Trans Hormone Replacement Therapy Hair Regrowth: The Science

Hormone replacement therapy for trans male-to-female (MTF) patients sometimes leads to major hair regrowth. The science behind why isn't totally understood, but there's building evidence of a simple (and fascinating) explanation. This article attempts to explain why some trans MTF patients recover so much hair, and in doing so, reveals underutilized targets for hair regrowth.

Edited and reviewed by:
Rob English, Medical Editor

Read time: 20 minutes

Men Who Transition To Women Regrow Hair… But How?

When Bruce Jenner transitioned to Caitlyn Jenner, many people noticed a change in Caitlyn’s hair quality. During and after the transition, her hair grew thicker and longer. Her temple recession even filled in — giving the appearance of what looked like a juvenile hair line.

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It’s easy to assume Caitlyn’s hair regrowth was due to a cover-up spray, hair transplant, or even a wig. After all, Caitlyn Jenner is a celebrity — with the means to afford all three.

But if we dive deeper into the research, that assumption might be wrong. Many male-to-female transexuals and transgenders achieve significant hair regrowth during and after their transition. Some even experience near-complete hair recoveries — from slick bald to a thick, full head of hair.

Here’s just one (of many) examples of male-to-female major hair recovery.

(read her story here)

This regrowth occurred during her gender transition — after beginning something known as hormone replacement therapy. This involves taking drugs to increase female hormones (like estrogen) and decrease male hormones (like testosterone and DHT) circulating in the body.

That’s real hair regrowth — and without a cover-up spray, a hair transplant, or a wig. And this degree of hair regrowth is incredible — for two reasons.

First, it dispels the myth that once hair is lost, it’s gone forever. Secondly, it baffles hair loss researchers. Why? Because according to them, hair loss is caused by a male hormone called dihydrotesterone (DHT) — and while eliminating DHT should slow, stop, or partially reverse hair loss… it shouldn’t result in full hair recoveries.

But some trans male-to-females taking hormone replacement therapy are both eliminating DHT and recovering massive amounts of hair. The question is… how? Nearly all hair loss researchers say these results aren’t explainable by the literature — or our current understandings of the causes (and treatments) of pattern hair loss…

…except that’s not true. These results are explainable by the literature. We just need to do some digging.

The short-answer: hair regrowth from male-to-female hormone replacement therapy likely has less to do with eliminating DHT… and more to do with hormone replacement therapy’s one-two punch: eliminating DHT + increasing estrogen. The end-result: 1) potential (small) skull bone structural changes, and 2) the likely atrophy of scalp muscles, both of which may lead to the relief of chronic scalp tension — the very tension that is the precursor to scalp inflammation that kicks off the DHT-hair loss cascade. When this chronic scalp tension disappears, hair begins to regrow.

This article uncovers the science. We’ll explain exactly why male-to-female hormone replacement therapy leads to major (or sometimes complete) hair regrowth, why DHT-reducing drugs don’t, and what this means for future hair loss treatments.

Along the way, we’ll uncover…

  • Misunderstandings. What researchers get wrong about the causes of hair loss
  • Questions. If DHT causes hair loss, then why don’t DHT-inhibiting drugs regrow all lost hair?
  • Evidence. The real drivers of hair loss (structural tension + an inflammatory response)
  • Answers. How male-to-female hormone replacement therapy addresses both hair loss drivers

Note: this article gets technical. If you have questions, you can reach me any time in the comments.

What Is Male-To-Female Hormone Replacement Therapy?

Male-to-female (MTF) hormone replacement therapy is when we manipulate our amount of hormones circulating so that estrogens increase and androgens (like DHT and testosterone) decrease.

HRT’s rationale is as-follows: in humans, hormones play a major role in sexual dimorphism — or the physical differences between men and women. Around puberty, boys’ testicles begin producing more testosterone, and girls’ ovaries begin producing more estrogen.

These difference in hormone production then affects tissue function. Testosterone and its byproducts (like DHT) fuel bone growth and muscular development — along with the onset of chest and facial hair. Conversely, estrogen fuels the onset of menstruation, and the development of a “female figure” — like retention of more subcutaneous fat and even breast development.

These hormones subtly (and not-so-subtly) affect our tissues, until they eventually culminate into the different physiques we attribute to men and women.

As such, male to female hormone replacement therapy attempts to replicate a female’s hormonal profile inside a biological male — in hopes that the person undergoing the therapy will appear more female

And it works. Studies show that when we manipulate a male’s hormonal profile to produce more estrogen and less testosterone — that male begins to take on the attributes we commonly associate with women (facial structure changes, breast development, etc.).

To achieve this, male-to-female hormone replacement therapy (HRT) users sometimes…

  • Inject (or supplement with) estrogens — typically in the form of estradiol.
  • Take anti-androgenic drugs — like spironolactone — to reduce testosterone and DHT
  • Undergo gender reassignment surgery to remove the penis and testes. This reduces testosterone production by 95% (and DHT production by roughly the same)

Interestingly, one side effect of male-to-female hormone replacement therapy is massive hair regrowth… which is why this therapy fascinates (and baffles) most hair loss scientists. And it’s why I wrote this article.

Hair Loss And The Hormone Replacement Therapy Paradox

We’re attempting to answer one of the most challenging paradoxes in hair loss research:

If the male hormone DHT causes hair loss, but DHT-inhibiting drugs like Propecia only stop or partially reverse hair loss… then how come hormone replacement therapy for male-to-female trans patients (reducing DHT + increasing estrogen) can lead to near-full hair recoveries?

I know that’s a mouthful, so let’s slow down the hormone replacement therapy (HRT) paradox more:

  1. Research shows the male hormone dihydrotestosterone (DHT) causes hair loss…
  2. …but research also shows that stopping DHT production doesn’t regrow all lost hair.  It typically just stops hair loss, and sometimes leads to partial hair recoveries.
  3. However, male-to-female HRT patients (who take drugs to decrease DHT and increase estrogen) have achieved full hair recoveries.
  4. The question is… why? If DHT causes hair loss, but reducing DHT typically only stops hair loss… then how come reducing DHT + increasing estrogen can lead to major hair regrowth?

This is a complex and caveated question — with a complex and caveated answer. And in order to explain why MTF hormone replacement therapy regrows hair, we actually need to answer two questions:

  • First — if DHT causes hair loss, why doesn’t stopping DHT production regrow all lost hair?
  • Secondly — how can stopping DHT production + increasing estrogen lead to full regrowth?

In the next few sections, we’ll tackle that first question. We’ll reveal the evidence behind the “DHT causes hair loss” claim. Then we’ll explain why that claim is wrong. Finally we’ll uncover the two likely drivers of hair loss — calcification and fibrosis — where DHT fits in, and how calcification and fibrosis explain why stopping DHT halts hair loss, but doesn’t necessarily reverse it.

Once we cover those bases, we can explain the science behind the HRT-hair regrowth paradox.

Hormones & Hair Loss: The DHT-Causes-Hair Loss Theory

What causes pattern hair loss — the hair thinning that men experience after puberty, and women experience after menopause? Most doctors (and researchers) believe that pattern hair loss is caused by a hormone called dihydrotestosterone — or DHT.

I first heard about DHT after being diagnosed with pattern hair loss in 2007. My doctor’s explanation: for reasons not entirely understood, DHT begins to accumulate in our scalps. Our hair follicles then become sensitive to this DHT, and as a result, begin miniaturizing. Over a series of hair cycles, this leads to thinner hair until eventually that hair is too thin to see — and we’re diagnosed with pattern baldness.

When I asked my doctor why men bald more often than women, he said that this was simply due to to the fact that men have more androgens (like DHT and testosterone) than women. When I asked him why men bald in a unique pattern, he replied that no one knows (remember that — it’ll be relevant later).

Evidence That DHT Causes Hair Loss

There are three findings that (sort of) cement the DHT-hair loss hypothesis:

  1. DHT is higher in the tissues surrounding balding hair follicles.
  2. When a man is castrated, his testosterone (and DHT) levels permanently decrease. Men castrated before puberty (before their DHT levels increase) don’t suffer from pattern hair loss later in life.
  3. Some men lack the enzyme needed to convert testosterone into DHT in the scalp. Men with this genetic disorder don’t develop pattern hair loss — but they do look more feminine (since DHT is a masculinizing hormone).

At first glance, this hypothesis seems airtight. Look at the extremes: if we never produce any DHT, we never develop pattern hair loss. Conversely, hair loss develops as scalp tissue DHT increases.

These findings were why pharmaceutical companies began targeting DHT to treat hair loss. So came the creation of finasteride (Propecia) — a DHT-reducing drug.

Propecia can reduce scalp DHT levels by up to 70% (depending on the dosage). It’s an incredibly effective DHT inhibitor — and as a result, an incredibly focused hair loss treatment.

So, let’s logic-check the science.

If DHT is truly the sole cause of hair loss, then by reducing DHT with Propecia, we should be able to regrow the hair we lost. Right?

Wrong. While the literature suggests this should be possible, clinical trials on DHT-reducing drugs show a different result.

Evidence Against The “DHT Causes Hair Loss” Hypothesis

Despite DHT’s implication in the development of pattern hair loss, DHT-reducing drugs like Finasteride typically only slow, stop, or partially reverse hair thinning. They rarely — if ever — lead to full hair recoveries (even at the highest daily dosages).

In fact, we can push this even further. What happens if we’re suffering from pattern hair loss, and rather than attenuate DHT with a drug, we just eliminate it entirely? Will we regrow our hair?

We can find our answer by reading studies of men who were experiencing pattern hair loss and then got castrated. Castration reduces circulating testosterone levels by 95%, and since testosterone is a precursor to DHT, castration also plummets DHT production to nearly nothing.

So did these male pattern hair loss sufferers — who then got castrated — regrow all of their hair? No. They merely stopped their hair loss — with minimal (if any) significant hair regrowth.

This suggests that while DHT is absolutely implicated in the progression of pattern hair loss, eliminating DHT isn’t an effective treatment for hair loss reversal. And this also reveals two unanswered questions in the DHT-causes-hair loss theory:

  • Why does DHT in our scalps start increasing in the first place?
  • If DHT allegedly “shrinks” our follicles, then why doesn’t removing DHT regrow all lost hair?

Hair loss researchers don’t have the answers, but other fields that also study DHT do. And once we take into account all research on DHT spanning hair loss, endocrinology, and cardiology, we realize that…

DHT probably doesn’t directly cause hair loss. But DHT contributes to the development of two chronic conditions: calcification and fibrosis. And when these two conditions develop in the scalp, they restrict blood flow to the affected tissues — starving them of blood, oxygen, and nutrient supply — thereby leading to the degradation of what those tissues support — our hair.

I promise this is all relevant to male-to-female hormone replacement therapy. Stay with me!

The DHT-Calcification-Fibrosis Connection

Hair loss and heart disease are closely associated. In fact, pattern hair loss is a predictive determinant in a person’s risk for heart disease. Could these two conditions share the same mechanism of action?

The answer: yes. Heart disease is commonly characterized as the narrowing of our arteries — and thereby the reduction of blood flow to and from our heart. According to the research, two major drivers of this arterial narrowing is the accumulation of fibrosis and calcification inside the arteries themselves — leading to the restriction of blood flow.

Calcification is essentially calcium deposits in unwanted places — like our soft tissues (blood vessels and capillary networks). This impedes blood flow. Fibrosis is essentially scarring — or the accumulation of collagen fibers in a tissue. If you’ve ever gotten a cut that left a scar, that scarring is fibrosis (the imperfect accumulation of collagen).

Interestingly, calcification and fibrosis are also implicated in pattern hair loss.

The DHT-Hair Loss-Heart Disease Connection

Cardiologists have long suspect that androgens — like DHT — contribute to heart disease. Why? Because studies done in vivo (in life) show that testosterone and DHT injections can increase arterial calcified lesions by 200-400%. And this increase in DHT can also lead to increased fibrosis in heart tissues.

In other words — DHT appears to be a prerequisite for the arrival of both arterial fibrosis and arterial calcification. And here’s where it gets interesting: fibrosis and calcification are chronic, progressive conditions. They very rarely improve or reverse with medications. They tend to get worse over a series of years.

And even more interestingly, calcification and fibrosis don’t reverse when we stop DHT production… even though DHT helps contribute to the development of both conditions.

DHT Causes Fibrosis And Calcification; Fibrosis And Calcification Cause Pattern Hair Loss

As it turns out, fibrosis and calcification are documented all over balding scalp tissues and inside the blood vessels supporting thinning hair follicles. And studies suggests these conditions cause hair loss — not DHT.

For purposes of this article, we’re not going to go into the overwhelming evidence supporting the DHT-fibrosis-calcification-hair loss theory. If you’re curious about the research, read this article.

Rather, I’m going to summarize the takeaways from the above-mentioned article so that we can get back to answering the question: why do so many male-to-female hormone replacement therapy patients regrow all of their hair?

The net: DHT doesn’t directly cause hair loss. Chronically elevated scalp DHT (alongside other variables) causes scalp fibrosis and scalp calcification, and those two conditions cause hair loss by restricting blood, nutrient, and oxygen supply to our hair follicles.

DHT Androgen Receptors Imbalanced Calcification Regulators Hair Loss

Fibrosis and calcification develop slowly over a number of years. They don’t go away by reducing DHT. And now that we’ve covered this, we’ve just answered the first-half of the male-to-female hormone replacement therapy paradox:

Question: if DHT causes hair loss, then why do DHT-inhibiting drugs like finasteride (Propecia) only stop our hair loss or partially regrow lost hair, but rarely (if ever) lead to full hair recoveries?

Answer: because DHT doesn’t directly cause hair loss. But DHT does cause fibrosis and calcification — two chronic, progressive conditions that reduce blood, oxygen, and nutrient flow to the tissues they affect. Calcification and fibrosis appear to be the main drivers of pattern hair loss. If we inhibit DHT… we stop the progression of calcification and fibrosis, but we don’t really remove much of the calcification and fibrosis already present. This is why DHT-reducing drugs stop hair loss, but don’t lead to full hair regrowth.

Now that we’ve covered that, we can begin to answer our real question:

If stopping DHT production only stops hair loss… then how come male-to-female hormone replacement therapy (stopping DHT production + increasing estrogen) can fully regrow hair?

The Evidence: Trans HRT (Stopping DHT + Increasing Estrogen) Can Lead To Significant Hair Regrowth

Remember those studies on men who suffered from male pattern baldness and were then castrated? They stopped losing their hair, but didn’t regrow much of their lost hair. But that’s not the entire story…

…Because those same studies showed that when castrated men were injected with estrogen, they began regrowing significant amounts of hair. Or in other words, men suffering from pattern baldness who 1) stopped DHT production, then 2) increased estrogen — made major hair recoveries.

Those studies were done decades ago, and now their results are also occurring in male-to-female hormone replacement therapy patients who are basically doing the same thing (increasing estrogen, stopping DHT production).

In fact, here’s another example of the efficacy of increasing estrogen + reducing DHT production. While the following hair loss sufferers’ intention wasn’t to transition from male to female, they did end up taking the same drugs many use to gender transition, and as a result, saw similar hair regrowth:


So what’s the explanation behind these results? Why does stopping DHT production + increasing estrogen lead to major hair regrowth, while simply stopping DHT production only stops hair loss?

