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.
119 thoughts on “Do Scalp Massages Improve Hair Loss From Androgenic Alopecia? (Our 2019 Study)”
A highly nuanced, honest, and extremely insightful study – thanks Rob! I read it with considerable interest. Quantifying the results of your research was the most important step now, and again you did a terrific job. I am pretty sure that if these results can be sustained in a controlled study (which, I am sure, will be your next aim), your name will soon become famous. Millions of people have tried to beat AGA – maybe you are the one who made it in the end!
May I ask one question that bothered me while reading your two papers?
Consider the following scenario: an AGA-sufferer starts taking Finasterid early, let’s say for ten years. He then stops the medication and suddenly loses a lot of hair – most often one reads: ‘the amount of hair that would have fallen out without taking Finasterid’.
However, if we assume that DHT accumulates in the scalp as a result of chronic tension, how is this possible? Should we not rather expect that after the ten years of medication during which global DHT levels were kept low (which is why hair status remained largely constant) DHT in the scalp now only BEGINS to accumulate again, so that hair loss after stopping the treatment would be a slow process? In other words: if the tension theory is correct, shouldn’t we expect that after discontinuing DHT blockers the balding clock simply (re-)starts at the level where it was before treatment rather than resulting in a loss of all the hair that was saved during this interval?
Thank you for the kind words. And it’s a GREAT question. After discontinuing finasteride, most people lose the hair they’ve maintained within 3-12 months – even if they took finasteride for years. This begs the question: what explains the “acceleration” of the balding process following finasteride discontinuance? And does this conflict with the tension hypothesis?
There’s a great study that I hope answers your question. First, a little background for anyone less familiar with the literature than you:
Finasteride is a type II 5-alpha reductase inhibitor used to treat androgenic alopecia. However, it’s also used as a treatment for benign prostate hyperplasia (BPH). Like androgenic alopecia, type II 5-alpha DHT is causally linked to BPH. As such, the treatment for BPH is 5mg doses of finasteride – all in an effort to “deprive” the prostate of as much DHT as possible.
Unfortunately, this comes with consequences. Animal studies have shown that during finasteride use, prostate tissues respond to androgen “deprivation” by upregulating androgen receptor activity. It’s sort of like when a plant is put into the shade and starts growing in all directions looking for sunlight.
Unfortunately, that study also showed that the upregulation of androgen receptors does not go away after finasteride is discontinued. In other words, the androgen receptor remodeling is irreversible (at least for the duration of that study).
As you can imagine, this is a problem for our prostate. DHT has a very high affinity for androgen receptors. And when someone stops using finasteride, DHT essentially floods the prostate – because so many more androgen receptors are now present. And just like with androgenic alopecia, when a BPH sufferer quits finasteride, their symptoms rapidly reemerge (and often worsen).
The same is likely true in the scalp: during finasteride use, scalp tissue androgen receptors upregulate as a response to androgen deprivation, and this remodeling remains after someone quits the drug. The consequence: DHT flooding in the scalp, rapid hair follicle miniaturization, and within 3-12 months, a return to baseline (or worse) if someone had never taken the drug in the first place.
I hope this helps answer your question!
many thanks for your prompt reply! Two quick follow-ups:
(1) If this was the case, should not beard growth massively increase (probably by the same amount at which scalp hair decreases) when quitting Finasteride, as receptor density will be greater in this area, too?
(2) Given that you assume that DHT only accumulates in the scalp (in a harmful way) when it is under tension, do you think that the following would happen: if the patient on Finasteride managed to loosen his scalp really efficiently before discontinuing the drug (say by massaging and / or Botox injections), the burst in DHT when the subduing agent is removed would not have any negative effect (or even increase hair growth like it does in body areas not under tension)?
(1) It’s certainly possible, but for this to be true, I would expect that the ratios of type I, II, and III 5-alpha reductase in beard tissues would need to be equivalent to those of balding scalp tissues. To my understanding, while DHT elevation has been demonstrated in both tissues, the enzymatic ratios are less studied.
Finasteride reduces type II 5 alpha reductase – but that only reduces DHT converted from that specific enzyme (not that of type I or type III). Interestingly, finasteride users (at least from one survey study) don’t note any increases (or decreases) to body hair:
So this suggests to me that secondary body / beard hair might rely more so than balding scalp hair on additional pathways for DHT conversion (i.e., type I 5AR, type III 5AR, etc.). In this case, finasteride use (or discontinuance) wouldn’t affect body hair as greatly – because DHT wouldn’t reduce as greatly in these areas and the androgen receptor remodeling wouldn’t be as dramatic. That’s just my two cents; I could be wrong but this effect still seems in-line with the literature.
(2) It’s possible, and there are anecdotes of people safely transitioning away from long-term finasteride use without major hair sheds, but this is such an under-researched area that unfortunately I just don’t know.
The other thing worth mentioning is that while I’ve written about the scalp tension hypothesis, put forth a case for its support, and argued against genetic sensitivity as the sole driver of AGA – it’s also possible that I’ll revise my opinions in the future in light of new evidence. It’s just as that as of right now, it seems more and more obvious that there’s an epigenetic interaction that catalyzes AGA. Tension is one plausible mechanistic “environment”; so is the contraction of muscles around the scalp perimeter (and the subsequent pinching of the branches of blood vessels stemming from the carotid artery that help support balding-prone scalp tissues):
Either of these mechanisms can lead to hair thinning – so it doesn’t just need to be one or the other. Interestingly, in the last few years, more research teams are beginning to revise their beliefs on the idea of strict follicle sensitivity. Take this team, for example, that now argue that the galea is likely a driver of the patterning of AGA and may even explain aspects of AGA’s morphological changes (and through completely different arguments than I’ve made):
Great write-up. When I started massaging for about 15-20 minutes per day, I noticed within a month that the texture and fullness of my existing hair was much improved. That alone was worth it. However, not sure how much it has helped with reversing any hair loss yet (Norwood 3v), but will keep at it.
Anyway, are you planning to do your own study on micro-needling? I’d be interested to see how that compares to your scalp massage research at some point.
Thank you! I’m not currently planning on conducting a study on microneedling, but we did collect data on people who were microneedling + massaging in our study.
The evidence suggested that while those doing microneedling + massaging reported better average hair change scores, these results were not statistically significant versus massaging alone. In any case, I’m sure the dual approach wouldn’t hurt. And by itself, microneedling studies have shown a strong response rate and a 15% increase in hair count over 6 months.
I read almost all of your articles and found them very informative however i can’t find a method to overcome AGA anywhere, i mean great information here but nothing on how to fix it.
Anywhere to get these information from? Perhaps i am missing the links or something.
The methods are different for everyone – and will depend on your age, gender, hair loss type, comfortabilities with FDA-approved drugs, and time availability. That’s why much of the information here focuses on education – to help people sort to the pathway they’d like to take.
This article (i.e., scalp massaging) is an option for those disinterested in the drug approach and with the capabilities to make the time investment. If you want a high-level overview of other options, you can sign up for the treatment “cheat sheet” I put together at the bottom of this page:
We need to understand why massage is effective and what the proper technique is.
As you’ve pointed out, one major factor in male pattern baldness is calcification.
I can see this clearly on top of my head where there is a bulge across the middle of my scalp. There are also two smaller bulges close to the main bulge above ears.
These bulges are a thick buildup of calcium. Calcium is almost everywhere in areas of hair loss, especially on the frontal part, but there is more of it in the bulges.
