grain vegan, and I noticed a complete change in my skin and hair growth, without any negative health effects as I was very intentional and focused on my nutrient intake balance. I believe this coupled with 30-60 minutes total daily of scalp massage and almond oil to moisturize was what encouraged my hair growth over this year. I also use an apple cider rinse and a vegan dry shampoo to cleanse the scalp. It has been disappointing to see some back-tracking and progressed recession, but perhaps this is part of the learning process. I hope to see if there will be any marked improvement over the next month or two. In one of your articles you say that veganism didn’t work for you, but could it be that it might work for others?

        Thank you for all the research you’ve done and I hope to be able to be adding to the perspective here.

  55. Hi

    Richard M

    Your 5 months into the regimen . This is still good for an early start, and its interesting to see how diet plays a factor. However could your progression and regression be related to the massage progress rather than diet ?

    I noticed at around month 6-7 if i recall correctly I also had regression at the front, before it improved.

    Recently im leaning towards nutrition and diet being a less factor in MPB, but something keeps telling me that its present. I mean we always hear the question why do we have unhealthy people with hair ect. And then the opposite.

    My own diet was less in grains , much less wheat. More fruit , fish, vegtables. Milk , sugar and eggs everyday.

    However im alsmost two years into the regimen , And this weekend I noticed that I have almost restored my teenage hairline on my left temple, which has been receded since i was 22-24, more than i hoped to gain.

    However im not going to pretend diet didnt help. Since Jan 2017 ive eaten , salmon, fruit, green tea, porrdige, cheese, halloumi, gluten free foods. Fries potatoes ect.

    I have been eating bad things to , but like once a month or once a week depending on what it is. If i have weekend of bad diet, or a day. I try to make up for it , by detoxing food like blueberries, green tea, and salmon and then spend the week days eating healthy.

    I eat 2 to 3 meals a day with in between snacks ( apples , fruits) , excersize regularly and do the massages twice a day without fail, and oil my hair twice a week.

    I did take supplements , pumpkin seed, saw palmetto, K2, ashwaghanda, rhodiola , ginseng,
    But i dont think people need to take all those.

    My honest advice is , eat healthy , eat a lot, stay fit , stick to the regimen , and be patient.

    However Richard , I still believe that your very early into this regimen. Id like to hear what happens around month 7-8 mark.

    Hopefully Rob will give you better information.

    Regards.

  56. Hey all, I am in the same boat as Benjamin in regards to heavy shedding even after months.
    Shedding from sides was also common while brushing.
    Top of scalp continues to get thinner over time.
    After 3-4 months of solid massage I still shed heaps but no sign of slowing or any regrowth.
    I am noticing skull expansion too which is horrible as I’m not sure if it can be reversed.
    I am reluctant to re start massage as after two separate stints, I only ever saw shedding and accelerated loss.
    Iodine as a topical stops my heavy dandruff and makes my scalp feel way less inflamed but I am not feeling very positive that anything good can be done in my situation.
    It sucks that what ever is happening to us in each of our own individual situations, all results in hair loss.
    How can so can many so many different conditions all have the same net result.
    Oh man.

    1. Hey Andrew

      You said your noticing skull expansion, what is the status of your scalp skin ? is it tighter after 3-4 months of massage ?

      Do you still have greasy hair ? itchiness ?

      Apart from shedding have you noticed any changes in scalp health or anything in general ?

      I still think 3-4 months is early, I urge you not to give up and continue until month 7 or 8.

      Are you making any lifestyle or diet changes at all ?

      Shedding is expected, I too shed quite a bit at first, but no enough to cause concern. Except the odd day.

      Hopefully Rob can give you advice on this aswell.

      Regards.

    1. Post
      Author

      Hi Samet,

      It really depends on the peptide. Typically when people refer to peptides for hair loss, they’re referring to copper peptides. These have been around for years, and you can find them in shampoos and topicals. The evidence on their efficacy is mixed, and at best, I’d put a peptide cream in the realm of a minoxidil.

  57. Hey Rob,

    Thanks for the great work, I bought your book about a month ago, have been doing the massages every since. Havnt seen any results yet, but my scalp already feels way looser. Hopefully, it will work for me.

    I have 2 questions (unrealted to the article):

    1. I read your study about the Vitamin D/water correlation. I actually started taking quick, cold showers only. However, I like to go to the Swimming pool about 3 times a week (45 min. sessions). Could this have a negative Impact on my hair? Should I find another way to exercice?
    2. Does products like Toppik (hair fibers) can have a negative Impact on your hair? Im balding at the crown/top of my head, and hair fibers cover my balding spot very well. If this could have any type of negative Impact on my hair i’d stop it right away or at least slow down its use.

    Again, thanks for the great work!

