Do Scalp Massages Improve Hair Loss From Androgenic Alopecia? (Our 2019 Study)

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.

Early participants

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.

Research goals

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.

Early insights

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.

Key findings

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:

  1. 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.
  2. 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 [20], micronutrient excesses of iodine [21], and hypothyroidism can present as diffuse hair loss [22]. Some studies suggest a subclinical hypothyroidism prevalence of up to 10% in adult populations [23]. 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 [24]. 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…

  • Hypothyroidism
  • Hyperparathyroidism
  • 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:

  1. Can we predict a responder versus a non-responder?
  2. Does diet have any relationship to massage success?
  3. 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.

68 thoughts on “Do Scalp Massages Improve Hair Loss From Androgenic Alopecia? (Our 2019 Study)”

  1. 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?

    • Hey Wayne,

      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.

      https://www.ncbi.nlm.nih.gov/pubmed/?term=19484778

      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!

      Best,
      Rob

  2. Hey Rob,
    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)?

    • Hey Wayne,

      (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.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3253436/

      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:

      https://www.accessdata.fda.gov/drugsatfda_docs/label/2001/20788s3lbl.pdf

      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):

      https://www.ncbi.nlm.nih.gov/pubmed/8628793

      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):

      https://onlinelibrary.wiley.com/doi/full/10.1111/exd.13379

      Best,
      Rob

  3. 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.

    • Hey Aaron,

      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.

      Best,
      Rob

  4. Hi Rob,

    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.

    Thank you,

    • Thanks NHF!

      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:

      https://perfecthairhealth.com/start-here/

      Best
      Rob

  5. 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.

  6. Hey Rob,

    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?

    Thank you.

    • Hey Adam,

      (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!

      Best,
      Rob

      • Rob,

        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.

        Thanks again

        Adam

      • Adam,

        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,
        Rob

  7. Hey Rob,
    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

    • Hey Tyler,

      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.nejm.org/doi/10.1056/NEJMicm1801633

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746228/ (mentioned in this article.

      So it can certainly work!

      Best,
      Rob

  8. Hey Rob,
    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!

  9. 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

  10. Hi Rob,

    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,
    Stefan

    • 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!

      Best,
      Rob

  11. Hi Rob

    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.

    Thanks

    P.S. Am I getting a notification if you reply to this comment? Sorry but I am no used to do this.

    • Hi NR,

      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.

      Best,
      Rob

  12. Hi Rob,

    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.

    Question:
    Do you think its really possible that upregulation is irreversible? Even after 10 + years?

    Many thanks! Truly fantastic work!

    Cheers,

    F

    • Hey Fred,

      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.

      Best,
      Rob

  13. 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!

  14. HI Rob

    First Congratulations to having a baby, MY heartiest congratulations on being parents Wishing you lots of happiness with your little one.

  15. Dear Rob,
    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?

    • Hey Wayne,

      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!

      Best,
      Rob

  16. Hey Rob
    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.

  17. 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?

    Thank you!

    • Hey Bebe,

      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,
      Rob

  18. 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?

    • Hey Wayne,

      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:

      https://www.ncbi.nlm.nih.gov/pubmed/8628793

      Best,
      Rob

  19. Hey Rob,
    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 !

    • Hey Bebe,

      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.

      Best,
      Rob

  20. 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.

    • Hey H,

      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!

      Best,
      Rob

  21. 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.
    Thanks

    • Hi Mibe,

      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.

      Best,
      Rob

  22. Another question. Is there a video anywhere which summarises all the correct routine of the excercises it’s necessary to do?

  23. 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.

    • Hey Alex,

      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.

      Best,
      Rob

      • Hi Rob,

        Is AIR CONDITIONER (AC) causes hair loss?? Is it one of the factor of AGA??

  24. Dear Rob

    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

    • Hey Anto,

      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.

      Best,
      Rob

  25. 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! 😀

    • Hey Rob,
      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?

      Thank you!

  26. 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.
    Thanks.

  27. 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.

      • 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 :

        http://jddonline.com/articles/download_article/2827

        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.

  28. 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?

  29. 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?

    • Hi Wayne,

      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.

      • Dear BB,
        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!
        Thanks, Wayne

  30. Hello Rob,
    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

  31. Hey Rob,

    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 ?

  32. 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

    • 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…

  33. Hey Rob,

    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.

  34. 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?

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