For the past few days I was pressing down REALLY heavily on these bulges. You know what happened? I started hearing cracking sounds – it sounded as if a glass was being smashed. This wasn’t localized – I would press heavily on a small part of a bulge and a big area around it would start cracking.
When I press down on other areas there is a small dent, which are probably softer calcium deposits, unlike hard calcium deposits where I hear cracking.
How is calcification treated on other parts of the body?
A common technique used is called shockwave therapy. Focused shockwave therapy targets calcium buildup, dissolves it and then the lymphatic system absorbs it.
You can read more about it here: https://www.sciencedirect.com/science/article/pii/S1743919115011917 .
Massage works in a similar way to a shockwave therapy which is why it’s effective.
One thing to keep in mind is that you need to clean up the entire area before the hair can truly regrow in a healthy environment.
If you read the detumescence study, you will notice that results only came near the end. It wasn’t a linear progression!
The main massage technique should be based on pressing down HEAVILY on the area. Pinching and other techniques don’t do much to break calcium deposits.
2 Questions: So basically you are saying 10 minutes per day will get you about the results as 60 minutes but in a lot longer timeframe correct?
And what about the maintenance program? Let’s say you massage 20-30 daily for X amount of time and you stabilize your hair loss and get good hair regrowth can you cut back to 5-10 minutes daily to maintain or 10 minutes 3-4 times per week? ETC?
(1) That’s what the data suggests. It seems like our best predictor for massage success is total cumulative effort – even if someone has taken breaks from massaging, and even if someone massages fewer minutes per day than whatever is recommended.
(2) I’ve been doing my own n = 1 maintenance test for the last two years. After 2016, I significantly reduced my massage routine to around twice weekly sessions. All remained well. Starting in 2018, I decided to stop completely to see how things would go. For most of the year, things maintained. Throughout winter, I noticed some slight thinning – though it’s hard for me to say whether this was from seasonality or from the fact that I’d barely committed to massaging for almost two years. I’m done with the experiment (for now) and have restarted doing the massages with more consistency.
So at least for me, I was able to maintain with twice per week sessions (followed by 6-8 months of doing essentially nothing). However, I think with absolutely zero maintenance, things will probably start to thin again. Long-story short: maintenance appears to require significantly less effort than regrowth!
That is great to hear! So based on your maintenance protocol I am going increase my massaging to at least 30 minutes daily knowing once I get the results I am looking for I can cut back tremendously!
I have also incorporated daily micro needling very lightly just to help with minoxidil absorption and my actual hairline has become the lowest I can ever remember. The new hairs are more than Vellus hairs and are growing longer each day. I know in 8-12 months I will go from a diffused Norwood 4 to absolutely no hair loss!
My whole program is very methodical it includes nutritional supplements, scalp massaging, micro needling, minoxidil and a very small dosage of finasteride. This for me is finally working. And I know everyone is different, it took me probably over 3 years to come up with this exact protocol.
This is AWESOME… and your augmented approach is exactly why I’ve started the membership site. Hair loss treatments are not “one-size-fits-all” – and the right regimen is going to depend on someone’s age, gender, hair loss type, comfortability with drugs, and time availability. I’m so glad you’re seeing results with a regimen that you’re not only comfortable with, but that is also working.
Share some photos!
All my best,
Hey Adam, I was wondering if your prediction was correct after all? Seems like it’s been a year since your post. I’m very keen to learn your progress!
You’re absolutely killing it. Thank you for all the hard work. Two quick questions for you.
1. Are blood tests the best way to test for all the mentioned conditions that commonly cause hair shedding disorders – Hypothyroidism, Hyperparathyroidism, Nutrient deficiencies, Nutrient surpluses, and Heavy metal / trace element toxicities ? (I’m aware that the SIBO test is different). What bloodwork specifically would you recommend someone with diffuse thinnning get?
2. Do you think pharmaceutical medication is an ideal route for someone who tests for hypothyroidism?
Thanks a lot
Thanks for the kind words! To answer your questions–
1. It’s hard to say — because symptoms are often so person-specific. Usually I’d suggest that someone catalogues their symptoms, compares those symptoms against the symptoms of underlying conditions associated with hair shedding disorders, and then cross-compares which tests they find relevant to them. Some of these tests are blood; others are urine; others might even be a hair analysis. I’ve built a survey program (that’s part of the new book + membership site) that does a lot of this work for you – and shows you the symptoms of each condition so that you can self-select into which ones might be worth testing in the future.
2. It depends on each individual, but in many cases, the pharmaceutical route can absolutely help (so long as it’s managed properly). Two examples come to mind: two hypothyroid individuals with major hair loss, and both who saw a full hair recovery following the right pharmaceutical intervention:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746228/ (mentioned in this article.
So it can certainly work!
First I want to say thanks for all you do in regards to hair loss research. Great article!
I sent you an email with a similar question to what I am asking here, so feel free to respond to either message.
I read the story above regarding Ben and his diffuse thinning, and feel like I can relate to his story.
As you know, I have had 3 hair transplants and have been on finasteride for about 5 years now. I also did the 2×20 minute DT massage routine last year for a solid year. While I feel like I have had some results with massaging and finasteride, after 5 years of various methods and therapies I still can’t seem to get my hair density where I want it.
I did start using the Derminator about 2 weeks ago, and am hopeful for some good results (using it every 10 days for 15 minutes on 1.5mm + 2 20 minute DT massages per week ). I also just started using oral minoxidil 2 weeks ago.
One thing I’d like to note is I had PRP injections along side my second hair transplant. When I look back at all my hair pictures over the past 5 years, PRP gave me the best looking hair I have had since starting any treatments.
I also should note that my hair loss was very rapid 5 years ago, and occurred quickly over a period of about 1 year following a series of really stressful events (My body/state of mind has always been very sensitive to high levels of stress and anxiety). Prior to this I had awesome hair.
So, I am wondering 2 things: 1)based on my experience with PRP, would you expect my new Derminator routine to be helpful? 2)Could it be possible I have some kind of nutrient deficiency, thyroid issue, gut issue, etc that is giving me underlying issues therefore being the reason I lost hair so rapidly?
I feel like I could be missing something here not allowing my hair to reach the next level.
I look forward to hearing from you!
Hey Elliott – I responded over email!
Hi Rob , thanks for all the info your the best source i have come across so far .The DHT paradox you mentioned really interested me , i got an infection a few years back ..through out my body …and all my body and facial hair was almost growing before my eyes ..while losing hair dramatically on the scalp at the same time …up until then i had regrown nearly all my hair through head taps .and a few other things …i was 57 losing hair since 32 .
Got this metod of the net ..called Hollywood hair techniques .15 mins a day ..i was 56 when i started it ….After being sick my hair ..what was left ..wouldn’t grow or go ..it was about 1/2 all over ..and in like a state of shock !…the head and brush taps no longer worked ..nothing would. Until i came across your massage techniques and after sometime it has finally improved quite a lot ..although still quite a way to go .Im 66 now started your technique at 64 ..
Here are some of the things that got at least some hair growing for me ..till i went to the Hollywood thing which got a lot of growing for me …..a herbal mix .(Chinese) called dabou
No longer available…was very good ..not complete regrowth though
Vasaline and crude oil …Edgar Cayce ..both good ..but harsh at the start ..and actually shedding the hair to begin with .
Laser …okay new white hair ..not that great ..
Hope this has some interest for you Rob
Thanks Mark! And congratulations on seeing some regrowth. Please keep us posted on how things progress!