The short-answer: stopping DHT production + increasing estrogen may slightly change skull bone structure and atrophy the muscles surrounding the galea. In doing so, this therapy may indirectly relieve chronic tension in the scalp skin — the same chronic tension that precipitates scalp inflammation and thereby the DHT-hair loss cascade.

Or in other words, trans male-to-female hormone replacement therapy fixes the two major underlying drivers of pattern hair loss, and in doing so, regrows an incredible amount of hair.

In this second-half of the article, we’re going to explain exactly how this happens. And to answer that, we’ll need to…

  1. Explain the connection between chronic tension, inflammation, DHT, and hair loss
  2. Reveal the causes of chronic scalp tension: 1) muscular overdevelopment, 2) skull bone growth
  3. Explain how DHT-reducing drugs may slightly remodel bone structure — but not to the degree required for full tension relief (and thereby full hair regrowth)
  4. Uncover how male-to-female hormone replacement therapy 1) atrophies the muscles around the scalp and 2) potentially changes skull bone structure, and in doing so, alleviates chronic scalp skin tension
  5. Explain why this is the perfect hair regrowth recipe — and why full hair regrowth for male-to-female HRT patients isn’t paradoxical — it actually makes complete sense.

Let’s take these one-by-one.

Chronic Scalp Tension, Inflammation, DHT, And Hair Loss

Note: there’s an overwhelming amount of research showing that chronic scalp skin tension is the major driver in pattern hair loss development. To keep this post shorter than a novel, I’m only going to highlight a few relevant studies. If you’re interested in a major overview of the scalp tension-hair loss connection, please read this article.

A 2015 hair loss study showed that balding scalp regions corresponded with hair loss sufferer’s highest scalp skin tension points — the vertex and the temples.


The authors also showed that chronic skin tension can upregulate androgen activity, in addition to signaling proteins that encourage the development of fibrosis. In fact, this same study demonstrated that scalp skin with the highest chronic tension was not only balding, it was also fusing with fibrotic material with the underlying layers of the scalp (the galea).

Why is this important? Well, let’s take this into the context of the hormone DHT — the alleged “cause” of pattern hair loss.

The above study suggests that DHT increases in places of inflammation. And research on the prostate shows that DHT might even be anti-inflammatory.

What does this all suggest? That DHT increases in our scalps, simply because it’s a part of our bodies’ inflammatory response.

Here’s the order of events:

In our scalps, chronic scalp skin tension turns on pro-inflammatory signaling proteins. These signaling proteins then send inflammation to our scalp tissues. Our bodies respond to that inflammation by sending DHT — a hormone with anti-inflammatory properties — to the inflamed tissues. But since this inflammation is from chronic tension — and not an acute injury — DHT cannot resolve it. As a result, DHT chronically stays elevated in the scalp skin. And unfortunately, chronically elevated DHT (along with other factors) ends up causing fibrosis and calcification, which then cause hair miniaturization.

One more time, step-by-step:

  1. Chronic scalp skin tension turns on pro-inflammatory signaling proteins
  2. Pro-inflammatory signaling proteins send inflammation to our scalps
  3. Our bodies respond to the inflammation by sending DHT to our scalps
  4. Rather than resolve the inflammation, DHT instead forms calcification and fibrosis
  5. Calcification and fibrosis restrict blood, nutrient, and oxygen supply — which leads to hair loss

No wonder why DHT-inhibiting drugs don’t regrow much hair. They only address the response to inflammation… and not the actual cause of the inflammation: chronic scalp skin tension.

And before we can explore what causes chronic scalp skin tension, we need to do a logic-check — just like we did with the DHT-hair loss hypothesis.

If Scalp Skin Tension Causes The Inflammation Which Causes Hair Loss… Then If We Eliminate Scalp Skin Tension, Can We Reverse Hair Loss?

While the research is still in its infancy, all signs suggest yes. If we eliminate scalp skin tension, we not only stop hair loss — but we can likely reverse it — meaning full or near-full hair recoveries.

In fact, there are studies testing rather crude ways of relieving chronic scalp tension — and its effects on hair regrowth.

One study hypothesized that chronic scalp tension was in part due to the overdevelopment of muscles surrounding the perimeter of the scalp. The study revealed that by injecting these muscles with botox — and essentially “forcing” them to stay relaxed — hair count increased ~20% over 48-weeks:

Another study tested a tension-relieving device on balding men. The device pushed the scalp skin upward in order to relieve the chronic tension along the temples and vertex. The data showed that the longer the device was worn, the more regrowth occurred for the individual testing it.

So if relieving scalp tension leads to regrowth — with time-dependent results based on the duration of tension relief — then this begs the question…

What Causes Scalp Tension In the First Place?

There are several hypotheses, but in my opinion there are likely two major contributors:

  1. The overdevelopment of muscles surrounding the scalp (continuously pulling tight the scalp skin). This has been at least partially confirmed by the above Botox study.
  2. Skull bone growth (which creates constant tension across the top part of our scalps). This is evident even at birth — when babies show male pattern baldness until their cranial sutures shift and their hair slowly fills in over a series of 3-5 years. In addition, Paul Taylor also wrote a theory about skull bone growth causing pattern hair loss — which you can read here, or my critique here.

In any case, the evidence is clear that skull structure informs chronic scalp tension, and that chronic scalp tension informs the pattern and degree of hair loss.

And this means that we can boil down the causes of hair loss to a simple two-part equation:

Structural Tension + Inflammatory Response = Pattern Baldness

The structural tension: either 1) overdeveloped muscles surrounding the scalp, or 2) undesired scalp skull bone growth. Either of these scenarios creates chronic tension — the same tension we observe in scalp skin. And that tension creates an inflammatory cascade on the scalp.

The inflammatory response: this is largely where epigenetics and genetic predisposition come into play. Not all bodies respond to inflammation with DHT. In fact, our genes largely determine how much DHT arrives at an inflammatory site, and how long it stays.

It takes chronic scalp skin tension + an inflammatory response to trigger pattern hair loss. And as a result, any effective treatment needs to tackle both 1) structurally-caused scalp tension (scalp bone structure + scalp muscle overdevelopment), and 2) the inflammatory response (the DHT cascade).

Enter male-to-female hormone replacement therapy. And ignoring all side effects, this is probably the most effective therapy for reversing male pattern baldness.

Why? Because MTF hormone replacement therapy likely 1) changes our skull bone structure and atrophies scalp muscles, and 2) eliminates DHT production so that we stop responding to inflammation with DHT.

Male-To-Female Hormone Replacement Therapy May Remodel Facial And Skull Bone Structure

The hormone DHT encourages bone development by promoting both bone growth and bone turnover — even throughout adulthood. In addition, human studies show that…

  1. Testosterone is needed to encourage bone formation
  2. Estrogen is needed to suppress bone resorption and turnover
  3. Both testosterone, estrogen, and the ratios of testosterone:estrogen inform bone structure

So, it’s possible that in adults when we start playing around with hormone levels, we may also see subtle bone structural changes.

This should be no surprise for some Propecia users — who’ve reported facial structural changes as a side effect of the DHT-inhibiting drug. Propecia can inhibit DHT to near-castration levels, and depending on how long someone takes it, facial structural changes are likely unavoidable.

With that said, those changes from Propecia appear minimal — and likely don’t move the needle enough to relieve chronic scalp tension. Rather, since Propecia is exclusively targeted toward inhibiting DHT — it only really helps with the second-half of our hair loss equation: attenuating “the DHT response”.

Propecia Doesn’t Change Bone Structure That Much… But MTF Hormone Replacement Therapy Might

Changes to bone size, density, and structure are observed in postmenopausal women taking long-term hormone replacement therapy to increase estrogen. And improvements to bone fragility are also observed in low-testosterone men taking hormone replacement therapy to increase testosterone.

This suggests it’s possible for male-to-female transgenders and transexuals — especially 1+ years into their transition — to maybe undergo a small degree of bone structural, density, or mineralization changes. And these changes may present in the face and skull (and potentially affect pattern hair loss).

First, just look at the profile differences of male versus female skull bones:


Then let’s refer back to our MTF hormone replacement therapy example. See how this person’s facial structure changes throughout their 12-month transition. While it’s impossible to say with certainty, it seems as though their jawline softens, their face narrows, and their frontal bossoming (typical male-related bone protrusion at the forehead) decreases.

Without question, these changes are the result of hormone replacement therapy: a near-arrest of testosterone and DHT production + an increase in estrogen. It’s possible that these subtle changes to skull structure have some sort of impact on the structural tension of the scalp — and that during these bone changes — much of that tension is relieved.

But to clarify — if there is bone remodeling during male-to-female hormone replacement therapy, it’s likely minimal… and probably doesn’t majorly contribute to the mechanisms by which MTF HRT reduces scalp tension.

However, this therapy does something else too…

Male-To-Female Hormone Replacement Therapy Atrophies The Muscles Surrounding The Scalp (Which Relaxes It)

Muscle growth is fueled by both testosterone and DHT. Unfortunately for Propecia users — while Propecia can reduce DHT (and thereby hair loss), it doesn’t do much to atrophy the muscles surrounding the scalp that are contributing to scalp tension.

Why? Because Propecia only reduces DHT — not testosterone (in fact, Propecia increases testosterone and estrogen by roughly equal percentages). As a result, Propecia really only targets one of the major determiners of muscle growth (DHT) — rather both major determiners (DHT and testosterone).

Conversely, male-to-female trans hormone replacement therapy targets to reduce both testosterone and DHT. How? By either 1) taking drugs that reduce total testosterone production, or 2) castration — whereby testosterone production decreases by 95% and DHT by roughly the same.

This has serious effects on muscular atrophy. Again — just look at those above photos of MTF HRT hair regrowth success. We see 1) an atrophy of muscles in the face, and 2) a change to skull bone density and/or structure. Both of these likely relieve chronic scalp tension, and thereby lead to major improvements in hair loss.

Potential Skull Bone Changes + Muscular Atrophy May Reverse Chronic Scalp Tension And Thereby Encourage Full Hair Regrowth

And this is why it makes sense to see major hair recoveries from MTF hormone replacement therapy. It’s not paradoxical. In fact, it’s expected — and fits perfectly with the body of evidence on pattern hair loss etiology.

It all has to do with the MTF HRT addressing the underlying causes of hair loss: chronic structural tension + a chronic inflammatory response. While Propecia might address the second-half of that equation, it does little (if anything) relieve scalp tension — and therefore the drug is merely a bandaid to prevent future hair loss.

What Does This Mean For Future Hair Loss Treatments?

It means that hair loss drugs, supplements, and topicals that target to…

  • Reduce signaling proteins associated with inflammation (like transforming growth factor beta)
  • Reduce prostaglandins (like prostaglandin D2)
  • Reduce DHT (like Propecia)

…will only help slow, stop, or partially reverse hair loss. They’ll never lead to full hair recoveries. This has been demonstrated — time and time again — with every single male pattern hair loss treatment study. The results are never that impressive.

This also partially explains why drug companies have yet to develop drugs to reverse calcification and fibrosis — particularly for hair loss. Why? Because when it comes to reversing scalp calcification and fibrosis — these conditions are due to chronic tension. If a future drug will reverse scalp calcification and fibrosis, it’ll do it by targeting chronic scalp tension — not a single signaling protein that contributes to either .

We Can Reverse Fibrosis (And Maybe Hair Loss) By Relieving Chronic Tension

Here’s the kicker: dozens of studies now demonstrate that by relieving tension in inflamed or fibrotic-ridden tissues — the body begins to metabolize that fibrotic material, and instead replace it with healthy, unscarred tissue.

What does this mean? The best way to reverse hair loss likely isn’t with drugs, topicals, or surgeries. It’s by relieving chronic scalp tension. If we do that, we shut off the inflammatory cascade — including reducing DHT and all those pro-inflammatory signaling proteins naturally — and give our hair a fighting chance to regrow.

That doesn’t mean that all men need to undergo male-to-female hormone replacement therapy to see hair regrowth. It just means that we should find therapies that target the scalp’s chronic structural tension and the subsequent inflammatory response.

Summary: Trans Hormone Replacement Therapy, Hair Regrowth, And Why Propecia Doesn’t Get The Same Results

Pattern hair loss is essentially a two-part equation: 1) structural changes to the scalp that evoke inflammation (overdevelopment of the muscles lining the scalp + skull bone growth), and 2) our bodies reaction to that inflammation (ie: whether we send DHT to the inflamed tissues).

For hair loss to occur, we need both chronic structural tension + a DHT response. This creates the conditions necessary for calcification and fibrosis to develop. Over time, these two conditions eventually starve the hair follicles of oxygen, blood, and nutrients — causing them to miniaturize.

Male-to-female hormone replacement therapy resolves both sides of this equation. When a male transitions to a female with hormone replacement therapy, they shut down DHT production and increase estrogen. This likely does two key things: 1) it eliminates chronic scalp skin tension by a) potentially changing skull bone density and structure, and b) atrophying the muscles surrounding the scalp which pull the skin tight. And 2) MTF hormone replacement therapy reduces the likelihood of DHT being sent as a response to any inflammation — since the liver cannot produce as much DHT anymore because the testes (which produce testosterone, the precursor to DHT) are either suppressed or gone.

As a result, trans MTF hormone replacement therapy often gets better hair regrowth results than any drug, supplement, topical, or hair transplant.

Unfortunately, Finasteride resolves only one half of one part of the hair loss equation — the amount of DHT arriving at inflamed balding scalp tissues.

Finasteride may slightly influence bone and muscular structure — but not enough to resolve chronic structural scalp tension. As a result, Finasteride is more of a bandaid to hair loss. It slows, stops, or sometimes partially reverses hair loss… but because it doesn’t relieve chronic tension, it’s not a solution to reversing any of the scalp calcification or fibrosis already present.

The biggest takeaway from these male-to-female hormone replacement therapy case studies: we need to start targeting both sides of the hair loss equation (structural tension + inflammatory response), and not just one.

246 thoughts on “Trans Hormone Replacement Therapy Hair Regrowth: The Science”

  1. Rob, I am getting somewhat confuse. Wasn’t the probable reason that men could lose their hair is because of testosterone:estrogen imbalance? In which its possible that there is more estrogen in a man’s body? I mean its in one of your articles…

    I think Danny Roddy has briefly talked about this in his free book. Where he had observed one of his co-workers transitioning into a woman. He saw that during the transition, his co-worker’s hair seems to have thinned as well.

    This led me to believe that both of your research are in sync, that estrogen is the likely culprit in males.

    But now, there’s this…. supposedly males growing hair with estrogen?

    • Hey Ray,

      The ratio of testosterone:estrogen is a good indicator to determine someone’s risk for pattern hair loss — and the ratio varies between sexes. For example, high estrogen levels are observed in young balding men. Contrast that with women: who often begin seeing hair thinning after menopause when their estrogen levels plummet. There’s also an association with male estrogen dominance and arterial calcification.

      With that said, we should be careful taking this ratio relationship into context when evaluating transgender / transexual testosterone:estrogen ratios. We have to keep in mind that the former is a relationship within the bounds of normal hormone production. The latter is literally forcing the body to emulate a hormonal profile through drugs and sometimes castration. MTF hormone replacement therapy is literally a body-transformation therapy. So we have to exercise caution when comparing it against hormonal profiles we see within normal populations, or even hormonal profiles we see in conditions or disease states.