    K

  58. Hi Rob

    I’ve been doing this process for about three months. So far, I’ve only had a dandruff problem that is constantly rising because I do not use any shampoos (just hot water and rubbing). Please introduce some natural and harmless remedies to reduce dandruff and these white skins sticking to my scalp .
    Tnx

  59. Let’s explain the condition of my scalp more precisely, I always look at my head scalp after bathing. I see white skins sticking on my scalp that can be cut off by scratching them.before i going to massage regime, my scalp did not have these symptoms. And these are the effects of not using shampoo for 3 month. Because Rob advised not to use any shampoo, and these white these white peice that look like dandruff all around my scalp especially the places I give them a lot of massage.have you had such an experience during the first three months? Are you using rosemary oil to reduce dandruff i heard these good effects ، what do you think about it? Rob i will email you a photo of my scalp after bathing
    Thanks

    1. Hi Rob,
      it is interesting to see that my research and articles are copied from you and your followers do not even notice it! And it is not the first time my articles are cited here (despite you cancelling the links I noticed them). Obviously I am ironic and I just wanted to highlight that despite many things overlapping in my model and yours, we are proposing two different things (even though similar). There is a main distinction between my model and yours: you say galea compression causes calcification and fibrosis which in turn cause blood vessels compression. Instead I say that galea compression causes blood vessels compression which causes calcification and fibrosis, which in turn further promote blood vessels compression. Despite the difference looks minimal, I think there is a huge implication in the causative-consecutive understanding of hair loss. Furthermore, I think we are giving emphasis to two different problems: you are stopping at the calcification and fibrosis, while I am trying to go deeper and understand where blood vessel compression originates: I found my answers and I wrote about them here https://tmdocclusion.com/2018/07/14/more-on-hair-loss/ .

      1. Post
        Author

        TMD — I’ve yet to “cancel” or remove any links that you or others have directed to your website. It’s also not one of my readers’ responsibilities to identify how original or plagiaristic someone else’s content is. That responsibility falls on the writer of the content in question, and the author of the previously published content who feels the former’s phraseology, argumentative mapping, citation ordering, and general takeaways overlap too greatly with their own work to not warrant, at a minimum, a citation (even if it comes with a caveat that the writer disagrees with one element of the other’s AGA flowchart).

        I stand by my previous comments about your articles (which begin here):

        https://perfecthairhealth.com/nutrient-deficiency-hair-loss/#comment-38782

        At the end of the day, there are many authors who build upon others’ research and make corrections to their work in light of new information / evidence. These authors still cite their source material. In my mind, this isn’t what’s happening here. Accordingly, I can only surmise that the real reason you aren’t citing my manuscript isn’t because we disagree on one ordering element. It might be because citing my manuscript would make your articles look less original and more derivative.

        Moving on–

        Luc — I think the arguments in TMD’s articles are great. Despite my frustration with certain aspects of his content, TMD certainly does expand upon the origination of galea-generated tension more so than I do in my paper — and in this respect, he does a good job.

        There’s a debate over whether calcification is a protective vs. adaptive response to inflammation:

        https://www.ahajournals.org/doi/pdf/10.1161/circulationaha.107.749655

        That debate is still ongoing, and unfortunately, research on this hasn’t moved much since that editorial publication in 2007 (I’ve had discussion with its author). Whether or not calcification / fibrosis is protective versus adaptive is relevant to the pathology of many forms of hair loss — including. For instance, here’s an example of where this has been discussed in the context of hair loss, and in the literature (however, this is for hair loss post-surgery):

        https://www.ncbi.nlm.nih.gov/pubmed/26763856

        Depending on where you stand on this debate, it’s possible that TMD’s model may more accurately depict AGA pathology versus my own (from my paper here):

        https://www.sciencedirect.com/science/article/pii/S0306987717310411

        What we do know is: 1) tissues under chronic inflammation undergo tissue remodeling, and 2) during tissue remodeling, it’s really hard to separate cause from effect. At the end of the day, we need more research. I’m in the process of partnering with a university to answer some of these unknowns, and hopefully will have more information within the next couple of years (or sooner).

        Best,
        Rob

  60. Dear Sir !

    Greetings,

    I am a customer who have newly start the massage therapy after purchasing your program. (Book + Demonstration Video @ 49$ ).

    As it seems a hard work for hairloss sufferers to work hard for about 10 months to regrow hairs, but it worth it.

    Why i am commenting you is that i like research in this field like you, and want to ask you a question and want you to do more research on this topic. Have you ever wondered or have thought in a different way that which people in this universe have healthiest hairs ? i have think about it and seem that people who they smoke Crack have the healthiest hairs on the planet. They even don’t wash their hairs in a 2 months period and their heads are full of dust and soil because of sleeping near the roads during the nights, and you know what ? they eat a very unhealthy diet and breath the very dusty air ! i live in Kabul, Afghanistan(Top in pollution)

    Still they have the healthiest full head of hairs on the planet. What is the missing key Rob ? you are a researcher but haven’t looked at this yet i think. Please let me know if you have any understandings about this topic, or if you don’t have any information related this, please investigate and find the real reason behind this. You maybe the first one who could find a perfect solution from the drug Crack for hair loss sufferers or for bald heads.

    Thanks and let me know about your opinion.

    1. Hey Jordan,

      I just bought the book and read through it, and still there are many tough, unanswered questions regarding hair loss. You have to keep in mind that some people aren’t genetically predisposed to pattern hair loss, no matter what bad lifestyle they live. They will never lose their hair. Rob talked about this in the book. There are some homeless people that are on drugs that don’t wash their hair, and they are completely bald. Some aren’t. The people that are genetically predisposed to pattern loss need to keep their diet in check, and focus on the massaging and life style factors. But just because someone has a bad lifestyle and doesn’t lose hair, it doesn’t mean they are healthy inside. They will have other health problems unrelated to hair loss.

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