I bought your book in autumn 2017 and since then I’ve been massaging almost consistently, around 30mins a day. I haven’t recovered all my hair, but I’m more than happy with the results. Before starting the massage therapy, the biggest problem for me was the lack of solutions for this problem, which affects so many men. I felt depressed and without options. Now I know there is a cure, even if it involves a lot of work and commitment. In my opinion the best part about it is that it don’t have to take any pills.
Just to share something, I think that the most important parts of the massaging, are the pressing part but also folding the scalp from all directions. To explain a bit, before I was massaging from left to right let’s say, from ear to ear, but I noticed the skin is tighter from forehead to neck, so I started folding also in this direction using fingers from both hands, because the skin is tighter and is much harder to do.
Again, thanks a lot and keep spreading the news,
This is really helpful Stefan, thank you. A lot of readers have reported that folding / pinching the scalp in alternating directions is helping to break through plateaus. It’s also something I’ve incorporated into the latest massage recommendations and video. It sounds like you’ve intuitively already made these adjustments, which is great news. Please keep us posted!
thanks for this article and for your continue efforts on this topic and congratulation for the baby!
Unfortunately, I still can’t see ANY sign of regrowth, aftert committing to the massages twice a day for 15 months. To be precise, I did it twice a day for around 12 months, then I must admit I got quite discouraged but still wanted to keep going… so I have been massaging only once a day for the last 3 months now. Still no changes (neither bad or good).
I don’t have diffuse thinning and I don’t have any kind of deficiency.
In this article you reiterate that the more time you spend massaging, the better. But as I said, after a full year of massages twice a day, no results.
Perhaps, at least for me, there is something I need to change in HOW I do the massage? Because at this stage, I don’t think it’s a matter of “how long” anymore.
P.S. Am I getting a notification if you reply to this comment? Sorry but I am no used to do this.
I’m sorry you’ve yet to see any hair changes from massaging. The silver lining is that at least it sounds like you’ve seen hair loss stabilization (i.e., “Still no changes (neither bad or good)”).
It’s possible that you just might not respond well to this sort of therapy. Even after controlling for the issues with diffuse thinners, there were still a handful of non-responders in the study who were doing everything by-the-books yet didn’t see the hair changes they desired. It’s also possible that there’s something within the technique itself that’s preventing you from seeing any improvement. For example, one reader here saw no results for six months. We had a Skype call and realized he was skipping massaging the scalp perimeter muscles. He made the change, and even started using lacrosse balls and PVC pipes to help roll out these muscles and relax them. Six months later, he saw a lot of progress at his vertex:
I’m not saying this is your case, but it’s just one example of how a single technique change can make all the difference. Otherwise, you can always experiment with other treatments or therapies: microneedling, PRP, rosemary oil, or even more conventional choices like minoxidil or finasteride. There are a lot of options out there, and obviously I want the massages to work for everyone. But for non-responders, a different approach might be necessary.
I bought the complete package 10 months ago or so, but have been doing this massage routine daily for 2 years +. I haven’t yet booked in a Skype session because honestly, you seem rather busy and mildly put it, overwhelmed by enthusiastic questions and studies. I would like to support this work financially in other means if possible.
Your work is incredible I must say, and truly one of a kind in this weird pseudoscientific space that many “hair-miracles” tend to roam. Fantastic indeed.
Anyway, a question, since I saw you talked about it just now regarding that the upregulation of androgen receptors does not go away after finasteride is discontinued, that it’s irreversible.
I used Finasteride for about 2 years, which I quit at least 10 + years ago. My intuition, scientifically not valid I’m aware, was that every hair that was protected by the use of Finasteride, would eventually disappear and that after that, it would basically go back to normal, hormonally speaking. I was at the time of quitting Finasteride doing the Tom Hagerty Scalp Excercise (I still do, in combination with the massages you propose), so my hair loss has been slowly getting worse, gradually progressing over the years (slowly, probably due to the scalp exercise). The first time I saw regrowth was about 10 months ago, doing your pinchy massages.
Do you think its really possible that upregulation is irreversible? Even after 10 + years?
Many thanks! Truly fantastic work!
Thanks for the kind words. I really appreciate your support to keep the site going, and for taking the time read and comment.
To answer your question: it’s hard to say if AR upregulation is truly irreversible after discontinuing finasteride. For instance, that one study on gerbils administered finasteride for 30 days then waited 21 days after discontinuance before examining the prostate tissues. At that time, the AR remodeling had remained the same compared to the gerbils examined just a day after stopping finasteride, and so the possibility of irreversible AR remodeling was proposed.
What’s less know is if this extends far beyond 30 days and continues for months to years into the future. In biology, a common phenomenon is that as you increase the circulation of any hormone or signaling protein or hormone, the receptors for that hormone or signaling protein decrease. The converse is also true: as you decrease the circulation of any hormone or signaling protein, its receptors increase. It’s like a balancing act to always make sure a tissue is getting only what it needs (nothing less or more). That’s what makes the findings on that finasteride study so interesting: the effect didn’t go away like we’d expect.
There’s probably a good chance that our androgen receptors do return to normal… but it just takes a really long time. I wish I had a better answer for you. If I read any studies that better answer your question, I’ll certainly pass them along.
I’ve switched from Rob’s method of 40 minutes a day after 3 months to using a wooden hair brush to move my scalp and brush it between 5-20 mins. I started with Rob’s method in August 2018 and did it daily untill around December, then I fell off and bought the wooden brush.
My hairline is filling up with one or two thicker strands of hair every two weeks or so, now that it’s May I’m really seeing the results, I think I won’t have completely reversed it untill about early 2020. I started off as a nortwood 3, took me 11 years to get there so I’m definitely growing more hair faster than I’m losing them.
I haven’t done anything on the diet front, I also use Tom hagerty’s technique from time to time in my daily life aswell as inversions as you said helped in the book.
Congrats Ayanle! That’s very encouraging. Given that it takes us infants 5+ years to grow their hair and adults 10+ years to lose it, it’s pretty remarkable how we can see transformations in any shorter of a time period. Please keep us posted with your progress!
can you please share you wooden brushing method? do you just brush or do massages too with it? thank you
First Congratulations to having a baby, MY heartiest congratulations on being parents Wishing you lots of happiness with your little one.
Thank you Sigatapula! I really appreciate it.
thanks for your detailed reply and the links – very interesting! These may indeed be possible explanations. There are so many variables involved…
Stefan, thanks for your tips regarding technique. I was thinking the same: ideally, one should probably put stress on the skin from every direction, at least at 90°-angles. What do you think, Rob?
What I also found very intriguing is the question of maintenance. Rob, you said that you could maintain most of your gains with much less massage effort. My best guess is that once one has passed the threshold of a certain degree of looseness of the scalp, keeping it that way requires less mechanical stress. Put differently: acquiring looseness is much harder than maintaining it – probably because the former involves breaking up structures, while the latter does not (or only the small amount that has built up since the last session). So far, this is all very intuitive. Now consider the following:
Imagine someone starting the massages BEFORE the first signs of AGA appear and his scalp is still naturally loose. One might, for instance, prescribe this as a preventive treatment option for people with a high likelihood of being affected later in life (on the basis of genetic tests or mere observation of family history). If our assumptions so far are correct, this would mean that this person would have to invest muss less time and effort because he will always just be maintaining instead of reversing if he sticks to the regimen.
This could become the real beauty of Rob’s method: preventive instead of retrospective – with much less effort!
Rob, do you think this make sense?
I certainly think that the earlier we start tackling this issue, the easier the battle. On that note, I think you might be right: that starting these methods even before hair loss should help prevent or even significantly delay its onset.