      In terms of Danny Roddy’s anecdote — I’d need to understand more of which drugs his coworker was taking and if gender reassignment surgery was involved. According to the literature, hair regrowth is what we’d most expect during male-to-female HRT… not hair loss.

      We also have to keep in mind that while yes, MTF transexuals / transgenders do regrow hair, they also develop the figure of a woman — breast development, fat redistribution, etc. There aren’t yet any therapies that isolate the hair regrowth side effects of MTF HRT to the scalp, so it’s not necessarily a viable therapy for male pattern hair loss sufferers who want to save their hair but still appear male.


      • Rob , don’t you think that problems with hairloss starts in prostate gland? I was taking testosterone, now I am quit. Earlier I saw much symptoms with prostate. The problems with prostate started , I was noticing problems with hairs. So what is your opinion about that? Many studies shows that stinge nettle ,zinc,iodine can help with hairloss but these medicines are look into prostate , not hair! This way we treat prostate, not hair and consequently with have good results too with our hairs. Other and I think better way is doing excercises for enlraged prostate gland. Maybe when people more consider their prostate health the better result they can achieve. I mean here not only medicine but just excercises. The newest medicine doesn’t know how treat this problem but as I can see there are methods (excercises which treated this problem with many success) What do you think about my idea?

      • Hey Kuba,

        Prostate disease and pattern hair loss are closely associated because the prostate and our scalps use the same 5-alpha reductase enzyme to convert free testosterone into tissue DHT (type II 5-AR). So I think the relationship is more associative than it is causative.

        I’m not sure I understand your idea. Are you suggesting to massage the prostate as well?


      • Hello, i have just read all of this article but i don’t understand exaclty this comment.

        Im man, Etrogene are not good for treat hairloss ? If i take estrogene what will be the consequences for me plz ? Will i loss more hair ?

        Sorry for my bad english, i’m French

      • Hey Pierre — for most men, I wouldn’t recommend taking estrogen topically or orally to combat hair loss since even in low dosages, estrogen can have feminizing effects. Rather, the article just makes the argument that estrogen supplementation + androgen suppression leads to more hair regrowth than androgen suppression alone because the combination may further decrease scalp tension.


  2. This is an interesting point of view regarding the root cause of pattern hair loss. I had not heard of scalp tension and inflammation leading to calcification and fibrosis.

    I did not know MTF hormone treatment lead to reducing scalp tension and increased hair regrowth. Fascinating!

    Does this mean that I as a postmenopausal woman could reduce my scalp tension and therefore increase hair regrowth, by taking estrogen?

    It sounds like the root cause is all hormonal, I just did not understand how low estrogen played a role. I knew that DHT from testosterone played a part.

    Thanks for helping me think deeper about the issue.

    • Hey Carolyn,

      It’s certainly possible that some form of estrogen therapy could help — though I think it’s important to first explore all non-drug opportunities to increase estrogen levels for post-menopausal women. I didn’t mention this in the article, but male-to-female hormone replacement therapy may increase the risk of certain cancers — specifically breast cancer. Data on this is sparse but technically, anything that increases exogenous estrogen (estrogen made from outside of the body, not inside the body) may increase the risk of breast cancer.


      The same is true with some forms of progesterone. Women’s health clinics that specifically treat menopausal women — and gender reassignment centers — might have better data on this than what’s currently available in the medical literature. If you’re considering any form of estrogen therapy, I’d first talk to your doctor and see if you can get in touch with any clinics.


      • I have dealt with transsexual m/f females for 20 years and I will tell you categorically here and now what your insinuating is “False!” M/F estrogen therapy even post SRS ‘Sex Reassignment Surgery’ does “Not” cause the scalp to recover a full head of hair. where you got your evidence is a mystery? endless thousands of Post-Op transsexual women are still “Losing their hair” and that is why if your readers wil care to go on to transgender Boards online and read for yourselves. They are in fact in a state of panic seeking all kinds of advice just the same as any Cis Female in the same boat. So I have to say although your “Theory” of calcification and fibrosis may play a role, I would urge you to stop using transsexual female as an example to promote your theory as you are talking complete rubbish! If there was just a small bit of truth in what you say then there wouldn’t be so many transsexual women out there worried sick out of their minds losing their hair despite female hormone therapy. Have a nice day.

      • Hi Amyee,

        I understand that not all MTF HRT patients experience major hair regrowth. And I’m not saying that major hair regrowth should be the expectation for every single MTF HRT patient. After all, everyone responds differently to the therapy.

        But I’m not making up evidence. Observational studies on castrates injected with exogenous estrogens showed better hair regrowth than androgen suppression / castration alone — whereas castration appeared to only stop hair loss progression.


        Moreover, here’s an interview with Dr. Cotsarelis about this exact phenomenon (better regrowth from androgen suppression + estrogen therapy vs. androgen suppression alone):


        Finally, the anecdotes of the trans women featured in the article speak for themselves. That’s better hair recovery than anything I’ve ever seen from a finasteride patient. Maybe not full hair regrowth for every single trans HRT patient (which I’ve never claimed anyway), but a better response versus other therapies. Which begs the question: why? Hence the article.

        I’m not using transexual females to “promote” my theory. I’m explaining how MTF HRT regrowth stories still fit within the context of the calcification-fibrosis hair loss pathogenesis model.


  3. Hi Rob. I have been a perfect hair health subscriber for around 5 months. I find your videos and emails to be very interesting and useful. I have been suffering from female pattern hair loss since menopause. I have cleaned up my diet and have been performing your recommended hair massages for around 5 months now. So far I have not had any hair regrowth. I am wondering if female hormones may help regrow some of the hair I have lost?

    • Thanks for reaching out Betty. It’s possible that estrogen therapy might help — but please exercise caution and speak with your doctor before making any decisions. If you have a chance, please read my response to Carolyn’s comment — it should illuminate why I have reservations (but why this therapy could be helpful when administered correctly).


  4. Hi Rob, Your research is impressive, makes sense and agrees with my experience and limited research, namely, massaging the scalp with fingers seems to be the most effective therapy to relieve scalp tension; but not a quick and easy therapy. Most give up after a few weeks or months. Therefore we now need to know the best way to do this therapy and see if any gadgets can be made to improve on finger massaging if possible.

  5. ” castrated men were injected with estrogen, they began regrowing significant amounts of hair.” — the link you provided with the text asks for login, could you provide some other link where atleast the abstract is visible ?

    • Hey Dante,

      The link is to an interview with Dr. Cotsarelis (the leader of the UPenn team who discovered the relationship between PGD2 and pattern hair loss). Here’s the quote from the interview:

      “Dr. Van Voorhees: What is the mechanism that accounts for the miniaturization of hair?

      Dr. Cotsarelis: We know that inhibiting the testosterone pathway slows down the miniaturization of the follicle. Jaworsky, Kligman, and Murphy had a paper 20 years ago showing that half the time there is also inflammation around the hair follicle, which led to some thought that maybe inflammatory cells including mast cells were contributing to hair loss. Studies and case reports of transgender operations where men become women and receive high doses of estrogen show that a scalp that was almost completely bald can have, after castration and high estrogen supplementation, a tremendous amount of hair growth.

      The overall feeling is that the follicles can be thought of as being in three states. Either they’re terminal, and they’re large, or they’re miniaturized, and they’re small, and the hair they’re creating is microscopic, or they’re in between, called indeterminate. It’s thought that follicles reach a point where they’re producing a hair so small that at that point the chance of reversing that follicle is small. There seems to be a point of no return with respect to androgen removal; even if you castrate someone who’s bald he won’t regrow all his hair. If you give him estrogen, too, he might.”

      Dr. Cotsarelis is referring to 1) individual case studies on trans MTF hormone replacement therapy patients, and 2) the observational studies done on male castrates in the early 1960’s:



  6. So rob as for relieving tension and replacing fibrosis with healthy tissue are you alluding back to the method of scalp pinching and head massages to achieve this?


    • The evidence suggests that mechanostimulation (massaging, dermarolling, skin stretching, etc.) works in a variety of ways — one of which might be tension relief. This is likely due to the scalp skin elasticity changes readers most often report after a few months of massaging. In any case, I think mechanostimulation is the first line of attack for any hair loss treatment — because it tends to make every additional / adjunct treatment so much more effective.


  7. Great Article Rob,

    I was waiting for you to write another article and here it is!

    In terms of how we can address what you talked about in the article, maybe we can use a natural topical anti-DHT formula with little to none systemic effects throughout the whole body because we need DHT as a man to be a man, and for the second part of the equation we can use the DT massages or a scalp tension releaser like the one in the study you linked in the article

    • Hey Michael,

      Thanks for reading! Anti-androgenic topicals (like spironolactone) seem to work very well, and have much less of a systemic effect than oral anti-androgens. There’s absolutely an opportunity to develop an effective topical anti-androgen that tackles the DHT-side of the equation from multiple angles: androgen receptors, 5 alpha reductase, DHT metabolism, etc. And in terms of the second-half of the equation — mechanical stimulation, muscle atrophy/relaxation, and the tension-relieving devices are all steps in the right direction.

      I’ll send you an email later today to touch base on our call last week.


  8. Good article Rob.

    I had a feeling that the bodies inflammatory response was genetic.

    So men regardless , need to tackle scalp tension and calcification mechanically ?
    And tackle inflammation with diet / lifestyle

    You said you asked your doctor about why MPB has a pattern ie vertex ect. So is the fused Galea theory accurate in describing why hair is lost in a certain pattern amongst males ?

    And is scalp tension why diffused thinners loose their sebuceaus fat layer ?


    • Hey Paz,

      RE: scalp tension–

      As far as the current evidence stands, I think you’re right. Our best bet to relieve scalp tension — short of a MTF transition — is improving scalp laxity and elasticity. Mechanical stimulation of any form (stretching, massage, dermarolling, scalp tension relievers) should help.

      RE: inflammation and the galea fusion theory–

      I tend to put more weight on the galea-fusion theory than any other hair loss hypothesis to date, because it 1) explains the pattern and progression of male pattern hair loss, 2) fits in with the calcification/fibrosis/DHT theory, and 3) also explains subcutaneous fat erosion (the tension increases inflammation which increases tissue androgen expression with erodes subcutaneous fat).

      Aside from addressing this structurally with mechanical stimulation, diet/lifestyle are great tools to controlling the inflammatory response. We know that diet and nutritional profiles control the degree of signaling proteins expressed throughout the body — and this carries over to inflammatory sites. The wrong diet/lifetyle will likely exacerbate the inflammatory response. The right diet/lifestyle will attenuate it — so that in doing so, we’ll reduce our chances of overreacting to inflammation. And since diet/lifestyle can control our hormonal output, the hope is that this will also reduce the amount of androgens sent to inflammatory sites.

      Another approach is simply supplementation. While this is more of a bandaid approach, supplementation with the bioavailable forms of curcumin, or with saw palmetto, can help reduce both tissue androgen expression and the inflammatory response.


  9. Hi Rob,

    I am not entirely convinced by the reasoning in this article.

    I think in your book you are onto something with your theory of testosterone/estrogen ratio and here you are pretty much disputing it here. There a couple of points I would like to raise:

    1. As you also mention in a reply above, young balding men tend to have higher estrogen ratio. But if a male’s testosterone levels plummet while estrogen rises, shouldn’t that mean that his levels are even more so out of wack (as per mtf transition) and the hair loss should accelerate even further?

    2. Ray Peat believes that estrogen has pro-inflammatory properties, which would add to your idea of increased estrogen in males creating chronic inflammation. I have been growing sceptical of Peat’s work on hormones recently, one just needs to have a look at his hairline once for that, but he appears to have done a lot of research in the area of endocrinology. But to be specific, it is his views on sugar and aspirin that made me cautious, not work on estrogen.

    3. It appears that hair loss in bodybuilders never came to your attention. Bodybuilders take high amounts of exogenous testosterone and their hair loss often accelerates while on cycle. One would think that it has to do with DHT that results from higher testosterone levels, but there is more to that: excess testosterone eventually converts to estrogen, causing so called “gyno”, development of female sexual traits, like breasts. Those are hard to get rid of, so along with testosterone they customary take estrogen suppressors after some time into the cycle. I think that it also supports your t/e theory, where the hormonal imbalance causes hair loss.

    4. I am not entirely convinced about the muscle atrophy improving hair, in fact I think scalp massaging might actually improve scalp muscle tone? Also, Tom Hagerty, of him I am sure you have heard, claims that scalp muscles exercises helped him to recover his hair.

    5. Also, I do not find the theory of scalp tension particularly compelling either because skin is not rigid like a piece of plastic. If that was the case, one would not be able to gain weight as the skin would not allow to the underlying tissue to change size. In my understanding, it simply adapts by growing as it senses pressure, or shrinking in the absence of it. In this case, as the muscles pull back, the skin cells would divide and the skin surface would increase until the muscles are not able to pull back any more. There would be no excessive pressure on skin here, not in the long term.

    • Hey Yuri,

      Thanks for taking the time to read and comment. I initially had a hard time wrapping my head around the MTF transgender hair regrowth findings — especially in the context of what we know about the testosterone:estrogen ratio and how closely it’s correlated to hair loss in both men and women.

      However, I still think this makes sense. And I think further clarification is needed on my end:

      The studies showing that the testosterone:estrogen ratio in men and women are linked to both 1) calcification/fibrosis, and 2) hair loss are all focused on normative hormonal data for men and women. In other words, these studies compare an excess (or absence) of testosterone or estrogen in men or women — relative to the other men and women in each respective study.

      This is an important differentiator in comparing the testosterone:estrogen levels we’d expect in men or women suffering from hair loss, and the testosterone:estrogen levels we see in MTF HRT patients who regrow significant amounts of hair. Here’s why:

      In non-transitioning men and women, typically an imbalanced t:e ratio is an indicator of either poor thyroid function, inflammation, or both. For example, young men with relatively higher estrogen appear to be at a higher risk for balding than young men without high estrogen. The phrase most people like to characterize this hormonal profile by is “estrogen dominance.” And estrogen dominance is typically a function of…

      -Inflammation (as a result of endocrine disruptor exposure, a nutrient deficiency, an inflammatory diet, or even chronic alcohol consumption — all of which raise estrogen)
      -Autoimmunity (as a result of a compromised gut biome, or prolonged cases of any of the above)

      So in a sense, a man with a relatively lower t:e ratio is simply suffering from chronic, systemic inflammation — which eventually expresses itself as calcification/fibrosis, or even hair loss. So it’s not that a man’s t:e ratio determines whether he will go bald. Rather, a man’s t:e ratio is a benchmark for their degree of systemic inflammation, and it’s the inflammation that likely contributes to their increased hair loss.

      This also fits within your model of HRT for men taking anabolic steroids — as arterial calcification often increases in men taking exogenous testosterone. This suggests there’s an underlying inflammatory factor at play (either an inability to full metabolize exogenous testosterone, or its conversion to estrogen).

      Now let’s compare this to transitioning males to females. All else equal, these males transitioning to females might have testosterone:estrogen levels within normal ranges (suggesting little autoimmunity or inflammation)… or they might have imbalanced testosterone:estrogen ratios — suggesting prolonged inflammation and autoimmunity (and thereby hair loss).

      But once transitioning males start taking drugs to stop DHT production and start taking drugs to increase estrogen, they no longer become comparable to that normal data set. The reason why is because they’re now using drugs to control their hormonal output — and a side effect of this is muscular atrophy / bone remodeling — which is likely what improves their hair loss.

