I’ve spent the last twelve years researching hair loss, and the last five years sharing everything I’ve learned on Perfect Hair Health — writing dozens of long-form articles about the causes, treatments, and misconceptions of androgenic alopecia.
Today, I’m thrilled to announce another major step forward for this site and our community. We’ve just published a second peer-reviewed paper. And this paper (which is technically a study) made its way into a top-20 dermatology journal.
The study is entitled, “Self-Assessments of Standardized Scalp Massages for Androgenic Alopecia: Survey Results“. And as the name implies, it evaluates the effectiveness of targeted scalp massages for pattern hair loss (androgenic alopecia).
The rest of this article uncovers how this study came to be, why I felt it was necessary, and its key findings: the results, interpretations, and what it all means for everyone trying the massages.
For anyone who participated in this study, I can’t thank you enough for your time and commitment to this process. I’m forever indebted to your efforts, and I hope the insights here help us all push our progress even further.
Note: I’ve also updated this site with a few new before-after photos (all of them involve massaging). You can see them here.
How this study came to be
For anyone unfamiliar with this site, here’s how it got started (and how I became an advocate for scalp massaging).
My hair loss trials (and introduction to massaging)
I was diagnosed with androgenic alopecia (AGA) in 2007. For the next six years, I used Rogaine® and experimented with low-level laser therapy trials, topicals, supplements, and nearly every “natural remedy” under the sun. Nothing improved my hair.
In 2012, I read a study on scalp massaging that suggested significant hair recovery (in just ten months) for participants adhering to twice-daily, twenty-minute massages. After looking more into soft tissue manipulation, mechanotransduction, and the potential targets of the therapy – I decided to stop all other treatments and give it a try.
Within a year, I saw significant hair improvements. And in 2014, I started this website to share the approach, supporting evidence, and my hair changes with others. I also wrote a book and made a demonstration video detailing my interpretation of the massages – specifically, the techniques I’d used during my ten months of trial-and-error.
As interest in the massages grew, so did this site’s readership. Subsequently, I spent the next two years working with readers, interviewing responders / non-responders, and revising the techniques based on new studies and feedback from participants. Eventually, patterns emerged to suggest that certain massage techniques might achieve better results.
So, in an effort to maximize everyone’s chances for success, I updated the book and video to standardize the massages based on the techniques of the best responders. I re-released everything in 2016, and waited to see how people would respond to the new information.
How did the new techniques stack up?
Overall, most readers of the revised material emailed me to report better results. This was encouraging, but also biased. Email exchanges aren’t a fair reporting sample; they don’t provide hard data or objectivity. In fact, a reader is far more likely to email me if they’re either (1) not seeing any regrowth, or (2) seeing great hair recovery. What about everyone in between?
What about those who’d committed to the scalp massages but hadn’t yet reflected on their progress? What about those trying varying massage timings (i.e., 2×10 minutes daily, 1×60 minutes daily, or 40 minutes every few days)? What about those who’d never bothered emailing me but may have gotten great (or terrible) results?
I didn’t know. All I had were anecdotes from email exchanges. No hard data or objectivity. And without hard data, we can’t really determine response rates, recovery rates, or even if the scalp massages were actually improving androgenic alopecia.
So I decided it was time to get data and try to answer these questions. And the best way to do it? To design a survey study of participants already committing to the scalp massages: readers of the book’s second edition.
So that’s exactly what I did.
Do standardized scalp massages improve AGA?
Designing the study
Designing this study was quite an involved process — especially because I wanted to do everything as fairly and objectively as possible. This meant having safeguards in place to preserve the integrity of any data we’d collect. For instance, since I run this website, it’s a conflict of interest for me to do any data analysis – because I might be biased in my own interpretations of the data (and not even know it).
So I did everything I could to legitimize the process. I hired two statisticians, set research objectives, got approval from an Institutional Review Board, and designed a 25-question survey to collect data on the factors we deemed most important to answer our research questions.
The objective of the survey was to not only collect data on someone’s adherence to the massages, but also each respondent’s age, gender, severity of hair loss, regions of hair loss, diets, topical-, supplement-, FDA-approved drug-use – and their perceived hair changes throughout their time massaging.
That way, we could isolate the massages from any factor that might influence results… and determine if massage success was contingent upon other variables. After all, if a participant reported great results from massaging, but couldn’t tell us he was also on Propecia®, that wouldn’t be a very fair analysis. So we’d want to control for those in our regression models.
We launched the survey in December 2017. Within a few weeks, we had over 350 responses and enough statistical power to start doing proper analyses. So we closed the survey, and then the statisticians started digging through the data.
Over the next couple months, we gained a lot of insights. For starters, we finally had a clear picture of massage therapy’s response rates and time-until-regrowth for androgenic alopecia. And digging deeper, we were also able to answer questions I’d had for years, like:
- Is there an “optimal” minutes per day to massage?