A living example of this is Christopher Walken. To my understanding, he started receding several decades ago. You can also tell that he’s genetically prone to AGA because he’s lost a lot of eyebrow hair (there’s an overlap in eyebrow hair and balding scalp hair genes). But when you look at photos of Christopher Walken today, he’s essentially had the same hairline for 40+ years. He’s been asked about it in interviews, and he says he uses no drugs, but instead, he spends ten minutes per day “yanking” at his hair. Fascinating stuff!
The eyebrow observation is interesting – what causes that fall then? Is inflammation also at stake? If eyebrow hair fall despite being found in a zone nowhere near as tense as a scalp, how can we make that fit with the scalp tension theory ?
It’s a great question. In my opinion, it might be a combination of (1) frontal bossing, (2) the closure of the emissary veins (due to calcification) which would’ve otherwise supported skin tissues underneath our temples and eyebrows, and (3) reduced blood flow from the chronic contraction of peripheral muscles at the forehead.
Thanks for the answer! Out of curiosity, is there any way these things can be measured?
I had great success with scalp massaging, albeit with an electrical massager, until it broke down. I was wondering whether you’d consider electrical scalp massagers, some are even ultra-sonic as it is physically easier and more efficient than using your hands.
I was also wondering whether there might me massaging scalp caps which could remain on for hours if necessary, even while watching TV or taking a nap.
Congrats on your success so far. I’ve had a few readers reach out to me and have said that this device has made the massaging significantly easier:
I know a few people who’ve purchased two (one for each hand) to cut their massage time in half. So that’s a good place to start!
That seems like a really helpful device. I consider getting one, too. Do you think there’s anything we need to pay specific attention to when choosing one of these massaging devices?
I am incredibly interested in the standardized scalp massage method. Is there a way to access a video demonstration of it?
Thanks for all of the work you do!
You can access the 2016 version of these massages right here. We’ve since updated the massage techniques (of which the new video is available inside our membership). But the 2016 video is what was used in our study and should be more than enough to get started.
Hi Rob 🙂
Thank you for all your research and informative articles and congrats for having a baby!
So I have a diffuse thinning since years and last year, I’ve tried your massage techniques exactly like written in your book for almost a year, but I didn’t notice any improvement so I gave up as I was frustrated for wasting my time and efforts and not getting any positive results like everyone else, and I thought maybe because I’m a female so it’s different. A few days ago I read again about the benefits of scalp massaging so I decided to give it another try and buy saw palmetto supplement and topical rosemary oil, then I got your email. And I’m surprised to hear that 93% from female’s hair thinning is caused by underlying issues! I feel this might be my case cause my parents and both their families as well as my sisters and brother everyone have really really thick hair! so how can it be genetic for me, it doesn’t make any sense. Also the massage did nothing for me. So I have two questions if you’ll be so kind to help me out:
1- Should I just buy supplements like Zinc or Vitamin D3 on my own and see how it works? and how long approximately should I take them to see the effect?
2- In case that the hair thinning was caused by such underlying health issues, should I keep doing the massage too or is it useless for such cases and there is no need to do it?
Thanks for sharing your situation, and I’m sorry you’ve yet to see results from the massages. To answer your questions – yes, female hair loss is frequently misdiagnosed as AGA when it’s actually a function of a multitude of underlying factors – many of which are listed in the article. I wouldn’t supplement with zinc or vitamin D3 before doing more lab work. And I think it’s best to first try and identify (and resolve) these underlying issues before sticking with the massages. This is because if you have a hair shedding disorder, trying to treat it with massages is sort of like trying to treat type I diabetes with diet and lifestyle changes (recommendations for type II diabetes). They’re similar conditions, but totally different causes (and thereby require totally different treatments). The new book update and membership site focuses much more on female hair loss – and on getting to the roots of the issue – so I hope you’ll find benefit out of the information.
All my best,
Great discussion here!
Christopher Walken’s case is very interesting, thanks for pointing that out, Rob! If his statements are accurate, he has apparently managed to maintain a certain looseness with very little effort (timewise, that is; who knows how hard he is ‘yanking’ 😉 ).
Like many men, he apparently suffers from recession in the temples, while the mid-section has remained stable. This is one thing I have been wondering about ever since I read Rob’s book: many balding men have the infamous ‘bulge’ extending along the midline of their heads (along the sagittal suture) – should we not expect hair to fall out here FIRST? It nearly seems as if this bulge induces hair loss in the areas right next to it (i.e. the temples), but is itself affected last. How is this possible vis-à-vis any tension- or bloodflow-related theory? Shouldn’t tension, fibrosis and calcification be highest, and bloodflow be lowest in this bulge region? (NB: I do not really buy the study using the von-Mises-stress model as an explanation, since it is only done in 2D and thus completely ignores skull shape and consequently the bulge that maybe Christopher Walken and certainly other men have under those areas that are still covered with hair.)
Any thoughts, Rob?
I think it’s time we try to develop a few three-dimensional tension models of the scalp to see if the two-dimensional von Mises tensile readouts are comparable across models. That’s probably the only way to effectively answer your question.
In terms of temple recession, it seems like tension points (at least in two-dimensional models) do peak at the temples where the galea aponeurotica roots into the connective tissues and force at the muscles is applied. In fact, you can even simulate tension patterns of diffuse thinning with just a change in surface area (i.e., head size) and force direction. Having said that, there are certainly limitations with 2d, and the 3d model is probably pretty necessary at this point if anyone is interested in furthering the tension theory.
Again, tension is just one mechanism by which the AGA cascade is plausible. Another plausible mechanism is simply that the contraction of this perimeter muscle band pinches the arterial branches running from the neck to the top of the scalp, and we start losing hair. This was the model proposed by this team, and it’s just as possible:
Thanks for the quick reply! maybe you are right I will just try to do some tests, the thing is I was responsive to minoxidil but I didn’t want temporary results which I will lose whenever I stop it, I want to target and heal the main problem not the symptoms. The doctor said I had an iron deficiency but I’ve already got iron injections and treated the issue, do you think the iron supplement affected negatively something else in my body? :-/
I’ve got a couple of more questions though, In the cheat sheet which compares all treatments, that micro-needling has a higher response rate than standardized massages, so why not only do the micro-needling then?
And in case I had a nutrient deficiency and got that sorted out, should I do massages? or it won’t be beneficial for me?
Thank you !
There’s A LOT to unpack with these questions, and while I can’t get into all of the details here, iron deficiency (even if it’s not full-blown anemia) can absolutely cause hair shedding. In fact, iron deficiency is often one of the biggest predictors of non-AGA-related hair shedding in women. The next challenge would be to determine if that iron deficiency is a result of lacking intake (diet), lacking absorption (SIBO), or increased demand (hypothyroidism, physical stress, etc.).
Massage response rates at 75% at 8 months and continue to rise with time, while microneedling alone has a response rate of ~80% at 6 months of use. So the response rates are certainly comparable. However, if you’re tight on time, then microneedling alone might be a much better option for you.
If your hair loss is nutrient deficiency-related, then sorting out the nutrient deficiency should drastically improve your hair even without the massages. If you have AGA + nutrient-related hair loss, then sorting out the deficiency then starting the massages is likely the better order of operations.
Great work as usual – fantastic stuff Rob aka the hairloss saviour
Looking forward to the insight on diet and also hoping for more future insight into the galea and also posture. Also am I correct in thinking a forum is on the way? If so this is also something I eagerly anticipate…
I’m coming up to 6 months on the massage…seen some hair thickness and also the odd sprouting dark hair in the temples.
p.s Congrats on the birth of you daughter.