      Conversely, men who aren’t transitioning — with low testosterone and high estrogen — don’t get that same remodeling / atrophy effect, because their hormones are just so much closer to the male camp than female camp. The degree of which MTF HRT replacement therapy manipulates hormone output is incredible — and I don’t think it’s even remotely possible for a man to increase his estrogen that high and shut down all testosterone / DHT production without those drugs.

      As a result, comparing trans hair regrowth to male regrowth — from the perspective of the testosterone:estrogen ratio — is more of an apples-to-oranges comparison. I hope this helps clarify my position.

      RE: scalp tension and skin growth–

      In almost every other part of the body — you’re absolutely right. In moments of tension, the skin should divide and recalibrate to adjust for the newly created tension from bone growth. The problem in the scalp is that this tension is maintained once fibrotic material sets in (ie: the galea fuses with the underlying layers of the scalp). If you and anyone you know ever received a cut when you were little, and the scar never faded (but rather grew / morphed as you/they aged), this normal skin stretching is exactly what that fibrotic tissue limits. The collagen cross-hatching is too thick and disoriented to allow for the normal division of cells — and as a result, it sticks around.


      • The problem in the scalp is that this tension is maintained once fibrotic material sets in (ie: the galea fuses with the underlying layers of the scalp).

        In this case, could that be that the regrowth effect is achieved by preventing and undoing the fusion, which should be possible with mechanical stimulation?

        That would explain the mechanism behind scalp massaging, as well as Hagerty’s system of scalp muscle exercises: it could be that regular forced moving of the galea against the scull prevents its fusion, and if that is the case, it may also mean that the specific stimulation approach is not important, as long as it helps to maintain the mobility.

      • Hey Yuri,

        It’s certainly possible that you’re right. With such limited data, we’re bound to extrapolate/interpret differently, and I don’t want to take any possibilities off the table. Constant galea movement could help “unfuse” the galea by indirectly relieving tension, and this would partially explain the results of the massage.

        Though I think the biggest benefits of the Tom Hagerty exercises come from teaching the scalp muscles how to relax. It took me almost two years to figure out how to wiggle my ears — and now that I can do it freely, I also know that part of the reason why I couldn’t wiggle them was that those muscles were likely already chronically contracted. It took a lot of massaging of those muscles to finally get them to stop staying tense.


  10. Hey Rob,
    Thank you for all your hard work. It’s truly amazing.
    Do you know of ways that we can remove tension from the scalp? Is there an exersize that will do this. Also I found something called jawsersize and was wondering what you thought and if there could be beifits to hair regrowth. I’m including a link. It clams to increase blood flow to the head and neck along with tone the face. Could be trash but I thought I’d ask.


    • There may be some truth to the claims on the site, but unlikely it would help with hair loss.

      Shortly, modern people have poor facial development, faint jaw lines and crooked teeth, as well as weak facial muscles, which has to do with our diet, which is very soft. Seems like their idea is to put jaws back under the stress in order to improve the facial structure, which can probably work, if you manage to stick with it for at least a couple of years of everyday exercising.

      But hair loss, not very likely.

    • Hey Bryce,

      Thanks for reaching out. I tend to agree with Yuri’s comment. This device is an exercise tool for the jaw and likely informs jaw shape through continued mechanical stimulation over a series of years — much like chewing harder, more fibrous foods informs wider jaw development and less teeth crowding in indigenous populations surrounding the Amazon.

      I don’t think the device will help with hair loss, but that’s not to say that it won’t help reshape the face. If you try the device, keep us posted and let us know how it goes!


  11. Yuri

    In Rob’s massage video , their is an excerize for the scalp ridges, between the vertex and sides.

    From practical experience this part of the scalp is very tight ! However after time it loosens to a point where you can pinch them without resistance.

    I’m quite sure this exercise would target the fused Galea effectively.


  12. Some trans women do get this much regrowth. Many of us only get a little. Much of this is due to the fact that we are dropping our testosterone and thus DHT by a ton. Our skulls do not reshape. I really really wish they did, but bone structure stays the same with HRT.

    • Hey Katherine,

      Thanks for reading. I’m going to do more digging into my bone remodeling statement. Bone remodeling is just one (of many) terms to describe the changes that hormones can exert on our bones. I know that in post-menopausal women receiving hormone replacement therapy (increased estrogen), there were improvements to bone strength (fragility), and the researchers believed that this was not due to bone remodeling, but rather estrogen’s effects on suppressing bone turnover and a reduction in size of resorption cavities.


      So some slight changes to bone shape were observed, but that doesn’t always imply bone remodeling. That means that I need to be more specific in my terminology of changes to bone structure. Thanks again!


  13. Another very interesting concept, Rob. Thank you.

    I’ve been struggling for several years with disperse hair loss across the top of my head. Like you, I’m a “scientist by nature” actively investigating, and then modifying my course of action based on findings. I appreciate your willingness to share your research.

    I’m trying multiple approaches simultaneously, which is not helpful in terms of “scientific method” but of course my priority is saving my hair NOW. I’ve been using the following two methods in addition to changes in diet, Saw Palmetto supplementation, etc. Your article has cast these methods in a new light. I would appreciate your perspective on the first question in reference to SCALP SKIN TENSION and SCALP MUSCLE ATROPHY. The second question may bear on the issue of DHT as a RESPONSE TO INFLAMMATION:


    About a year ago I discovered the website http://www.hairloss-reversible.com run by one Tom Haggarty, an 80-year-old man who has relied on a method of exercising the scalp and underlying galea to retain his hair – very much the exception among his male family members. In brief, the exercise employs muscles at the back of the head to alternately contract and release the tissues spanning the top of the head. The process is akin to “wiggling the ears.” I can’t wiggle my ears, but have been doing the exercise as best I can on a daily basis (more or less) for nearly a year.

    The exercise clearly tones muscles in the area of the scalp, forehead and brow. Do you think it’s HELPING my cause, or UNDERMINING it?


    Each week I use a 1.5mm derma roller to make thousands of tiny wounds all across my scalp. I’ve been doing it for about five weeks and am not seeing the success I hope for, but it’s early days… Your article suggests that DHT is sent to the site of inflammation, inflammation that is typically the result of ACUTE INJURY. But when that inflammation turns out NOT to be due to injury—but is instead due to CHRONIC TENSION—the DHT remains in the region at an elevated level.

    There are studies demonstrating positive hair re-growth as a result of derma rolling. Your article makes we wonder if those positive results might actually be due to the tiny INJURIES providing “something for the DHT to do” other than wreaking havoc on hair follicles. In other words, perhaps the tiny puncture wounds DIVERT the DHT from attacking the follicles by giving them ACTUAL INJURY INFLAMMATION to act upon. (Idle hands are the Devil’s Workshop, ha!)


    Not to sound naïve, but might mind/body relaxation techniques help to relieve chronic scalp tension by relaxing tense muscles in the surrounding areas of the head (and the entire body)?

    I really like this STONE SOUP approach to solving the mystery. Keep up the GREAT work!

    • Hey Tom,

      Thanks for reading and for reaching out. And no worries on the misspelled name — I edited your original comment and removed your corrected comment for clarity.

      To answer your questions–

      RE: Tom Hagerty–

      I’ve tried his exercises before. It took me almost two years to learn how to wiggle my ears, and the only way I did it was by intensely massaging the muscles surrounding my ears so that they relaxed. I think the biggest benefit to Tom Hagerty’s scalp exercises is teaching these scalp muscles how to relax — so that they’re not chronically contracted. In this case, I think the exercises will help. In general, most people trying TH’s methods report a slow or stop in hair loss. Some people doing the massages + TH’s methods have reported hair regrowth. I think there’s a synergy, and that the synergy is likely coming from the muscular relaxation aspect of his exercises — rather than anything else. I wouldn’t worry too much about this — but focus on if your scalp stays relaxed post-exercise. If it doesn’t, maybe you’re going too long and need to reduce intensity.

      RE: DHT and dermarolling–

      This is a tough question to answer. DHT arrives at our follicle sites from the blood. It converts from serum free testosterone into DHT via 5-alpha reductase, and then binds to an androgen receptor at a tissue site. Based on everything I’ve read, it’s unclear how long this DHT stays attached to an androgen receptor, but I do think that it’s unlikely that during dermarolling, the DHT detaches from the androgen receptor, gets metabolized into something else, then gets reconverted back to DHT at the dermarolling injury site (thus pulling DHT away from the follicles and toward the injury itself).

      With that said, nothing is out-of-question at this point. We have such limited data on DHT metabolism in balding scalp skin tissues — ie: how long this DHT stays attached to an androgen receptor or exerts an effect on the follicle before it’s metabolized. I wrote a little bit about DHT metabolism here, in case you’re interested:


      RE: meditation–

      It’s possible! And there are several benefits to meditation beyond relaxation — including increases to grey matter and a resilience to brain-related aging benchmarks:


      Please keep me posted with your progress!


  14. Hey Rob, great article!

    so if I theorize correctly, would applying botox loosen the scalp to the point where we could apply the detumescence therapy easier, and yield better results on hair growth?

    Any thoughts?


    • Thanks Julian! I’m curious about this too. If botox keeps the scalp muscles continuously loose, then the question is: just how synergistic will botox + mechanical stimulation be? My bet is that it’ll help tremendously, but there’s not enough research yet to know, and I don’t know of anyone who’s ever personally piloted the botox method — let alone both at the same time.


  15. Hi Rob, I feel the tension in my scalp is the same all over my head but only my crown suffers hair loss. If that’s because blood flowing uphill is more restricted the higher up the blood flows then I expect hair loss would be the same from my crown across to my forehead but that’s not my case. He anyone studied the length and diameter of capillaries in different parts of the scalp that supply blood and then use this data to estimate differences in blood flow rates? That could tell us a lot.

    • Hey Mike,

      There have been studies done on oxygen levels of balding scalp tissues — all suggesting that balding regions receive ~60% of the oxygen of non-balding regions. Since oxygen is transported through the blood, we can assume these regions also receive less blood flow (and likely even nutrients — since blood carries with it essential trace elements, too).

      As far as capillary length and diameter — I’ve never seen a study on this. Unfortunately, research into the underlying skin layers and bone on balding scalps is extremely limited. My hope is that we can push the research in that direction, because I think that’s where we’ll find our answers to the etiology of hair loss (and the most viable solutions).


      • Rob, I guess scalp massage helps regrow thin stunted hair mainly by improving blood flow and my guess is that diet, exercise, and emotional stress only contribute slightly to male pattern baldness. Very few men can completely regrow hair by massaging their scalp and probably because it’s tedious and tiring to continue effectively for at least 30 minutes a day and for more than a year. Managing emotional stress, a good diet and exercise is comparatively easy but doesn’t help much. My hope is that a survey on the effects of scalp massage will accurately determine how many people might benefit if they persisted long enough and how much regrowth is possible. Then the next step is to identify techniques and gadgets that will perform scalp massage more effectively than we now manage to achieve.

  16. Hi Rob – my son is suffering at 21 with mpb. He is currently using your protocol but we are only one month in. In light of this article, I have had some experience with calcification in soft tissue – from sports injuries. I did some research and did a protocol of taking magnesium, vitamin K and ibuprofen(for inflammation). After a month, my injury got totally better which I was glad as the dr. wanted to give me cortisone shots. There is also heart disease in my family and I believe through the research I have done that a lot of it is due to inflammation and lack of vit. C at least for blood vessels. What I am getting at is I know for calcification, that magnesium is important as well as vitamin K. I am wondering if you’ve found any research that might indicate these nutrients being helpful with the fibrosis and calcification of mpb. Especially since you mention that a lot of balding men tend to have heart attacks. Perhaps combining it with your protocol could help. This article is about vascular calcification but I think it might apply. http://drsircus.com/magnesium/calcification-and-its-treatment-with-magnesium-and-sodium-thiosulfate/

    • Hey Virginia,

      Thanks for reaching out. Many people have experimented with both transdermal and oral forms of vitamin K2 and magnesium for hair loss — but I’ve yet to see any anecdotes of real regrowth coming from these nutrients. Based on all available literature, here’s my rationale for why:

      -The calcification and fibrosis observed in balding scalps is likely a function of chronic scalp tension (chronic inflammation)
      -The calcification and fibrosis observed in sports injuries is from acute injury (acute inflammation)
      -Magnesium and K2 likely help attenuate/alleviate both conditions in acute injuries because those tissues aren’t under chronic inflammation
      -These nutrients are likely less effective when the cause of the fibrosis / calcification is less so acute injury, more so structural tension — because by eliminating the calcification / fibrosis present in these tissues, you haven’t eliminated what’s causing it (the tension).

      However, if you can loosen the scalp and then apply magnesium + K2, my bet is they’ll go much further in hair loss reversal.


      • I also wanted to ask if you’d ever seen anything about proteolytic enzymes – which I have read can dissolve fibrin and help with inflammation. Most studies I’ve read about involve serrapeptase. Could that also be helpful with the fibrosis? Just looking for anything that could help things move a bit faster – having a 21yo at stage 4 hairloss is tough and certainly would make anyone a bit panicky to try to reverse that asap.

      • Anything that targets fibrosis from a signaling protein standpoint — for hair loss specifically — is likely just going to be limited to preventing more fibrosis and not necessarily reversing what’s already there. To do the latter, we likely need to target structural tension — which drives the inflammation which drives the fibrosis which drives the hair loss. Anything further upstream — like a signaling protein involved in fibrotic development, or an enzyme that might help metabolize fibrosis — probably isn’t the most effective approach.

        If you do try serrapeptase, let us know how it goes. If anything, I don’t think it’ll hurt.

      • Hey Kevin,

        I have a hard time taking whatever that YouTube user says seriously. Last year I had to a hire a lawyer because he’d stolen research, photos, flowcharts, and content from my book and website then positioned it as his own. When I bought his book, it was filled with charts / photos / studies lifted my book, Danny Roddy’s articles, and other health researchers. This person was also a past customer of mine and essentially took my content, combined it with Danny Roddy’s, then created his own website. At one point, my chapter on “genetics and hair loss” was directly copied/pasted into his email course and on his website. This person adds no new perspective to hair loss research. He simply steals others’ work, calls it his own, then profits.

        In terms of magnesium, it’s not a bad idea to increase magnesium if you’re deficient. But magnesium and K2 have yet to move the needle on reversing calcification and fibrosis that 1) hasn’t been induced by warfarin, or 2) in human models. In general, I think addressing nutrient deficiencies is a great idea — but it likely just tackles the second-half of that hair loss equation (reducing systemic inflammation and the inflammatory response). What we really need to focus on is relieving scalp tension.


    • According to how most people define it, telogen effluvium is hair loss that’s a result of a change in the hair cycle and not necessarily pattern hair loss — which is due to scarring. Telogen effluvium is more linked to autoimmunity, stress, and nutrient deficiencies. And according to the research, it’s most likely reversible if you can uncover (and resolve) the underlying driver of it.

  17. Hey.. Such a great article. But i have some doubts. If chronic scalp tension is the root cause of MPB, then why it is that one side of scalp eg left one in my case is having more baldness than others. Also massage is the treatment to such scalp tension so if u do too much massage then will the condition deteriorate? In my case i have used massage techniques to my scalp extensively for last 9 months qnd past few weeks i am experiencing severe hairfall. So it made me think if more mechanical stimulation can worsen the scalp condition? What do you think about it?