- Do supplements, topicals, or specific diets influence someone’s results?
- Does massage success vary depending on someone’s age, gender, or hair loss severity?
- Does the use of finasteride or minoxidil alongside massaging influence results?
With the help of the statisticians, my co-author and I spent the next several months writing out our key findings into a manuscript. And at the end of 2018, we submitted it to a top-20 dermatology journal for peer review.
In January 2019, we survived peer review and were accepted for publication. You can read the entire study right here.
Just like my first paper, this study is open access. That means the content isn’t protected behind a journal’s paywall. You can read the findings and benefit from the information – all for free. You can also download the data, run your own regression models, and uncover your own insights – all for free.
The rest of this article highlights our findings, our interpretation of the data, and anything else you might want to know about scalp massages as a potential therapy.
1. Scalp massages improve perceived hair changes in a time-dependent manner
Our dataset included men and women who’d been massaging from 0 months to 3+ years – with daily commitments ranging from 0-10 minutes daily all the way to 41+ minutes daily.
Across the board, our results showed that massage adherence improved perceptions of hair change in a time-dependent manner – with minutes daily, months, and minutes daily x months (i.e, total massage effort) all significantly correlated with positive hair changes.
These trends continued even late into the therapy (i.e., 2+ years). This is encouraging, because most other therapies and treatments (i.e., minoxidil and finasteride) tend to show a plateau in hair regrowth within 6-24 months of use – with patient’s self-assessment scores of their own hair reflecting this plateau.
However, we can’t directly compare the massages to these treatments. These other treatments have been carefully studied in clinical settings, and as such, our study’s data doesn’t have the same power. Think of our study as more of a preliminary glimpse into massage therapy for AGA. We’ll need future studies to confirm if results really do continue for years – like in the case of Mike (who massaged for 3+ years and saw, what he considered, a 40% recovery of his bald spot):
2. If you can commit for 8+ months, response rates are 75%+
In most studies, “response rate” is defined as any improvement to hair loss. In other words, it’s the percentage of people who saw a slow, stop, or reversal in their hair thinning.
Clinical studies show a response rate to finasteride of 80% over a two-year period – with regrowth plateauing thereafter. Studies also show a response rate to minoxidil of 30-40% over four to six months – with results often declining thereafter.
If we narrow the definition of response to just include people who reported a stop or reversal in their hair loss, our study suggests a response rate of 75% for those making it to eight months of massaging. As commitment increases, so does the response rate.
3. Massage success is not influenced by age, gender, hair loss severity, supplement-, topical-, or FDA-approved drug use
This was one of the more interesting findings of the study. When controlling for the above factors in our regression models, results remained consistent across massagers. In fact, the biggest predictor of hair improvements was simply someone’s time commitment to the massages.
This is good news for anyone worried that their age, gender, or severity of hair loss might limit their benefits from the massages. This is also good news for anyone who doesn’t want to spend thousands of dollars on supplements, topicals, or restrictive diets.
For androgenic alopecia sufferers, what matters less are these inputs. What matters most is the amount of time you accumulate doing the massages.
4. If you increase your daily time commitment, the massages become more efficient
If we define efficient as the rate of hair changes someone reports over a standardized total number of hours, it seems that positive hair changes from these massages become more efficient as someone increases their daily time commitment from 0-10 minutes daily to 41+ minutes daily.
In other words, if everyone massaged for 100 hours, the data suggests that those reaching 100 hours by massaging for 41+ minutes daily would get the best results.
Having said that, there are two limitations with my above statement:
- There are a ton of ways to measure efficiency, and each way has its limitations. In our study, we approached measuring efficiency in a few ways which you can read about in our results section.
- After publication, I interviewed several participants who’d reported 41+ minutes daily in their survey results. When asked for more specific numbers, nobody reported massaging for more than 60-70 minutes daily. That means we really only have “efficiency” data for people massaging up to an hour per day. At a certain point, I have to imagine that the massages do become counterproductive.
Regardless of efficiency, it’s also worth noting that people with 0-10 minutes daily of massaging still reported results. It’s just that on average, those results took more months to achieve than those doing 11+ minutes.
5. Increasing your daily effort from 0-10 to 41+ minutes improves results from massaging… but at the expensive of a six-fold increase in total time investment
Again, the data suggests the more daily minutes you massage, the better your results. However, you’ll need to decide whether the additional results are worth the extra hours spent massaging over the course of months to years.
For instance, over six months, someone massaging 40 minutes per day might see better hair changes than someone massaging 20 minutes per day. However, at 40 minutes per day, you’ll need to put in twice the time investment overall. At the extremes (0-10 versus 41+ minutes), those additional results require 600% more effort.