Thank you! And yes, the revised book has a lot of new information on the diet-hair loss connection as well as the galea and its connection to AGA. Yes, there is a forum on the way! It’s part of the membership community that launches next week (which includes the new book).
Congrats on your progress so far! Keep it up!
Hi. When I massage my scalp It forms a lot of dandruff. Is it so just for the first month or what can be the reason?
If I don’t massage my scalp I don’t have dandruff.
This is commonly reported amongst people massaging. In terms of your other question, if you click into the study we published and go to the supplementary materials, you’ll find a PDF of the massage directions as well as a demonstration video. This should answer all of your questions about technique and dandruff.
Another question. Is there a video anywhere which summarises all the correct routine of the excercises it’s necessary to do?
Hey Rob congratulations on the work you are doing.
The thing I wanted to say is that the case of diffuse thinning of Ben you mentioned is painfully similar to mine.Like Ben I also have some vertex thinning more pronounced than other areas but overall diffuse thinning.My vitamin D levels came out to be 9ng last year.So please write an article about that in near future.
Thank you. I’ll certainly write more in the future about the difference between hair shedding disorders and AGA, when they overlap, and how to tell the difference. I’ve covered vitamin D a bit before in this article, and vitamin D is also discussed a lot within all versions of the book:
Hi Rob and thanks for this article,
What do you think about microneedling causing cancer ?
Thanks for sharing. Yes, any wound that we incur on our bodies technically increases the possibility of tumor growth. It’s really unclear if this relationship is just relegated to disease states and chronic infections / inflammation, or if microneedling also falls under this category. So we have to be careful about likening studies on disease-related wounding and cancer to microneedling.
In terms of the article itself, it’s a bit ironic that the author who writes about the dangerous of wounding-based therapies also sells an exfoliant product which creates the inflammation to which they warn against. There are a lot of studies demonstrating scarring improvement from microneedling, so again, this is another reason why we have to be careful about which studies we compare and liken to other therapies.
For any mechanical stimulation-based therapy specifically, we need to make sure we’re making apples-to-apples comparisons for the following variables. Otherwise, we’re going to mischaracterize the effects of hormesis, tissue remodeling, and just about a thousand other things going on inside the body.
Short-term versus long-term outcomes. Example: exercising induces muscle damage in the short-term. In the long-term, it leads to muscle gains, more strength, angiogenesis, and longer life. If we only ever analyzed exercise in the short-term, doctors would recommend to never do it.
Dose-dependency. Example: mechanical stretch at low- and high- thresholds has been shown to elicit the same signaling proteins — but at low-thresholds, studies have found varying forms of mechanical stretch to be anti-inflammatory, whereas at high-thresholds, it’s inflammatory. The difference in results is due to the translocation of those signaling proteins across nuclei at higher thresholds, and their containment at lower thresholds.
Mechanisms of action versus actual outcomes. Example: the derivatives in fish products can upregulate genes that ostensibly increase someone’s risk for certain diseases. But in epidemiological studies, we just don’t observe an association between fish consumption and increased risk of these diseases. It’s big picture versus little picture; mechanisms versus outcome. Zooming this far in and extrapolating outwards is a very reductive and risky way to make inferences.
The article you linked, in my opinion, falls victim to all of those errors above. That doesn’t mean we shouldn’t question microneedling’s effects long-term; of course we should! It’s just that the article’s evidence doesn’t necessarily fully support its claims.
Is AIR CONDITIONER (AC) causes hair loss?? Is it one of the factor of AGA??
I’ve also sent you an email
But I can’t even imagine how many you must get daily.
Thank you for injecting so much hope in our lives.
In December 2018 I stopped topical finasteride and started heavy massaging. After 3 weeks the hair falling during the massages went to 100 to 20 in average. Unfortunately in the following months shedding started to accelerate.
The paradox is that my scalp has become A LOT more flexible, the difference is crazy, I can pinch it with two fingers without any issue now.
I’m a little confused about what to do now.
Thank you so much for everything
Thanks for reaching out. This is likely the result of a finasteride-related shed kicking in. If I were in your position, I’d try to continue taking finasteride while committing to the massages, and then once you’re happy with your hair, I’d try to wean off the drug very slowly (over a period of 4-6 months). This should help quell your shed and allow you to ride the benefits of both therapies.
Perfect! now I understand! then I will check my iron levels and write back about any updates in case my hair got better. and I think scalp massage is beneficial in any case cause my scalp feels really tight & hard. but I will not do it until I get the results to see the main reason of the hair thinning. Thank you so much for answering my questions and for all your recommendations Rob! You are a hair genius! 😀
Thanks for the great job!
Just one quick question:
Have you come across any side effects of the massage techniques in your research or are they safe? For example, wouldn’t there technically be a possibility that pressing hard against the scalp (as you recommend in the video) could potentially damage the skull or brain?
Be patient with me. I’m a bit dummy.
You said:”…if you click into the study we published and go to the supplementary materials, you’ll find a PDF of the massage directions as well as a demonstration video”. I can’t find neither one nor the other. Could you show me the links of both or tell me the exact section of the materiale where I can find them? Mybe it’s because I’m checking from my cell phone.
This is the link of scalp massage video.
Hey Rob, it came to me as a surprise that you haven’t written an article yet regarding this study :
There are many different links to their studies, I choose to send you the PDF form from ncbi. I think the only downside would is that they sponsored the studies, but every major company has some type of involvement in research testing their products.
So, what do you think about it?
Let us know.
I hope you and your family are doing well.
The link was to a file on your computer, so I couldn’t open it. Is this the study you were referencing?
Hey Rob, I commented below too, but you can erase the other comment if you like.
Here is the link of the study I was talking about :
If the first link does not work, you can just copy the following title :
The Safety and Efficacy of a Sustainable Marine Extract for the Treatment of Thinning Hair: A Summary of New Clinical Research and Results from a Panel Discussion on the Problem of Thinning Hair and Current Treatments
After doing so, google results will show you a link which is in form of pdf from the website jddonline. The product of which the studies were done is Viviscal. Thanks for the super-fast reply.
Hey Rob, what do you think about people losing hair as young as 17 or 18 and very quickly at that? It would take years to accumulate calcification and fibrosis right? Could a different mechanism be at play?
I am sure other readers will have noticed this phenomenon, too: on some days the scalp is much tighter (and less foldable) than on others and sometimes even hurts a little when massaging – despite sticking to the rotations. Almost like a temporary regression back to the degree of looseness one has had a couple of months ago. Could it be that sometimes the 36 hours are not sufficient for a scalp segment to heal and the still ongoing healing process is what causes the sudden tightness? Rob, would it be advisable to skip a session once in a while to allow for thorough healing of the whole scalp? Or is this counterproductive?
I too have noticed this. It certainly seems curious – one day your scalp seems entirely pliable after several months significant effort, the next it seems you’ve backtracked several paces with the reintroduction of tightness. While I don’t discount your healing hypothesis, I also think perimeter muscles are key here, i.e. those at sides and back of the head attached to galea, as well as the occipital group too. Often times if I find I dedicate sufficient time to ‘rolling’ these muscles (I use the handle of a wooden spoon!), the scalp the next day will be readily pliable. I think these muscles can cause significant tautness, even to the extent of rendering a pliable scalp rather stiff feeling. Try it and see if it works for you.