    • Hey Sans,

      Mechanical tension can develop more on one side of the scalp versus the other (for instance, due to muscular overdevelopment on one side — maybe from chewing — or even uneven skull bone growth). So your pattern of hair loss still fits within the models of the article. Again, I’m happy to be wrong about all of this. It’s just that within all the available research, I haven’t found a better model to explain pattern hair loss than the theories described in this article and the book.

      If done correctly, mechanical stimulation should relieve scalp tension and improve hair loss, not make it worse.


  18. Hey Rob,

    Just reading through some of these comments, notedly the ones in regards to Tom’s scalp exercises. I have a question about this. People state that the exercise relaxes their scalp, I’m curious how this is possible in your experience? I’ve been doing them also for many years and in my own experience it actually tightens my scalp muscles giving them more of a ‘pump’, particularly the occipital muscles which tend to get super tight and pumped after many repetitions of contraction – pulling back on the galea. If anything was to relax the galea though, I feel it is in the contraction of the frontalis muscles only – curious what your take it on this?

    Secondly, As your article suggest, I’ve recently also started subscribing to the belief that hormone imbalance has a significant play on MBP, notedly those who propose ‘against the grain’ stating that it is in fact estrogen dominance that is the cause in men. In any case, I’ve started measures to ‘restore’ balance in my own body through various diet changes and herbal supplements, along with lymphatic drainage and increasing blood flow to the site. I have some test results coming back soon (both saliva vs serum) testing for (estrogen, testosterone, progesterone, DHEA, DHT), I’m just curious from all your research if you have any values that you can provide as a reference for healthy ranges of these tests – particular the E2 vs Test balance?

    Hope to hear back



    • Hey Joe,

      I find that the galea region of my scalp is most relaxed when I’m not doing any of the Tom Hagerty exercises. But I also remember that same region of the scalp feeling chronically “tight” before I figured out how to wiggle my ears. When I contract either muscle set involved in the exercises, I feel increased tension.

      I don’t have any hard ranges for serum and saliva hormones, but directionally, a good place to start is to look for anything out of the ranges of the test. It’s safe to assume that the low-end average of serum total testosterone range (200 – 1000 ng/dl) might be “clinically” normal, but should actually be treated as low testosterone. In fact, there are some insurance companies lobbying to lower the bottom end of the normal testosterone range even further — so that men with low testosterone won’t get diagnosed with low T and then put on hormone replacement therapy (with is a burden to the insurance companies that must pay for the treatment).


  19. The lady’s whose case you have cited ,her stack has been discussed at a forum earlier at a forum


    Quoting her stack at the time :-

    It takes a lot of stuff for me but it worked! Obviously ymmv

    minoxidil foam (2x a day, plenty)
    Finasteride (1mg)
    flutamide (125mg, this really accelerated things)
    Spiro (200mg)
    estrogen (sublingualy, 6mg, I just dropped myself though I was at 8mg for the past several months and injections before that, I just pushed a little too hard and actually started loosing hair again, dropping back seems to have stopped the hairloss again)
    biotin (20000mg a day, probably way to much)
    Keretin (200mg a day)
    viviscal (not sure if it actually helps but it might?)
    Nizoral shampoo, 1x a week while at 8mg of E, but now that I dropped to 6 I need it 2x a week or I get greasy
    I condition my hair daily, and no shampoo at all on they days I don’t use Nizoral
    Edit: as a disclaimer I don’t know if anything I’m doing is safe for anyone else and I don’t recommend anyone do any of it without a Dr’s approval. I have more than one endo (for different things health wise) plus my Dr who prescribes me hrt so I rarely go more than a month without panel of tests to make sure my liver and kidneys are not struggling

    Edit edit: I forgot to mention I cycle progesterone 10 days a month (an otc cream I get on Amazon) and it’s fantastic

    I am not sure what her current stack is but clearly she was taking a lot of things. Notice the bi-phasic response for estrogen, higher estrogen seemed to caused hair loss but dialling down back a little seemed to have stopped it.
    Plus ,she also cycles progesterone.

    • This is exactly what I’ve been looking into lately – the hormone imbalance between E & T (not my work) – but I feel this is key. Personally I feel that it is the Progesterone that is doing the trick here to restore proper “balance” between the two.

      Look into it anyway.

    • Hey Dante,

      Thanks for sharing this — it’s very helpful. The inclusion of progesterone might further encourage bone structural changes:


      I’m curious as to how much estrogen was too much for this individual. The difference between 8mg to 6mg of sublingual estrogen seems to be relatively small. At the same time, we don’t seem to have enough information about the amount ingested on top of the injections. A lot of moving parts, and it makes it hard to parcel out the effects of any one hormone.

      What is interesting are the anecdotes from the castration studies, and Dr. Cotsarelis’ remarks about increasing estrogen + inhibiting testosterone & DHT leading to hair regrowth in castrated men.

      Do you know of any men who have tried cycling progesterone for hair loss? And if so, what were their results?


  20. Hi.

    This is probably a really dumb question but is chronic scalp tension in any way related to psychological stress?

    Does having chronic anxiety and stress at the job, etc. make one more likely to have a tighter scalp and therefore increase their chance of suffering from MPB?

    This would also beg the question of whether relaxation techniques like meditation and progressive muscle relaxation would have any benefit to hair loss or at least a supplementary effect along with any massaging and scalp exercises.

    • There are no stupid questions here!

      I absolutely remember feeling that my scalp tension increased in periods of stress — especially at work. Scalp itch is also closely associated with scalp tension — which is something many men begin reporting at the earlier stages of pattern hair loss.

      Anything to control and relax the muscles surrounding the galea might help reduce this tension. That includes relaxation techniques — though I haven’t yet seen any studies indicating their efficacy.


      • Nice. I do meditation daily and I feel like that helps with stress and tension. It definitely feels different on days when I don’t meditate.

        Regarding the scalp massages and exercises, do you think they’re preventative or should they only be done by people experiencing hair loss?

        I don’t have any hair loss yet but I’m kind of anxious about the whole thing and I want to take preventative measures.

        My diet and lifestyle are the only things I’ve touched upon at the moment but I’m not sure if doing massages on a scalp with full hair will do anything.

        Thank you for taking the time to answer my questions.

  21. Rob that’s roght prostate massage and usual excercise of deer is very helpful and you can do it everywhere you are.

    I have one question yet. We were talking probably in the last year , I ve told you that I am using steroid. My hairloss started when I took steroid. No I am quit. Do you think I have better chance that people who have hairloss normally or the same ?

    • Thanks John!

      The lactate-hair loss connection is the latest “breakthrough” in hair loss research… just as PGD2 was in 2012, just as KROX20 was a few months ago, just as JAK inhibitors were the year before. The net: all of these signaling proteins and signaling pathways that researchers “discover” as breakthroughs are all simply connected to fibrosis and calcification. If these researchers simply zoomed out and stopped looking at treatments from a single-signaling protein target, they’d realize this.

      I’ll hedge my bet based on every past “breakthrough” in hair loss research: the buzz on lactate dehydrogenase will fade once people try (and fail) to see significant regrowth from targeting it.


    • Hey Michael,

      I think earthing has its merits for reducing stress and potentially inflammation. And the reality is that anything that acts to attenuate systemic inflammation is likely going to help slow pattern hair loss. I don’t think that earthing alone is going to lead to hair loss reversals, but if it’s something that fits in your schedule, I would absolutely include it. For reference — I play barefoot soccer in the park almost every day and always feel more relaxed walking out of a session.

  22. I had a childhood encounter with a concrete wall that left a permanent bump on my forehead. Nothing too cosmetically problematic but it’s obvious to the touch. I discovered the skin ringing the bump is fibrotic/calcified in exactly the same way my hairline is. Skin pinching is breaking up the stiff tissue around the bump, resulting in pimple like spots that eventually flake off, same as with my hairline.

    Kind of lends some credence to the skin tension idea.

  23. Hi,

    I’m 29 and will soon start my HRT (MTF trans woman). I always had long hair, but in the past 10 years i lost lots of hair. Probably due to genetic, i lost almost all the hairs on the top of my head (my case is almost like the pics of the trans in your article, it’s a severe case with lots of hair lost). It makes me daily depressed. I asked my doctor for Finasteride, but he said he can’t prescribe it, he said only my endo can do it (that’s very strange….). Meanwhile, my hairs continue to fall, and i still have 27 days to wait and watch them fall with nothing i can do to stop that hairlost, 27 days before i can meet my endo for the first time. It’s so depressing. I’m highly afraid, a lot, that my hair doesn’t regrow. You said that “most” trans get their hairs growing back, i really hope, but in my searching on various trans forum, most people never regrow their hairs, even with HRT+finasteride, most of them have to wear wigs.

    So even if reading this article make sense, how to explain that in reality, most trans was unsuccessful to regrow their hair with hormones??

    The one in this article is probably one of the rare lucky case who was able to get her hairs back. I don’t want to have to wear fake hairs for the rest of my life, and i’m afraid i lost too much hairs for hair transplant having a nice result. Chances are i will ‘have to’ wear wig, and It depress me a lot, i wish i made my transition when i was younger.

    • Hey Nina,

      Thanks for reaching out. There are certainly people who respond better to MTF HRT than others, and it’s possible that the case studies presented here are the exception and not the rule. The focus of this article is to explain the science behind these exceptions, and how significant hair regrowth is possible with this type of therapy.

      I re-read my article, but I couldn’t find the sentence you mentioned — the one where I say something along the lines of “most” trans MTF experiencing significant hair regrowth.

      I don’t think you should feel depressed about your current hair state, or transitioning late. No one can say how much hair you’ll recover during and after your transition, but what matters is that this process is a major step forward in becoming the person you’ve always wanted to be. Wig or no wig, no one can take that away from you.

      • I know this article and reply chain is a couple old, but. had ton throw in my 2 cents worth. I am a male-to-female transsexual who did not recover my hair loss and barely slowed down the progression. The harsh reality is that *MOST* of us MtFs do not see significant reversal/recovery of hair lost. A few do, and when they do it is so dramatic that their story (which is a minority) is publicized so often and so “loudly” that it takes on a bigger-than-reality impact among a wishful audience. The successful ones all have one thing in common, their hair loss was early in life, and it came on very suddenly and was rapid, and they began full MtF HRT before much time (no more than 3-4 years) of their big hair shedding phase happened. Anybody who waited over 5 years to begin HRT is “effed”, and the most dramatic recoveries are from HRT in less than 3 years from the big hair shedding. Unfortunately for me, I waited too long. I am going to need FUE transplants. When I was young, I had beautiful long, dense hair, and my loss was slow, over 2 decades. I wish I could’ve transitioned long ago, but couldn’t. Losing my hair has made me feel suicidal at time.

  24. Hi Rob, How many people have experienced considerable regrowth of thin stunted hair by managing emotional stress, a good diet and exercise without any scalp massage? Do you know any?

    • I’m not sure! I’ve only ever read of dietary changes / stress reduction improving hair loss driven by nutrient deficiencies. I’m open to the possibility that these things will help. But from my perspective, all of my dietary / lifestyle changes seemed limited to simply slowing/stopping hair loss, but not necessarily reversing it.

      The overwhelming majority of readers who email me report improvements to hair loss from the mechanical stimulation exercises (a stop in hair loss, increased thickening, and/or hair regrowth with the degree varying by the individual). I’m just now attempting data collection efforts to quantify this (as you know), and determine key metrics for success (pressure, intensity, session duration, session frequency, diet, lifestyle, etc.).

  25. Hey Mike

    I think if you have TE , then the above would work after a year. If it’s MPB then you will need mechanical stimulation. But I would like to know if there is any too.



    could hormone balance recover hair more efficiently than mechanical.
    Ie diet


    • Based on the literature, it seems that both hormonal balancing and mechanical stimulation are needed for significant hair recovery. The irony with MTF HRT patients is that the hormone therapy is so drastic that it likely ends up reducing chronic mechanical stress in the scalp, and in doing so, exerts similar effects to the mechanical stimulation exercises. But trans MTF HRT has more to do with a hormone overhaul, and less to do with hormone balancing. As a result, MTF HRT isn’t really a viable hair loss treatment for the majority of men, and I think for most men, the target should be set to instead 1) improve the testosterone:estrogen ratio so that systemic inflammation decreases, and 2) do mechanical stimulation.

  26. Hi Rob,

    Do you know if the itchy scalp that many hairloss sufferers have is down to inflammation? The itch in my scalp has always corrrasponded with my levels of DHT: lower DHT (from taking fin), less itch.
    But since I’ve been doing the scalp massages (once a day for about a month solid), my scalp itch is almost non-existent.

    Can I take it that this is a good sign?


    • Hey Luke,

      Scalp itch is commonly reported amongst readers, and while there are no studies measuring scalp itchiness and inflammatory biomarkers, we can assume that they’re likely related. In general, a reduction in scalp itch should be perceived as a good thing!

  27. Excellent article, Rob. As usual. I can’t help wondering if focused meditation might not help reverse the muscular tension that precedes hairloss…I’ve always heard that stress causes hairloss, and this article seems as though it may support that.

    • It certainly might work as a supplementary treatment. While I do believe in the powers of meditation, I think it won’t suffice as an exclusive treatment. There are definitely quite a few balding/bald folks who are meditating regularly, too. 😉

  28. ” Do you know of any men who have tried cycling progesterone for hair loss? And if so, what were their results? ” —
    It helped a few but others didn’t get any effect from it.
    Though both progesterone and finasteride are competitors with testosterone for 5AR enzyme, progesterone can also convert to downstream androgens . I have no idea under what conditions and what dosages , progestrone can convert to downstream androgens in males.

  29. Hi Rob few observation and updates ( long post)

    I think you have 80-90 percent cracked the case on hair loss with this article.

    Im now 10 months into the regimen which included, DHT reduction by natural supplements, diet, DT massages done in accordance to 40 mins daily. Lifestyle changes ie, cold water and inversion technique.

    You know from previous discussions that I had success.

    I have thickened existing hair, and improved scalp quality , ie no more greasy sebum overload, itch gone, scalp has become much more elastic.

    Im now able to pinch my ridges much more easier and my vertex aswell which was tough before.

    I have had some regrowth via vellus hairs, and my hairline is very slowly improving. Overall my hair quality has improved, but this is a very slow process which I understand requires time. And im not yet at 100 % full recovery, which I will explain below

    My question and observation is regarding Hair growth / regrowth cycle.

    I suffered from diffuse hairloss a year ago, and from my knowledge it seems that people with Diffuse and TE hair loss , hair growth cycle is disrupted substantially.

    I can feel smaller hairs on my scalp which have not fully grown to normal cycle lengths ie anagen ect.

    Can regrowth in a diffuse or TE ( which sorts it self out) take slighlty longer due to hair cycle ?

    I feel as if my cycle is restarting. IE I shed thicker darker smaller hairs , which have not gained full length. And that this process takes more time due to follicles becoming alive again via blood flow.

    How important is it understand the cycle when doing DT or mechanincal stimulation ?

    My equation would be for a diffuse thinner

    Mechanical stimulation > Break down of fibrosis calcification> blood flow > Hair begins to recycle> regrowth and dormant follicles re-cycle > Normal cycle

    My next regimen after month 12 , will include Rosemary oil once a week , as my scalp loosens.

    But To everyone here… Keep at DT, its a long journey which requires work and dedication. But worth it.