Factoring in effort and efficiency, what’s the optimal minutes per day to massage?
It all depends on personal preference.
If you’re looking at just efficiency, the answer is 60 minutes per day (or maybe higher). But if you factor in the time commitment, not everyone wants to massage for that long.
Looking at the data, I’d personally draw the line at 30 minutes per day. At that threshold, the response rates and hair changes are still comparable to higher efforts, and 30 minutes daily of massaging is just two 15 minute massage sessions (which sounds and feels much more manageable).
6. Diffuse thinners report less benefits from massaging (but still get results)
When we parceled out results by a participant’s region of hair loss (i.e., temples, vertex, or diffuse thinning), two things became clear that while all groups perceived positive hair changes from the massages, those with diffuse thinning reported less benefit versus those with temple recession or vertex thinning.
This, in my opinion, is probably the most insightful finding of the entire study… and it actually highlights a limitation of our methodology.
All of our massage participants self-identified as having androgenic alopecia. However, that doesn’t mean that all of our participants self-identified their hair loss correctly. For those with diffuse thinning, this is of particular concern… mainly because diffuse thinning is a form of hair loss that can often masque as androgenic alopecia but actually be the result of an underlying condition or nutrient deficiency.
To quote from the study:
“All SSM participants accessed materials targeted toward AGA sufferers. However, not all SSM participants received dermatological diagnoses of AGA. Resultantly, a percentage of diffuse thinners who self-diagnosed as AGA may actually be suffering from conditions which manifest as diffuse thinning—in addition to or in the absence of AGA. Chronic micronutrient deficiencies in ferritin and/or zinc , micronutrient excesses of iodine , and hypothyroidism can present as diffuse hair loss . Some studies suggest a subclinical hypothyroidism prevalence of up to 10% in adult populations . Hypothyroid-related hair thinning differs morphologically from AGA-related hair thinning, and cases of hypothyroid-linked hair loss have been fully reversed following micronutrient supplementation alongside thyroid medication . Consequently, the mechanisms by which SSMs might improve AGA may not apply to non-AGA-related hair loss, which may partly explain the lower assessment scores for diffuse thinners.”
In fact, this has been a common thread amongst several readers with whom I’ve worked long-term – particularly diffuse thinners. They assume their hair loss is strictly androgenic alopecia, then they try a battery of treatments for AGA only to realize those treatments aren’t working. Then they opt for lab tests to rule out the conditions commonly associated with hair shedding disorders that manifest as diffuse thinning…
- Nutrient deficiencies
- Nutrient surpluses
- Small intestinal bacterial overgrowths
- Heavy metal / trace element toxicities
…and discover that they actually have one of these conditions.
Take one of the readers here – Ben M. – who suffered from diffuse thinning and some temple / vertex thinning. He tried the massages for 13 months and things seemed to only stabilize. It was only after doing additional testing that he realized he was deficient in iron and vitamin D.
After course-correcting his deficiencies and continuing the massages, he saw major hair recovery within just six months. Here are his photos (click in for a full view).
If you think Ben’s case is unique, I can assure you it isn’t. For reference, here’s how common these underlying problems are of the hair loss sufferers with whom I’ve worked.
Of the men who were either diagnosed with AGA or only considered their hair loss as AGA, ~30% of them who went in for more lab work later discovered they had at least one underlying condition associated with a hair shedding disorder. For females, that number was 93%.
The bottom-line: scalp massages don’t target hair shedding disorders; they target AGA. And given the increased likelihood of diffuse thinners having a hair shedding disorder, this is likely why this group reported slightly lower hair change scores while trying the massages. (More on this in future articles).
Any other insights from our study?
Yes! There are a few questions I haven’t yet covered here (but that I wanted to answer at the outset of the study). They were:
- Can we predict a responder versus a non-responder?
- Does diet have any relationship to massage success?
- Since analyzing the data, are there new massage techniques and best practices?
We did answer these questions, but most of our insights were derived from qualitative data (i.e., interviews and Skype calls with some respondents after we published the study). I’m not yet ready to share these, but I will in the very near future.
In the meantime, rest assured that if you’re following the directions from the massage video, adhering to your three scalp segment rotations, and making the time commitment, the odds are that you’ll see results (i.e., hair recovery).
If you have any questions, please reach out in the comments. Otherwise, if you’d like more insights, or want a description or demonstration of the techniques, you can read our scalp massage study – in full – on PubMed or in the journal Dermatology and Therapy.
Rob English is a researcher, medical editor, and the founder of perfecthairhealth.com. He acts as a peer reviewer for scholarly journals and has published five peer-reviewed papers on androgenic alopecia. He writes regularly about the science behind hair loss (and hair growth). Feel free to browse his long-form articles and publications throughout this site.