Usually where one encounters a sort of pain or discomfort is where focus is necessitated, not dissimilar to the sensation of a muscle knot in your back or calf being worked, for example.
thanks for replying! Very kind of you. It is exactly as you describe it: one has the impression of temporary regression. That is curious as I would have expected this to be a linear process. But, with everything having to do with hair, things are apparently less straightforward 😉
Maybe you are right and it is a muscle-related problem rather then one related to healing! That was just my ad hoc hypothesis. I will definitively try your massage approach. Do you have any theory regarding why on some days the muscles suddenly stiffen? I imagine that if we could mitigate this effect, progress would be much quicker!
Hello B B,
Your wood spoon suggestion is a game changer! You go, girl!
When i would do minoxidil and scalp massage together, would i keep the regrowth from minoxidil when i quit it or should i expect some shedding?
I did scalp massaging for 6+ months but no regrowth yet, just more shedding. I think about adding minoxidil and microneedling to get a little boost.
Thanks for your work.
Greetings from germany
i have got a question, According to your ebook on the full program, it is discussed that people which they can’t make enough dht in their body never goes bald. But when we search for the reasons of balding their it comes calcification and fibroses. why these 2 aren’t the same answer for this culprit ? incase it must be the same. or does dht causes calcification and fibroses ?
Rob, you mention one guy who got better results when he started massaging / rolling out the scalp perimeter muscles – are you referring to occipitalis, auriculars and frontalis? Just making sure because I would like to integrate whatever he was doing.
Thanks a million,
Steve, just to add my own experience here… I really think this undertaking is key if not mandatory. A PVC pipe of a few inches diameter or indeed any such implement will suffice here – as noted above, I use the handle of a wooden spoon! Just roll them out, as a person might use a foam roller on their hamstrings or back. Use a pressure similar to that which you might with hand pressing.
Rob has noted elsewhere how these muscle groups may be key in respect of scalp tension theory, etc. I think, to the best of my knowledge, that the Von Mises illustrations would suggest occipital muscles too being implicated with crown thinning.
I was taken aback by how tight and ‘sore’ these muscles groups were when I implemented the above technique – this, even after many months of manual massage. I think this technique permits an extra degree of specificity in respect of muscle release. I suspect it may have been key to my successes of late. Best of luck…
I’ve been following your site for around 8 months now and what I love about your approach is how much more open you’ve been to challenging your own beliefs and views and your willingness to use the scientific method as best as you can to see if your ideas actually have scientific validity.
The response rate for the massages according to this new study is actually way higher than I ever expected. It is based off of surveys, which makes me cautiously optimistic, but hopefully you can keep pushing this treatment to be studied even more and more.
I will say from calcium + vitamin K supplementation for the last month as well as discontinuing my shampoo/conditioner regimen (at the very least, this saves me lots of money and my hair looks just fine without these products), plus some 10 minute massages, it seems as if there are small hairs growing in previously balding areas. It’s encouraging, but I also cannot be certain that those hairs were not there before. Hopefully it is a positive sign. I accept that I might just be going bald, but I will try what I can to preserve and hopefully regrow the hair I lost.
In any case, massive kudos to you for your commitment to intellectual honesty. I know these two studies you published are huge and it can get easy to become attached to your ideas by this point, but I hope you remain committed to finding the truth, as that is why I enjoy your site so much.
All the best.
Thanks a lot for the kind words, and thank you for reading!
This is all encouraging stuff. If you can, try to take progress photos using a few anchoring points on your scalp (a ridge, a mole, etc.). This is really the only way we can be sure of regrowth. I just added a few new before-after photos to this page, where people have done a pretty good job of finding these anchor points and replicating photo angles / lighting over the course of several months:
Keep us posted! And congratulations on the early signs of progress. And I promise to remain committed to the science rather than my own ideas. If you ever see me behaving in any way otherwise, please feel free to call me out!
Wow, Rob, what a great article, feels like we’ve found holy grail finally 🙂 I’ll start doing massages by now. I’m doing PRP injections for my hair, do you think I can do scalp massages in between PRP sessions?
This is a great question. It’s addressed in this new article about PRP! (and in the comments section):
Let me know if you have any questions.
Hey BB, thanks for replying. Just want to get some specifics so I can replicate your success. How long do you spend rolling these muscles at the sides and back of the head? How many minutes daily?
And you press hard with your tool? (i.e. using the same pressure as you apply with fingers/knuckles when doing Rob’s scalp massage?). This certainly sounds like something that should be a mandatory part of the regime.
Hi Steve, yes I simply incorporate this aspect of massage into the back/sides part of regimen. I use similar pressure to pressing, though you might find using a tool affords greater specificity and potential for myofascial release, so tailor the pressure using your own intuition – less may suffice. I simply spend a few mins doing this technique in addition to the manual form. Hope that helps.
I have been taking a vitamin d supplement after being diagnosed with low levels- I thought this would improve my hair health, however after a week on the supplements my hair fall is increasing, especially in the mornings. Has anyone experienced anything similar? It has gotten worse than before I was taking the supplements. Thanks,
Hello Arthur, depending on your vitamin D level, I think you should adjust the dosage appropriately. In your case, if you have insurance, I would order a full panel test once and for all. If you don’t have enough money/insurance then I would simply wait. You also need to make sure you are getting a good D3 supplement. Now Foods is a good company to trust with reliable products in good prices but if you want to extend it even further, then something like Vitamin D from Thorne in liquid form would be better. But remember, and I can’t stress this enough, if you don’t sleep, have a good diet with meat, cheese, vegetables and fish. All the supplements will do half of what they are supposed to do. I hope this helps.
Can anyone doing massage answer me how thin our top scalp should be. Like as thin as side and back scalp. It seems impossible to make it that thin. I am just starting to see hair miniaturization at forehead. Scalp is thin there and the scalp with hair is very thick. I would really appreciate if anyone answered my question.
this is the paradox that makes me wonder the most, too. According to all calcification/fibrosis theories, we should expect to see the biggest hair problems where the scalp is thick. Like you, my problems are in the front – and the scalp is very thin in this area. Where it is thick – at the top – I have perfect hair.
I we understood this paradox, we would have made a lot of progress…
Rob once suggested that this may have to do with the muscles that attach in the front.
Congratulations on the publication of your paper! The work you’re doing is so empowering and goes against everything the huge industry would have us believe about hair loss (and hair regrowth!).
I’m 6 weeks into the daily massage practices and have been trying to implement the dietary changes too. Although the latter I’m finding more of a challenge, being someone who struggles to put on weight, cutting out grains altogether led to lightheadedness and weight loss so I now have home made bread and pancakes made with buckwheat.
When I read the full paper something caught my attention which I hoped to clarify with you.
‘There was a marginal effect for plant-based diets versus a standard American diet, and no effect for a paleo diet.’
I’m not an expert in reading academic papers so I don’t want to assume anything. It sounds to me like this is saying the effect of diet was not so much a factor in the self perceived regrowth but was more around the cumulative hours spent.
Would you mind commenting on whether I’m interpreting your findings correctly or not please?
Thanks so much
This is a great question, and it’s something I discuss at length in the newest book update. The gist is that yes, those following a plant-based diet seemed to report slightly better results from the massages versus those on a standard American diet.
However, there were some caveats to this analysis worth mentioning about this specific group of massage participants that we discovered during qualitative interviews. Writing them out would warrant an entirely new blog post – so I’ll save it for a future writeup. For now, just know that if you are (1) nutrient replete, (2) avoiding a calorie deficit, and (3) minimizing your exposure to allergenic / inflammatory foods, you’re likely doing everything you can from a dietary perspective to improve your regrowth from any hair loss treatment… including massaging.
Thats a good question Lorna .
Rob has it become clear to you from results. Which particular massage excersize is most vital. And is the spine / posture at all related to mpb .