    For reference my Dietery foods which I eat.
    -Greens all of them
    -Gluten free most of the week
    -Oats with pumpkin seeds, and seeds
    – Potatoes
    -No wheat !

    Thanks Rob ! Your doing an awesome job.

    Kind regards

    • Hey Praz,

      Thanks for your message and keeping us posted with your results. And congratulations!

      There are several cytokines / signaling proteins involved in both chronic inflammation and hair loss — including hair loss from both telogen effluvium and androgenic alopecia. These include interleukin 1 alpha and 1 beta, as well as tumor necrosis factor alpha. And interestingly, these signaling proteins also regulate the hair cycle — and specifically a follicle’s transition from anagen to catagen phases.

      As a result, anything that likely reduces chronic inflammation will likely decrease the expression of these signaling proteins, which might improve the regulation of the hair cycle and thereby improve telogen effluvium or other forms of hair loss. If mechanical stimulation is loosening your scalp, then there’s a good chance that these effects will eventually improve your telogen effluvium (so long as its cause isn’t a nutrient deficiency or something else we’ve yet to identify).

      So I’d expect DT to help TE. I hope that helps!


  30. Rob I have big natural level of testosterone 1100, when I quit my 2 year steroid cycle I started doing your regimen and taking these suplements from : “ultimate hair regrowth” on bodybuilding.com . Is it the problem?

    • Hi Kuba — I’m not sure I understand your question. Are you asking if following that protocol is a problem, or are you asking if following that protocol is what’s causing your hair loss?

      • Sorry , I am taking a lot of supplements pro health. This supplements helps people regrowht hair and improve health BUT also increase testosterone highly. This is a little bit strange , supplements which are good for hairs raise level of T quite high. Is it a problem that I have now such a high level of testosterone.

        2 question. What is your opinion about BALAYAM?

      • In general, I don’t advise supplementation for the reasons outlined in the book (sourcing problems, unknown long-term side effects, very few manufacturing regulations, quality control issues, etc.). For instance, a recent study uncovered an association between vitamin B6 and B12, and increased lung cancer incidence in men:


        Extrapolating to all supplements, the question then becomes, “What else do we not know?” For reference, vitamin D supplementation used to be considered safe at very high levels… until we realized that vitamin D is biphasic, and that at low levels and high levels, it can contribute to arterial calcification. Now we understand the importance of pairing vitamin D with K2, A, calcium, etc. – to avoid the negative effects of higher supplementation… but only after people supplemented with it blindly for years.

        I can’t comment on an individual basis as to every single supplement in that list that you’re taking, but I’d exercise caution about jumping onto any long-term supplemental regimen.

        In terms of balayam — there is zero evidence that it helps at all. Most of the photos of people saying they regrew their hair from balayam are actually just hair transplant photos from clinics in India.


  31. That’s a great response Rob thanks. One more thing.

    Leaving TE to one side.

    We know that people who suffer from diffused loss , have eroded sebaceous fat layer , and hair thinning / loss tends to be more aggressive. In other words you loose hair quicker.

    Diffuse hair loss seems to Increase mpb at a faster rate.

    While standard MPB takes time.

    If scalp tension leads to inflammation and fibrosis , calcification , why do these mechanism work more rapidly in diffuse pattern loss ?

    I mean in a matter of months.

    And lastly a theory.

    Is that genetics determine how aggressively our body responds to inflammation ? Eg. More aggressive inflammatory system would favor hair loss. Could this be why we have people who have bone growth in scalps but no hair loss ?

    Thanks for your hard work.

  32. Hello Rob and everybody.

    I want to share a bit of my own experience.

    I do agree with Rob’s take on the “galea-fusion” theory. I have experienced diffuse thinning and the erosion of subcutaneous fat is noticeable. However, the most intriguing part are the sounds my scalp makes when I do the massages.

    I’m 11 months into the system and everybody agrees on my progress and I’ve been recently using a cloth for the pinching session and this has allowed me to go really deep into my scalp. Once I pinch firmly, what I do is to hold strong and get my hand from the head. This movement generates a “crack” sound as if something used to be glued. I believe this is exactly the galea and other layers of the skin being all one and then becoming separated.

    The thing is that maybe due to the use of the cloth my scalp looks always dirty. Flakes are now visible all the time and getting rid of them is no easy task.

    Would Rob and/or others have an opinion?

    Thanks in advance and let’s keep up with our progress!


    • Hi Julian !

      Thanks for the post , as that’s exactly what’s happening to me. Also suffered from diffuse.

      I’m 10 months in and I’ve been noticing the crack sound for a good 8 months now. Especially in areas like the temples , and top of the vertex where I felt I had bone growth and thinning.

      The crack sound started with knuckle pressing , and now I notice it with temple pinches and stretch.

      This is where the skin has become more elastic , and hair thicker. I’m now noticing the crack on top of my hairline.

      I’ve only ever used the technique that Rob did in the videos with fingers and knuckle.

      The flakes !
      I’m getting these more than ever. I use warm water to wash then go cold. This usually allows the flakes to fly off my head during the next massage. I’m getting them more at the hair line and the front. I’ve used no shampoo for 10 months.

      I’m thinking of applying Rosemary oil soon .

      Each time I get a itch and scratch , I notice flakes in my nails.

      Have you noticed shedding ? Hair size ? Growth differences ect.

      Keep us updated ! .


      • Dear Paz,

        Thank you so much for sharing!

        to be honest I have not noticed shedding at all since I keep my hair buzzed. However, When it grows a bit I can definitely see thicker hair on the top of the head and hairline.

        Since using the cloth, my pinches have allowed me to crack the ridges and sometimes the vertex. These areas are quite hard and stiff but eventually they will yield!

        I’m really open to try the botox synergistically with the mechanical stimulation.
        Nevertheless, after reviewing all Rob’s info above I read the article by David Hatch. He is the engineer that proposed the theory in 1997. The controversy that I found is that D. Hatch only recommended applying botox on the Occipitalis and Posterior Auricular muscles whereas in 2010 Dr. Brian Freund (the article listed above) did apply botox in all head muscles.

        I’m no expert but I also think from an engineering standpoint and as Hatch suggested they might be some issues with the jaw muscles if applied all over.
        If anybody else has opinion, please share!

        I do believe that releasing scalp tension through botox would allow us to go deeper, specially the pinching part, and thus we would break down fibrosis and calcification easier.



    • Hey Dan,

      It’s more likely that massaging reduces scalp skin tension (among other mechanisms of action), but less likely that it remodels bone structure. While there’s evidence that mechanical tension impacts bone growth and structural changes, that type of pressure needs to be applied constantly and typically throughout major bone growth phases (like childhood). For example, some indigenous peoples practice head-wrapping to achieve skull bone elongation:


      But head-wrapping’s effects are much more subdued if started in adulthood after the skull has done the majority of its growing. As a result, I tend to subscribe to the camp that massages work through a different set of mechanisms.


  33. Please address question that if hair loss was due to very brief supplimental testosterone injections, 200 mg X 2 over 3 week period, and then stopped, would hair growth return to prior level. This is provided by no prior balding or thinning at age 65.

    • Hey Bill – I saw your comment on the other post and also answered there. I’ll copy/paste the answer here to make sure it’s visible:

      “It’s hard to say if and how long it will take hair loss from steroids to grow back, as each case is highly individualized. Many temporary steroid users see their hair return to normal after stopping injections within a few months; others just see a stop in hair loss with no recovery.

      In regards to energy levels, have you also tried modifying diet, lifestyle, etc.? Those levers are typically less risky versus exogenous testosterone, and might be a better treatment long-term treatment approach.”


  34. Hi praz,
    Do you just wash your head with cold water or is it your whole body? I think my hairloss is similar to yours. I’m just not having much success yet. I really appreciate that you share your story here.

  35. Hi Nick

    I wash with warm , then cold water . All over. Once you get use to it , it feels good and is overall healthy for the hair.

    Just note , that I might not have any autoimmune issues , I do it as just to cover bases. But cold water has good effect on scalp in general.

    With diffuse or te… I think it’s worth tackling nutritional , lifestyle , and scalp health.


  36. How do DT fit into reversing skull expansion? Does it reverse the bone structure into its original state? What are the underlying causes of skull expansion? Your educated opinions requested.

    • My personal opinion is that men’s skulls being generally bigger is the reason why we are predisposed to hair loss when compared to women. DHT typically stimulates growth of certain cells, including bone apparently, so it seems to make sense that men with higher blood levels of DHT would have higher tension overall in their scalp leading to hair loss.

      It never made sense to me that DHT increases hair growth everywhere except for the scalp. There must be a reason that the only place that hair loss correlates with high levels of DHT is the scalp, and I’m inclined to think that it’s because of high levels of tension on the skin there from the skull beneath it, meaning higher DHT levels in the blood could indirectly cause hair loss because of that. These are just theories of mine though and I’m very open to debate and being corrected.

      As for DT, it does nothing to reduce the tension in the scalp because of our skulls, but because it reduces the buildup of sebum/fluid spillage/fibrotic tissue/ect ect in the scalp skin. It also increases bloodflow to the follicles and does all kinds of good things on a deep level that encourage hair growth. To put it simply it accomplishes the same end result for hair growth as reducing the skull size in my opinion.

      Anything that gives the hair follicles more room to breath so to speak will result in better hair growth, and I think that’s why transgender people regrow hair, because the skull reduces in mass to whatever degree from lower levels of certain hormones, and that decreases the pressure limiting the hair follicles ability to produce hair.

      Just my thoughts.

      • Hey Gray,

        Thanks for your comments. I’m currently working on a hypothetical AGA pathology model for a research journal. If it gets published, I think you’ll find a lot of your ideas in-line with what the paper argues. The one major difference is that in the paper, I argue that rather than serum DHT levels influencing hair follicle miniaturization, it’s chronic inflammation (mediated by chronic scalp tension) that induces DHT conversion in dermal papilla cells, which kicks off the miniaturization cascade.

        If the paper makes it through peer review, I’ll pay to have it published as open access (free to read). Then we can all have a healthy debate about it and hopefully grow our understanding even more.


      • Sounds awesome man. Looking forward to reading it, and I’ve got to say I’m loving how much your site is growing. Congrats to you and your success, you deserve it and it looks like your work is really picking up steam with more and more people getting results using it.

        I’m curious, do you think that serum levels of DHT in any way correlate with balding, or is it purely down to other factors. The apparent correlation between male sex hormones and balding is pretty undeniable, but there is clearly not a direct link between them and balding so I’m still trying to figure it all out.

        I’ve seen one theory state that it’s higher levels of estrogen that lead to converting more testosterone into DHT, which would explain how come men seem so predisposed to balding compared to women (due to our drastically higher baseline test levels,) but also how you can still have men with high test levels and full heads of hair.

        The problem with this idea is that I can’t find any actual science that points out this correlation between higher estrogen and elevated DHT levels, so I’m a little wary of trusting the idea because it seems almost too simple an explanation.

        Personally I think that elevated DHT levels in the blood aren’t directly responsible for balding, but they might increase scalp tension by expanding the skull ever so slightly, so it’s a factor in my opinion.

        I’m also curious about what resources you have on DHT’s connection to inflammation. I’ve seen all kinds of ideas on it, from it being there to help cope with inflammation, to causing it, and on and on and I have no idea what to believe on it at this point. Any links with accurate infowould be much appreciated.

        Anyway, cheers for all the good work Rob.

      • Hey Gray,

        Thanks again for the kind words. It’s tough to say whether serum DHT correlates to androgenic alopecia. On the one hand, studies suggest that young men with higher serum DHT are more protected / unexpressive of pattern hair loss. On the other hand, castrated males who have little to no serum DHT and tissue DHT never go bald later in life.

        Based on the available literature, I think serum DHT is much less correlated with AGA than scalp tissue DHT. But beyond that, it’s hard to draw any conclusions.

        I submitted the paper Friday, and if it survives peer review, there’s a section that reviews the relationship between DHT and inflammation. So I’ll have more to share with you in the coming weeks about that — and plenty of links!


    • It’s more likely that mechanical stimulation via massage (pinching, pressing, stretching) works through a different set of mechanisms rather than remodeling bone. For instance, massaging downregulates sebum production, increases scalp elasticity (and thereby helps reduce scalp skin tension), improves blood flow, upregulates genes associated with the hair growth phase, downregulates genes associated with the telogen phase, etc.

      In terms of skull expansion pathology, it’s likely that skull expansion is both genetically and environmentally mediated, with significant emphasis on genes.


  37. Someone mentioned balayam or the finger nail rubbing method. I did it for a month. My advice, DON’T do it. All I got was a terrible headaches. It really stressed my nerve system. My nails were so sensitive. I could feel all the symptoms like scalp itch and such. So it really excite the nerves going from your hands to your head. I talked with a guy who claimed some success. But for me I wish I’d found Robs book first. I mean those nerves also goes to your brain right. It was scary as hell, thought I had a brainhemmorage. Worst headache I’ve had in my life came from balayam. Be careful.

  38. Rob ==

    I posted before, but this is a different angle so I’m making a new start. I’ve been thinking about this article for a couple of weeks, mostly when I do what I do to (hopefully) restore my hair. I’m wondering how HAIR TRANSPLANTS fit into your hypothesis.

    If your theory is correct, why would hair follicles transplanted from the back and sides of the head NOT miniaturize and fade away just as the original top-of-head follicles do? Wouldn’t the calcification and fibrosis (and associated hormonal changes) take their toll on the new transplants, as well.

    I may have it wrong, but somewhere/somehow I got the impression that follicles from the back and sides of the head are “not susceptible to DHT” the way original top-of-the-head follicles are. IF that’s true, it might be another important factor for your current hypothesis to consider.

    ( Apologies if this has already been discussed. Not enough time to read through all comments. )

    • Your second paragraph answers your own question, the transplanted hairs do miniaturise and fade away, it just takes a while because they are so healthy to begin with.

      Look at any celebrity that has been open about their hair transplants, like Wayne Rooney for example. Over time the transplanted hairs miniaturise just the same and normally leads to needing more transplants, which completely blows the DHT sensitivity theory out of the water. That shouldn’t be an issue if the typical ideas about the hair at the sides of the scalp being immune to miniaturisation were true.

      Clearly there is no difference in either genetic or other kinds of susceptibility to baldness from hairs on different parts of the scalp. Granted it’s only the galea that loses hair, and the sides of the scalp don’t even in extreme cases of baldness (I’m talking general baldness here and not about other types that cause hair to shed all over,) but this seems to be down to other factors than sensitivity of specific hair follicles to certain hormones.

      • I’m not knowledgeable about hair transplants, which is why I formulated the question. The advertisements to which I’ve been exposed all give the impression that the good results “last forever.”

        The information you furnish certainly is not encouraging, but I appreciate the insights, and I’m not surprised that Rob’s hypothesis remains intact. As I mentioned, I’ve been thinking about this article for several weeks now and not only does it still make excellent sense, it continues to serve as Food for Thought.

    • Hey Tom,

      It’s a great question. I’m currently in the process of submitting a hypothetical AGA pathogenesis model to an academic journal, and answering this question is part of the discussion section — because it’s one of the biggest pieces of evidence that stands against the hypothesis. To quote from the paper:

      “Most HT surgeries transplant more than just the hair follicle itself. Follicular unit grafts (FUG) procedures transplant “1–4 terminal hair follicles, one (or rarely two) vellus follicles, associated sebaceous lobules, insertion of erector pili muscle, [and the] perifollicular neurovascular network”… HT donor hair and its surrounding tissues are not likely affected by the same perifollicular fibrosis or dermal sheath thickening observed in AGA-affected tissues. Comparably, AGA progression often takes decades until completion. If a majority of transplanted donor hairs survive for at least one year after hair transplantation, it’s possible that their supporting hair follicles have not yet had enough time to develop perifollicular fibrosis or dermal sheath thickening, and eventually the onset of hair follicle miniaturization…

      “Interestingly, one study comparing hair characteristics of transplanted hairs to and from legs and balding scalps showed that “the recipient site influences the growth characteristics of transplanted hairs”, with “the thickness of the epidermis, dermis, or subcutaneous tissue, blood supply, or other factors play[ing] a role in survival and growth rate differences.” Another study showed that balding human vellus hair regenerates just as well, and sometimes better, on immunodeficient mice versus terminal human hair. This suggests that tissue environment impacts hair follicle growth capabilities, and that the tissue environment in balding scalps may be a limiting factor in AGA hair follicle recovery. This is in-line with our hypothetical model, and suggests the need for long-term (decades) studies to determine the true fate of transplanted donor hairs in AGA sites.”

      The short answer: hair transplants also transplant the tissues around donor hairs, and these tissues are unaffected by fibrosis, which give the hairs that they support a significant cushion window until miniaturization. Since hair loss is often a decades-long process, more studies are needed to determine if transplanted hair follicles really do thin, or if they stay protected forever. From my experience, the majority of readers who’ve gotten a hair transplant and emailed me are emailing me because their transplanted hairs eventually thinned — so there’s also the possibility that donor hair miniaturization is much more common than we think.


      • Very, very interesting, Rob.

        My understanding (?) of your further remarks is this: The more donor tissue there is surrounding the transplanted follicle, the more cushion or barrier there is against whatever factors have been devastating the original scalp follicles. But that cushion is expected to deplete over time.

        Not so encouraging for anyone considering a hair transplant as a fallback for lack of success by other methods…but I’m sure the information will prove useful in narrowing “The Mystery.”

        In response to your comments I Googled FUG. FUT and FUE transplant methods. I can’t find any information on FUG, but here’s a basic comparison between FUT and FUE:

        Personally I dread the prospect of a traditional FUT “strip” transplant, and was encouraged by the new “individual follicle transplant” method(s) such as ARTAS. But if I read you correctly, ARTAS transplants will not likely hold up well due to the more the limited “tissue buffer” surrounding each transplanted unit.

      • Hey Tom,

        I agree with your interpretation. It remains to be seen if the ARTAS transplants will hold better or worse, but based on the evidence on hair transplants so far, it’s likely that surrounding tissue of any follicle unit transfer has a huge impact on the success and longevity of donor hair survival. In any case, ARTAS transplants will probably look way better, because there’s so much more control of follicle placement.


  39. On the german site, I mean exactly youtube canal, one guy recommended OPC, they said that production of keratin can be faster about 3 Times. Did you know about it? There are some articles in English also on hairloss sites. I ve never heard about it.

  40. Was just about to mention Wayne Rooney and Callum best . Two celebs who have had more than one transplant.

    Gray is right on point.

    Transplanted hair takes time to minaturise, and the original ht study didn’t monitor 10 plus years.

  41. Hi Rob, judging by all the comments on this forum, we are still struggling to understand the cause and cure for hair loss. One approach to understanding the cause(s) of hair loss is to study differences and changes in physiology and anatomy. After establishing and proving the different factors that interact and cause premature hair loss, the next step is to test therapies designed to eliminate or correct the problem. Another approach is to systematically investigate and compare different treatments that people claim to have already used to restore hair loss. I believe the second approach by way of a well-organized survey has more promise. It can be quick to complete and would not require large funding if we can find the time to make this happen. Results will be extremely valuable if done properly. Sharing random ideas, speculating and questioning one another doesn’t get us any further towards understanding the cause(s) of hair loss.
    Looking forward to reading your new article.

    • Hey Mike — I think you’re right. The survey is going to be the next big step, alongside follow-up interviews to anyone who’s reporting significant success or the opposite. I did a similar approach when writing the latest book, but it’s absolutely time for another reevaluation of the techniques, what’s working, what isn’t, and to refine / recreate a best practices guide — or as you said, identify which levers of the massage appear to be working the best for people.

      • After reading your book, I was also interested in applying your method in such a way that specific elements of your theory could be quantified. I remembered seeing a certain device in another skin health related video which was used in order to measure trans-epidermal water loss. This device was peculiar and innovative in that it used to be that you needed a whole room kept under very controlled conditions in order to be able to make these kinds of measurement, but now said room had been “miniaturized” and recreated into the head of a stick not much bigger than an electric tooth brush.

        So I went on their website to see what other kinds of product they were offering and, sure enough, they had devices to measure skin elasticity, sebum production and even (I think) fibrosis.


        It would now seem rather easy — at least in theory — to create an experiment designed to measure the effects of various protocols on skin elasticity, fibrosis and sebum production. (And perhaps other metrics.) You “only” have to take some measurements on set points of the scalp at regular interval + take some measurements of some non scalp area(s) and keep track of the score you get that way. It would be interesting — again, theoretically — to have a database were participants could record their progress, which could then be used as an admittedly imperfect data source, but still superior to what we have now by a long shot.

        Now, I say “theoretically” because the website doesn’t actually list any prices for its products, nor do we know what kind of distribution network they have, nor do I believe that they ever expected their devices to be used in order to perform some gonzo science experiment involving the general public with little to no institutional backing of any kind, whether in the private or the public sector. Moreover, I’m sure their devices are quite pricey, and are well outside the price range that would be necessary to carry such a gonzo experiment. Nevertheless, I thought you should know about these products. Feeling that your scalp elasticity is increasing is good I suppose, but quantification would be so much cooler.

        Anyway, for full disclosure, here’s the video in which I first came across this product line:


      • TCC — thanks for sharing this. Very interesting findings, and I was unaware of these devices until your comment. THANK YOU.

        We absolutely need better data on these methods, and these devices might make testing much simpler (at least at a crude level). I’m currently in the process of trying to public a hypothetical AGA pathology model in a medical journal, and if it survives peer review, then the community here will have legs to stand on, and maybe even an opportunity for clinical trials using these devices. At the end of the day, everyone here wants better treatment options and these devices will help us measure the impact of whatever treatments we pursue.


  42. That’s a good idea Rob .

    The massages in the book have been helpful. And any new technique will only contribute to tackling the target area.

    I think skin elasticity, blood flow , skull expansions is what seems to be the main culprit.

    I’ve recently done some small research on demographic and race when it comes to hairloss around the world.

    What I find is the following.

    1. Diffused hair loss seems more prominent in Asian / Mediterranean men than standard pattern loss over the course of few year’s.

    2. Hair loss is on the rise in more developed nations , and now effecting younger age groups.

    3. Japan is the most developed asian country ,which has more hairloss issues in recent times than any other asian country.

    Nations with more water in the diets( watery foods) seem to have less hair loss? Blood circulation and water intake are related.

    If we look at , blood flow, scalp tension, bone growth, lifestyle and diet. Then it starts to make sense.

    We know stress can increase scalp tension ,and poor diet/ lifestyle to internal issues.

    The pressing technique in the book have lead to my hair line becoming more elastic and thus leading to slow regrowth.

    Im now going to do a blend of essential oils and Avalon Rosemary shampoo 2-3 a week. As I believe that oiling the hair along with deep massage / wound healing could be more important for people with thinner hair.

    I’ll keep you updated.

    Kind regards

    • Thanks for sharing Paz. What’s interesting about that Japanese is that versus Caucasian males, pattern hair loss begins roughly one decade later.


      A lot of this likely has to do with genetics, as twin studies have suggested that 80% of MPB onset might be genetically determined:


      However — the above study was from 2003, before the realization of the failure of the human genome project in disease determinance, and before the recognition of epigenetics in disease development — which is influenced by environment (diet, lifestyle, etc.).

      All interesting findings! And thanks for keeping us posted with your results.


  43. Hi Rob, Better diet, exercise and meditation for stress reduction may help delay hair thinning and baldness but I have never seen scientific research to prove that. Fact #1: At least 95 % of men and women experience hair thinning and turn grey in late life. Fact #2: At least 50% of men also experience patches of baldness in late life. Fact #3: These experiences are generally independent of differences in diet, exercise and personal stress levels.

    Logical conclusion: These experiences are the expression of an age regulated biological process determined mainly by our genetic constitution.

    Fact #4: We can’t change our genetic constitution. Fact #5: Scalp massage therapy (or transplants) can delay or partially reverse hair thinning and baldness but not prevent it happening in late life for genetically pre-disposed men.

    Logical conclusion: Men who experience baldness at a relatively young age and persist with scalp massage therapy are more likely to regrow their hair and more likely to see greater recovery than men who experience baldness and begin therapy at a later age.

    Comment: Limited collective experience indicates that different techniques and durations of scalp massage therapy will produce different extents of hair recovery, depending also on the age when therapy commences. There’s no scientific research to date that proves this but a proper survey will do that.

  44. Hi Rob,

    I was just thinking why is that most professional soccer players or even bodybuilders have perfect hairlines? Im a huge soccer fan myself and if you were to see any player in europe they haven’t receded at all, check Steven Gerrard as an example it can’t just be coincidence, so i assume somethings going on.

    • Hey John,

      I tend to agree with Paz and Mike on this. Aside from age, soccer players typically pack a powerhouse aerobic engine — meaning their oxygen deliver to organs and tissues is often far superior to sedentary counterparts — through both genetics, environment, and training. This might improve hair loss outcomes in soccer players, or at least delay its onset until years later (if these effects carry over to cutaneous oxygen levels in AGA-prone scalp hair).

      And in terms of professional bodybuilders, I’ve never seen data on their hair health versus other populations, but most of the professional bodybuilders that I’ve seen are bald (this is especially true for Caucasion male bodybuilders)! But I’m happy to reevaluate my opinion.


  45. Yeah most soccer stars are young, not much stress , and are active. Also drink enough fluids and have a good liver system.

    About the age related material.

    I think this is where scalp tension and skull bone growth theories hold most weight. The ageing hormones might be involved , which increase growth factors potentially??

    But again I’ve seen old men with decent Hair, maybe the slow ageing hormones play a part.

  46. Skin tension in the scalp is distributed over all areas of the scalp because skin is elastic and automatically stretches and moves to spread tension evenly over the top of the skull as a whole. But patches of baldness are not evenly spread over the top of the skull as a whole. The crown and temple areas are typical areas where hair loss is experienced. Therefore, other factors besides skin tension in the scalp are responsible for baldness. I guess the other factors are the diameter and length of the blood capillaries. But whatever the specific factors – the best way to counteract baldness is the apply scalp massage. If anyone has practical experience to prove me wrong please tell me.

    • Hey Mike,

      Interestingly, skin tension isn’t evenly distributed across the scalp — at least according to this study…


      …which found that the scalp skin’s highest tension points correspond to the first places to go bald (the temples and vertex). This is because in balding-prone regions, the galea aponeurotica, subcutaneous fat layers, and epidermis layers of the scalp are all fused together as one unit — and this isn’t true in other parts of the scalp that the galea aponeurotica doesn’t touch (like the sides and back of the head).

      If the paper I submitted about AGA pathology survives peer review, I’ll share it here and it’ll hopefully explain this phenomenon better. But you are right — factors outside of skin tension regulate hair loss. Androgen-induced TGF-B1 expression is likely a big one.


  47. Hi Rob, It seems the stress analysis model predicted the same pattern of tension for all male heads. However, not all male heads suffer baldness. Therefore, the hypothesis is false. The researchers should have compared tension in the scalps of bald men with non-bald men. That would convince me. Secondly, finite element models for stress analysis do not always represent the real world of mechanical stress or tension. They should use a tensometer designed to accurately measure actual mechanical tension in the skin all over the head. An approximate way to do this is to press together the fingers of each of your hands and place them on the scalp to form two rows of parallel fingers with a space of about 1 cm between the rows and then push your fingers towards one another thereby forming a fold or hump of skin between the rows of fingers. By pushing together and pulling away again one can feel and see in the mirror how much movement and folding takes place. When I do this on my scalp with a consistent force, the movement (pushing together and pulling away again) is about 5 mm (back and forth) and it’s about the same for any part of my scalp. Doing the same measurements on other parts of my face, neck, legs, feet etc., measures a wide range of movements and folding. You will find variations in movement and folding from about 5 mm on the scalp to about 10mm for the skin on the back of the neck and about 25 mm over the front of my neck. If the bald patch of my head measured only 3 to 4 mm compared with parts of my scalp with thick hair I would say there’s something in this hypothesis. But the facts show otherwise.

    • Hey Mike,

      If the study concluded that mechanical stress is the only variable involved in pattern hair loss onset, then I’d agree with you. But the study argues something more nuanced: chronic scalp mechanical tension may upregulate androgen receptor coactivator Hic-5 / ARA55, which influences androgen activity, which may increase the presence of androgen-mediated transforming growth factor beta 1 — a signaling protein already implicated in hair loss as a precursor to dermal sheath thickening and perifollicular fibrosis (the tissue remodeling we see in pattern hair loss). In genetically susceptible individuals — for instance, those who tend to respond to mechanical stress by upregulating androgen activity — this chronic tension could lead to hair loss via tissue remodeling. As the scalp tissue remodels, the tension points change and hair loss progresses accordingly.

      If true, this explains the pattern and progression of hair loss, and why some men can have tension yet not lose their hair.

      There are absolutely limitations to the study, and the finite stress models need to be compared to human controls. But in order to properly study this, we can’t just measure mechanical stress in the subjects — we also need to measure androgen activity and TGF-B1 alongside scalp skin mechanical tension — because that will help better determine if the mechanical tension is potentially causative in MPB tissue remodeling.

  48. I’m going to try dermarolling. If anyone have suggestions on how to prepare the scalp before and after needling I’d gladly take them. I have 2% chlorhexidine for the roller but I won’t use that on the scalp. Maybe natural shampoo then ACV and then I can boil some water and let it cool before rinse?

  49. Hi Nick, I have searched but not found any scientific research that proves the long-term benefit of dermarollers even though the practice has been recommended for at about 4 years already. Only short-term effects have been scientifically tested to show it adds benefit to chemical applications. Rob is planning a proper internet based survey that will provide the facts we need.

  50. Maybe I should wait then and focus on stress and diet and continue with massages. I think some of my hairloss is stress related. Maybe DR is not the best method right now since my health might not be optimal. I’m trying some supplements and It will take time to notice the effects. B-yeast for B vitamins, I feel I have more energy from this. A zinkgluconate supplement. Too early to tell. The other zinc supplement (citrate, picolinat)gave me side effects. Also I will try some magnesiumbisglycinate. All in moderate amounts. Really I don’t think I need them with the diet I’m on if I can manage the stress. I’m on my second box of gastrus. It’s hard to say any specific benefits. Maybe I’m a bit more stable. My stomach feels good. I only take it every other day though. I eat natto for K2 a few times a week and take 20ug vit D every day now since september. Been taking omega 3 for a few months now. I might have TE since the hair growth is so slow other than the sides. I have a diffuse thinning but also a typical mpb pantern with balding crown and temples.