Is there a new book update coming soon?
The new book is out! It’s part of the membership community:
hello my friend
I have a dygnenese thyroid symptom .
I have a thyroid syndrome dysgenese.
but I am treated for this.
(150 ug T4 thyroid tablet)
My results blood one this item is correct.
I've been broadcasting thinning same to -Ben M., U.S.A on your site before after.
I think I'm AGA + diffuse thinning.
I have many symptoms of poor food absorption.
I also have the symptoms of low bile.
liver symptom feigning.
feigning stomach symptom.
stool not diced food still whole.
What blood samples should I take?
Congratulations on the baby! I was one of your first paid subscribers and then bought version 3 again – while I haven’t been able to keep up with the massages (I struggle with building habits) – I’d love to support the fantastic work you are doing (I’m leaving you my email address and would love to exchange ideas – I have long hair and while we may be in minority, trust me there are a lot us facing the same balding issues – and given we probably love our hair even more, hair loss hits us even harder – I’d be happy to be your Guinea pig). I had two questions :
1) I was a user of finestride and minoxidil and suddenly stopped both 6-7 months ago and saw a shocking acceleration of hair loss (leaving me worse than where I was) – is there a quick way to arrest this excessive fall?
2) I have had severe dandruff in last few months (almost a layer covering my scalp). I have a feeling the dandruff may have exacerbated the hair loss and miniaturisation of follicles – do you have any research that links hair loss to dandruff?
Lastly, I’d like to thank you for pointing towards other possible reason for hair loss – I underwent lab tests and found that I have dysbiosis – trying to treat that currently.
I just thought about bad head posture. If you have tight scalp muscles due to a forward head posture, wouldn’t the bad posture destroy any massage gains? Could bad head posture be the creator of non-responders? I mean if your head muscles are constantly tight because of bad posture, all your massage gains will be “neutralised” all the time?
I’m writing a Google translateden here. Sorry. I hope we can understand to each other. I have a few questions?
1. Is there a video for massage? How should I go for 20 minutes?
2. Can AGA crush the birth control pill into hair lotion?
This article has been very interesting for me as I have been doing twice daily massages for the past 12 months and just recently started microneedling but havent seen that great of results,have just recently found out that I have mercury toxicity and sibo as well so hopefully once I clear these things up I will start seeing better results. Thank you for bringing this to my attention as a possible cause for this.
Very interesting! Thanks for sharing. I look forward to your progress, please keep us posted.
Is your mercury toxicity due to mercury fillings? How do you plan on resolving both conditions?
Yes mercury was due to amalgams have had them removed and have started a detox protocol with dmsa,have just started sibo protocol with bactrex so hopefully both will be fixed in not to distant future.
Great article and study you did. But I have a question (probably asked before)
Do men who do not bald have less tension in their scalp than men who bald? I read balding men have more collagen tissue/fibrosis than non balding men, but that’s because of scalp tension right?
So maybe, are men who do not bald immune to the effects of chronic scalp tension? (but 80% of all men eventually bald, so maybe for some men the scalp tension has less effect?)
Thanks for your time,
Hi Rob. Excellent information you give us! I have two questions.. What is the difference between diffuse thinning and aga? I mean what it looks like? How can I say that someone has diffuse thinning or aga by looking at him? And can you name the possible underlying conditions for diffuse thinning. So I can check them out. I read a few but can you be more specific?
Thank you for your time.
From August I have been doing the massages following the instructions of your research, dosing them all to a routine of twenty minutes a day, and I am already seeing improvement in my hair, which was becoming very thin since a few years, probably by hypothyroidism, (despite the treatment).
Inspired by In Ben’s case, I’ve also been sunbathing for vitamin D and Zinc supplements three times a week. In May, three months before I had tried only with dermaroller of 1.5 every week but I saw no effectiveness, now I only roll it every two weeks.
Thank you very much for your work and give us hope, when I have more significant growth, I will send you photos of my case.
Hey Mike – just wanted to say thank you for your comment! I’m looking forward to reading more about your progress in the coming months. Please keep us posted!
Hi rob, so I have a question about the intensity of the massages. I got your book a year or so back and followed the massage routine and saw less then amazing results. ill admit I only did it for about 3 months consistently but was seeing more hair loss very tender scalp as well as much more dandruff. i was describing this to a personal friend who is a chiropractor and he suggested i was doing the massages too hard and this was potentially doing damage to the hair follicles. Now stress and other outside factors could have caused the more rapid hair loss but i didn’t see almost any benefit, whish surprised me because based on your research and that of my own i really believe in the massage to reverse hairloss. I was also pointed to some youtube videos done by people showing how they had reversed hairloss by just simply using a wood bristle brush to cause “slight” inflammation. i was wondering if you could speak to that any? It has been a year and a half since i did that 3 month of massage. I have gone from a NW 2 to a 3.5 only frontal recession. With the new year approaching iv set it as my goal to get back to a NW2 through massage and just want to be sure im not damaging my hair by going to hard, as well as how beneficial is it on the days i don’t have the time for the massage to use a brush to stimulate bloodflow.
Hey there Stephen, I’m the same.
Pretty much all frontal and increased hair loss from massage, especially at hair line.
I was going pretty hard at it as well.
Never really seemed to do much worse where hair was fine but close to hair line, it sure soed up the shedding process.
Hair pulling did the same too.
I’ve started derma stamping and so far tgat has not caused any issues abd I’ve even got a few new hairs turning up on my temples.
Came across a book about healing facial scars. A section covered scalp scars and hair issues caused by the tension created by closing scars. Seems to fall in line with your hypothesis.
Check it out:
Hey Sean – just wanted to say thank you for passing this link along. It looks like I’ve got some light reading this weekend!
Hi there, I have read through your study and looked at your graph and I saw that there were nearly as many participants that scored -1 and -2 in self-perceived hair regain, compare to the ones who rated +1 and +2. The growth obviously shows more +1&+2s the longer the massages persisted. So what I wanted to know is:
1. Why did so many people perceive a loss or no growth, despite doing it for the same amount of time as the people who perceive regrowth, mostly between 0-200 hrs?
2. Did the majority of people drop out of the survey after getting little results or good results within that 0-200hrs mark?
3. Were the people who scored at the -1 and -2, mostly at higher stages in hair-loss, thus their results were as visible to them?
Basically I was hoping to see a study rise in +1&+2 over time, but it seems fairly consistent with only a few holding on that long. I have seen the pictures that look promising on your website of course.
Thanks for your questions. My answers are below, and if you have any follow up questions, please feel free to reach out.
1. The trend line for self-perceived hair changes from 0-200 hours increases, indicating that overall, participants perceive benefit from the massages. For those reaching 8+ months, 75% of participants reported a stop or reversal in their hair loss. This is all a good sign that people perceive time-dependent benefits from the massages. But as you said, there are still many non-responders (-1’s and -2’s) in this time parameter, meaning that the massages don’t work for everyone.
These -1’s and -2’s are partially explainable by a few factors. (1) The massages have a tendency to knock out telogen hairs early into initiating, so many people report temporary increases to shedding in the first 6 months and thus perceive worse hair changes during this period. (2) A significant portion of the -1 and -2 responders also self-reported as diffuse thinners – a presentation of hair loss that is often confused with androgenic alopecia but sometimes is actually due to hypothyroidism, hyperparathyroidism, heavy metal toxicities, nutrient deficiencies (iron, vitamin D, zinc, etc.), and/or nutrient surpluses (vitamin A, selenium, etc.). In these cases, the massages probably won’t work – because its purported mechanisms don’t address these underlying drivers of hair shedding. (3) In post-publication interviews, many of these -1 and -2 participants had mentioned they’d essentially “tried everything” for their hair loss without success, so weren’t surprised they didn’t see benefit from the massages. This suggests a treatment-resistant form of AGA (which may account for 10-15% of pattern hair loss cases). On that note, there’s likely a slight selection bias with our study’s participants, because a lot of people reach this site after having exhausted other treatment options without success (hence the interest in search for alternative interventions). So we’re more likely to collect individuals who have treatment-resistant hair loss disorders.
2. This question was discussed extensively with our statisticians, as we didn’t want to be inappropriately interpreting our data and thereby drawing false conclusions about the efficacy of the massages. The good news is that there are a few ways to control for the potential of self-selection drop-out (i.e., missing data): Bayesian modeling and full information maximum likelihood (FIML) estimations. After exploring these models (which adjust the standard errors of our model’s estimations), we also talked extensively about participant behavior and the fact that asking someone to voluntarily commit to hundreds of hours of massaging will also naturally have a high degree of drop-off in later time windows, and thus should be expected. In the end, our reviewers agreed.
3. The people who reported hair changes of -1 and -2 weren’t necessarily of higher AGA severities. However, they did fall into the categories listed in question 1 – which helps to partly explain their results.
Just curious, what would you say to someone who has trouble breaking massages into two different times every day? I find it easy to massage after work for 30 minutes or so. Is this better than nothing? I was thinking of doing all the regions you mentioned in one setting since it’s difficult for me to break it into two sessions with my schedule. Also, I feel like I’ve since a bit more shedding on my frontal region since starting. I know this is normal but I’m a bit worried. How long does it usually take for shedding to stop?
Hey Seth – if you’re shedding excessively, I’d recommend reducing your intensity. One effective strategy is to taper your pinching/pressing/stretching force such that you only shed 15-25 hairs per session max.
As far as massaging 1×30 versus 2×20 minutes daily – you can certainly try this, and plenty of people have seen results from doing so. Having said that, it’s probably better to do two sessions. This is because there’s some evidence that post-massaging, blood flow can remain elevated in massaged regions for 30-60 minutes (sometimes longer). So breaking up your sessions twice daily means that you’re getting these benefits twice daily versus once daily.
To emphasize, there’s no hard evidence on that second point for scalp massages specifically. But we’ve seen this relationship studies in muscle tissues elsewhere in the body, and so we can presume that there has to be some overlap with the scalp as well.
Thanks Rob. Truly appreciate your insight.
Me too Seth, I have more shedding on my frontal region since I started two moths ago. How is going for you now. Is it normal or should I stop?
Hi, Rob. Thanks for sharing these great information. May I know what are the differences between AGA and diffuse thinning? I have been massaging my scalp 2 x 15-20 minutes each day, with microneedling once a week but has still yet to see any significant results. Sometimes looking into the mirror it feels like there are hair growing, but sometimes it’s the opposite and when taking picture, it feels like there’s no improvement at all. Felt pretty disgusted to look myself in the mirror these days 🙁 I think I am having AGA (my dad has AGA and he went bald) as my hair got thinner over the year since I was in my early 20s. And the thinning only happens on the top and temple, my side and back hair are pretty dense and thick. Is this AGA, not diffuse thinning?
after 6 months of massages (including 2 months of massages badly applied at the beginning), is it normal to lose hair at each session? does the fall have to stabilize at some point?
Thank you in advance for your answer
I am 5 months into scalp massage (2 x 20 -25 minutes each day) with rosemary + jojoba oil, and microneedling using needle size 1.5mm once a week (skipping massage on the day of microneedling). Yet, I have not seen any promising results. When I look into the mirror, it looks like my hair got denser but when I take pictures and compared, it looks the same, hair thinning did not improve. Should I just give up? Does it mean that I do not response well to any stimulation based therapy? 🙁 I saw the before and after photos in your blog, many of them achieved decent results even at the 3 months point. For me, nothing has changed. When I massage, my hair still fall, even the short ones.
Regarding this point: “Scalp massages improve perceived hair changes in a time-dependent manner” – did your observation take into account the fact that those that weren’t seeing results were likely to drop out before reaching those longer time-spans (6+ months)? Seems like an inherent bias there.
Also, as I understand it you’ve since updated the recommended massage routine from what’s described in the study. Do you have any plans to do a study to quantify response rates with the new massage recommendations?
Great question. And yes! We did discuss this in detail. I believe our statisticians also had discussed/experimented with models to account for dropout bias – i.e., Bayes’ theorem. Although I don’t believe any of the alternative models led to different results, the possibility of bias still exists – regardless of whether it is quantifiable.
Currently, we don’t have plans to launch a new study to quantify new response rates from the updated massage routines. While I believe the new routines are leading to higher response rates, the way we rolled out these new routines (i.e., inside a membership community versus a standalone download) creates some problems with future survey data analyses. For example, in our massage survey study, participants were siloed (as in, incapable of communicating with one another). But in any future survey, participants would be community members, and thereby have an opportunity to connect with one another through our message boards. We do plan on launching more surveys to do internal analyses (and make future changes to the regimen). But it’s unlikely that we would publish these results.
This is my first visit to this site. I came for the hair scalp massage stuff but I found what you said about diffuse thinning masking itself as AGA extremely interesting.
I believe I might very well be a “diffuse thinner” case rather than AGA, based on the following evidence:
1. I had a sudden episode of “hair fall” (that happened over a span of 2-3 months) when I was 19 years old, which affected the entire vertex and a bit of the temple. I am 41 years old now, but since that sudden “attack” my hair has remained more or less the same density as it is now. (“more or less” because I believe it waxes and wanes in density a bit over long periods of time, but I haven’t kept proper track.)
2. MPT doesn’t appear to run in either side of my family (judging from relatives such as uncles and cousins)
3. Visually it looks like Ben M’s case that you talked about, although maybe I am in a better situation than what he shows at 0 months. (I don’t keep my hair that short so it’s hard to say, but I’m pretty sure it’s no worse than what his photos show.)
4. I have not had any treatment for it at all. It’s been 21 years now; I think if it was MBT it would’ve gotten worse without any treatment.
It’s something I’ve always believed – that I’m not an MPT case – at some point gave up finding the right course of action to treat it. I was never interested in going the minoxidil/finasteride route and I never will. (Actually had to look up how to spell those words lol.)
I may be wrong about my case and at this point I should perhaps stop caring, but if it’s something that can be corrected even at this late stage I would be happy to know how I should go about investigating it. (Once every few years I get the urge to do something about it, like right now, but I never really get anywhere!) I think the prevalence of MBT puts guys like me at a diagnostic disadvantage (assuming I’m right about myself in the first place).
I do wonder if I have a bit of subclinical hypothyroidism (my body temperature runs lower than normal – I have measured myself at ~35 Centigrade immediately on waking up).
I would be happy to send photos to someone who was in a better position to judge, and would even be willing to spend a moderate amount of money on it, but it’s hard knowing who to talk to.
Hi Rob, I have a surgical scar between the hairlin and the top. It’s not very deep, it’s superficial. The tension resulting from this scar can affect the success of the massage. Please this doubt is devouring me.
Many thanks in advance
Hello, I have been massaging for more than half a year. Now there will be cracking sound when massaging the scalp. The number of hair loss has also increased, which is similar to the crazy period of minoxidine. Is this crazy period a normal phenomenon of massage? I’m a little panicked. I’m afraid my hair will get worse. Sorry, I’m a foreigner. My English is not good