  51. Hey Mike

    There is a reader who Rob helped, who now has his own site. His testimony is also on the front page.

    He had success with Dr . And his gains we’re permanent. Alot of people are reporting success with such methods.

    He also Incorporated other regimens alongside Dr,but owed much of his success to it.

    • Gentlemen, there’s a difference between short-term and long-term results and between partial and complete recovery of hair loss. Scalp massage and the dermaroller does provide some degree of hair loss recovery for some men who tried these therapies but no one to my knowledge has proven long-term success. Nor do we know how many men have tried those therapies and experienced no benefit. If anyone has found scientific research on long term effects please let us know. Remember, one swallow doesn’t make a summer as the saying goes.

  52. Hi Rob, I know the study in 2012 you referenced. It showed about 40% increase in hair density for micro-needling with Minoxidil and only 18% increase for Minoxidil alone. This shows the clear benefit of micro-needling. I wonder why no other trials have confirmed benefits of micro-needling alone. I found reports on proper trials of the benefits of Minoxidil but only one quantified hair growth recovery with use of Minoxidil alone and the results were relatively minor, approximately 15% new hair growth. No other trials have been reported with micro-needling alone and I wonder why not. We need a proper survey to tell us what’s really going on.

  53. Hi Rob, Most men in the studies published to date were less than 45 years old. I don’t know of any trials with men over 45 years old. Perhaps because older men accept their baldness more easily and don’t care too much or the researchers don’t believe prospects for older men are promising enough to study. I have my own educated guess and I don’t think anyone knows much better. Time for a proper survey.

    • Hi Mike about older men .

      There’s two cases I know of.

      One is covered in Rob’s book , where a man in his 70s recovered his hair when he tripped and injured his scalp( burnt it).

      There’s also another on a forum , where an older male above 50 injured his head via accident and began to see regrowth.

      So I guess it’s possible at any age. But your right about the studies.

  54. Rob,

    A lot of great content on your side and greatly appreciated. I purchased your ebook and have reviewed your site but notice you dont have much, or anything really, in regards to gray or graying hair. Any info on this, the cause and potential reversal?

    • Hey Fernando,

      Thanks for the note. This is a request that I’ve received before, and I’ll dedicate the next couple of months towards researching potential solutions. What I will say is that gray hair is a problem I haven’t yet solved for myself. I’ve got a few gray hairs but don’t mind them. In any case, I’ll get back to you with an article in the coming months.


  55. Hi Rob,

    Will your books information help with reversing receding hairline? Mine is drastically receding and ive had gut issues like acid reflux and ibs for a good 2 years now which i feel may be the culprit.

    Can i really get my hairline back again?

    • Hey James,

      As always, it depends on a case-by-case basis. But the evidence all suggests that pattern hair loss can be stopped and reversed with the right regimen. The book and videos are my best foot forward in terms of providing the science / theories / studies behind reversing hair loss without drugs like finasteride or minoxidil. But again, your treatment approach depends on your preferences: are you interested in reversing hair loss without these drugs (which requires more time, labor, and energy) — or are you interested in taking those drugs (and risking the sexual side effects from finasteride)? This is a question I can’t answer for you, but both approaches have resulted in the restoration of hair lines for some readers of this site.

      In terms of gut issues and acid reflux, we’d need look more in-depth in terms of your diet, lifestyle, etc. to understand more of what’s going on. I typically do these analyses during a Skype consultation, which is included in one of the book packages.


    • Hi James,

      For what it’s worth I too was suffering from the gut issues you mentioned (ibs/acid reflux). I’d recommend you read some of the other articles on this site which may help, things like improving diet and exercising etc.

      Perhaps it was coincidental, but for me the Vitamin D article (https://perfecthairhealth.com/vitamin-d-deficiency-does-it-cause-hair-loss/) really seemed to help eradicate my digestive issues, because I was already exercising and ate pretty healthily, don’t drink a lot of alcohol etc. Admittedly I have still had the occasional flareup, but the frequency has greatly decreased since addressing my Vit. D levels.

      See your doctor and get a blood test to check your Vit. D levels. If your doctor thinks you should supplement, you might want to consider a Vitamin D oral spray for more efficient absorption if your digestive system is still not good. Make sure you read the article thoroughly and understand that mega-dosing Vitamin D can be unsafe and obviously excessive sun exposure (how much depends on your skin type) is dangerous for our skin.

      To what degree this impacts hair I guess is likely dependent on the individual; but by logic we can assume any additional strain on the bodies major functions is never going to be conducive to healthy hair (perhaps Rob can elaborate?).

      All the best,

  56. Hi Rob,
    Whats your opinion on custom hair pieces? They look really good.

    On a side note i was wondering what would happen to the condition of the scalp in terms of calcification if you were to have a hair transplant, would it not de-calcify it and so what would happen to the old hairs underneath would that not grow through?


    • Hey Mark — it all depends on the person! I’ve seen some great hair pieces on celebrities. I’ve also seen some bad ones. It really depends on the shape and look of someone’s skull, and the style in which they want the hair piece. With enough shopping, I’m sure anyone can find a great-looking piece that might even look better than their original full head of hair.

      There haven’t been any long-term studies on hair transplantation to give us good data on this, but from my experience working with readers who’ve received transplants, these hairs eventually thin too. It’s likely because they eventually succumb to the effects of the tissue surrounding them (calcification / fibrosis / etc.) — but that because they’re starting at full follicle size, the “balding clock” is sort of reset. Since the miniaturization process takes years, these hairs often hang in there for quite some time before showing signs of degradation.


  57. Dear Rob,

    I’ve been using coconut oil and left it overnight.
    Since the next morning my scalp is quite oily I want to know if I need to shampoo. I reckon the benefits of not shampooing but warm water does not remove oil in my experience.

    Also, do you recommend that I leave my hair grow? I keep to buzzed and cut it once a week. Is there any difference massage-wise with the length of the hair?

    Thanks for your time!


    • Hey J,

      You can certainly shampoo the coconut oil out of your hair in the mornings, as I think the benefits of the nightly topical application outweigh any potential cons from shampooing. A lot of readers recommend Avalon Organics Rosemary Volumizing Shampoo, but any shampoo that’s organic, phthalate-free, and endocrine disruptor-free should do the trick.

      I’d recommend keeping your hair short! It makes the topical applications so much easier, and ensures higher deliverability to the scalp skin.


  58. Hi Rob, i wish to purchase your book and so as i am pretty desperate right now as my hairline is rather quickly receding, i was wondering if to go on Propecia and use Minoxidil for the short term, whilst i use your books knowledge for the long term and slowly ween myself off the 2 products after i establish the right health plan.

    Would this be a good idea at all for my own health and is that a viable strategy? Im 22 right now, looking forward to hearing your opinion on this situation.


    • Hey Tyler — it’s really up to you whether the potential risks of Propecia outweigh the benefits. It’s certainly a powerful drug, but there’s evidence of dependency long-term, since its effects on DHT-deprivation end up upregulating androgen receptor activity — a tissue remodeling effect that appears to persist even after stopping its use (at least in rat models). This means that getting off Propecia is much more complicated, and when someone does get off Propecia, DHT floods to the scalp potentially more so than if they never started it. That’s why so many men who stop taking it lose so much hair within a year.

      Minoxidil is far less problematic as it seems that most of its effects are catered toward activating more hairs into the anagen phase. I haven’t seen any long-term tissue remodeling effects from minoxidil, but some people (including me) have reported the development of bags under their eyes that have persisted since stopping its use.

      So if you’re going to take the weaning approach, go with minoxidil over finasteride. And if you’re going for quick resolution and a lifetime commitment, maybe try both.


  59. Hey Rob i’m going to purchase your book, and i understand the work you’re doing is ongoing so i assume there will be updates to the book as time goes on.

    My question is for those buyers who have this latest book, will we get updates for it, will they be free? or discounted at all for the newer versions of the book if you so happen to develop them?

    Best wishes, thanks!

    • Hey Kieran,

      If I release anything in the future (like a video course), those releases will be heavily discounted by the price of a person’s original purchase — so that nothing is paid for twice. And any relevant book updates are shared through my email list and blog (of which all book purchasers are subscribed).


  60. Rob,
    Thanks for all your detail research as always. In one of the research papers you mentioned, the researcher provided DR treatment once a week, applied minoxidil twice daily; except the day of DR treatment ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746236/ )

    Do you think there is any specific reason behind this procedure, or switching the DR and minoxidil frequency will yield a better result?

    • Hey Ethan!

      This study is covered, in detail, in the book. I suspect the main reasons why the investigators took a day off from minoxidil was to not interfere with the healing process post-wounding. Otherwise, I think this dual approach is great for those who are comfortable with minoxidil.


  61. Fantastic! I’m really looking forward to that gray hair article, especially in the context which you seem to be providing your information; functional root cause based research. Reading your hair ebook was like reading the functional approach to overall health with a focus on hair which I’ve never seen provided. Thanks for all your dedication to this effort.

  62. Hello again Rob,

    thanks a lot for the previous answer.
    Today I came across some interesting information regarding using caffeine as along with (olive) oil as topical. The claims seem to be hair recovery.
    On the other hand, I also had a channel claiming that applying vodka serves as a potent vasodilator and hair growth is expected as soon as 30 days.

    Do you have any experience on this?

    Best regards,


    • Rob,

      I also forgot to comment on something.

      I’ve been tracking my hairloss history and I remembered that when I used to have really long hair I became obsessed with growing it faster. Somebody told me to put birth control pills in my shampoo. I’m not sure if it actually did any harm or not but my cascade started soon afterwards.

      I would like to know your opinion and if anyone can relate, please share!

      God bless you all.


      • Interesting, as soon as i stopped drinking filtered water the year that followed is when i noticed my hair was receding and ive heard in tap water is traces of birth control pills so who knows.

      • This is true! Any retreated tap water typically has nanoparticles of contraceptives. My close friend is a PhD who’s research for six years focused partly on this — and its potential long-term effects on our physiology.

      • Hey Julian,

        I’d avoid putting birth control pills on your scalp if possible. Those are typically exogenous estrogens or synthetic estrogens, which can have all sorts of unintended effects on men (depression, weight gain, etc.). In any case, it’s generally unlikely that a few birth control shampoo sessions did long-lasting damage to your scalp. I haven’t had any experience with this, but if a reader chimes in or sends me an email about it, I’ll be sure to let you know.

        In terms of olive oil as a topical — you can certainly use it as a carrier. In general, most unoxidized oils have pro-hair properties (5-alpha reductase inhibition, antimicrobial, anti-fungal, etc.). And vodka (alcohol) often enhances penetration of any topical… though you might smell a little drunk after each application!


  63. Also Rob i was thinking can you actually reverse hair loss if the hair loss/receding is caused by nutritional deficiencies/autoimmune disease/stress etc. Can that be reversed at all by re-supplying your body with the right health habits ect? What do you think.

    • In cases where hair loss is driven by nutrient deficiencies or autoimmunity, correcting these factors can absolutely help. But more often than not, hair loss is a much more complicated equation.

      There’s also a difference between pattern hair loss and hair shedding. Stress can induce hair shedding (shift from a hair follicle’s anagen to telogen phase) and sometimes telogen effluvium. This type of hair loss is temporary, so resolving the stress often helps. Pattern hair loss is more related to skin scarring — which is a bit more challenging and involved to reverse.

  64. Hey rob,
    Regarding gray hair, some people are helped by bioavailable copper (I think that’s how dopamine agonist restore hair color). You have got to neutralize the free radicals and hydrogen peroxide ,so SODs enzymes and catalase come into picture.

  65. Hi Rob,

    First of all, congrats on this post! Really rich informations.

    The theory you’ve pointed out begs some question:

    1 – In healthy hair men there isn’t structural tension at all (and therefore no inflammatory response)? Or…
    2 – … there is structural tension but the way the body respond to the inflammation is not through DHT (and therefore no cascade effect). If so…
    3 – … do you have any guesses on what would be the that approach/substance the body uses to deal with that inflammation rather than DHT?

    • Hey Clayton,

      Great questions! To answer the first two — it seems that pattern hair loss is a two-step process: 1) chronic tension in the scalp skin resting above the galea, and 2) an androgenic response to that inflammation — which leads to the upregulation of transforming growth factor beta one, fibrosis, calcification, and finally hair miniaturization.

      If someone doesn’t have that structural tension, they likely won’t have that inflammatory response. But if someone does have that structural tension, it’s likely that genetics + epigenetics determines how our bodies respond to it. So two people might have similar degrees of tension — but one person could have a response that more favors androgenic upregulation (and thereby hair loss), whereas another could have another “toolkit” toward dealing with that tension outside of androgen activity.

      At the end of the day, we don’t yet know what the other side of the coin looks like (for those with tension but no hair loss). What we would need is a study that measures:

      1) Scalp tension points vs degree of hair loss
      2) Androgenic activity in those tension points / hair loss regions
      3) Signaling protein / cytokine activity in those tension points / hair loss regions versus non-thinning regions of the same scalp

      And then we’d need to compare the results of balding individuals versus non-balding individuals with the same controlled scalp tension. I’ve never seen a study do this — or even come close — but this would likely give us the answer (so long as we controlled for all the right variables and didn’t miss anything).


      • Hi Rob

        I have friend who has this.

        He has had a receeded hair line look for many years. However he has no other hairloss anywhere on his scalp.

        He also quite a wide head.

        Could this be a case of tension, but with no androgenic activity due to Genes ?

      • Hey Paz — it’s possible that most of his bone growth or muscular tension could reside just in the frontal / temporal zones of his scalp, and so any androgenic / scarring activity that resulted in hair loss was just isolated to that region.

        I have a few friends with the same pattern hair loss: just temporal hair loss, and nothing else.


  66. Hey Rob I’ve been hearing a lot of people talk about masturbation, more specifically stopping it, having a positive effect on hair regrowth. Any thoughts on this?

    • Hey Akeel — the book covers this in better detail, but in general, I don’t think masturbation within normal levels contributes to hair thinning. I’ve also heard the latter from some readers — that abstaining accelerated hair shedding.

      At the end of the day, some monks abstain from masturbation for decades and still lose their hair during that time period.

      • Hi Rob

        Some people on Reddit who did the nofap challenge also reported improved hair thickness and regrowth.

        How come nofap can cause both , shedding and growth ?

        Nofap increases testosterone levels .
        However research has shown that excess masterbation can cause dht increase ?


      • Hey Paz! I’m not quite sure — and I don’t think anyone knows the answer to this because there are so few studies measuring the effects of masturbation abstinence on human health — and absolutely zero on hair health.

        It depends of nofap increases serum DHT or scalp tissue DHT — the former wouldn’t be nearly as problematic. The only studies I’ve seen measuring testosterone increases in men who haven’t ejaculated showed a T spike at day 7 of masturbation abstinence, but a return to baseline thereafter. I’m not quite sure what the long-terms hormonal effects of nofap are.

        In any case, I think it’s a bit of a torturous strategy toward regrowing hair! Until more studies arrive, I don’t think that nofap is an effective strategy for most people trying to regrow their hair — and that in general, as long as you don’t abuse masturbation, it’s most likely a healthy practice when done occasionally.

      • Masterbation increases prolactin which in turn increasses DHT. Huge spikes in dht are detected prior to masturbation. Bottom line is induces hormonal rollercoaster and increases stress which in turn causes hairloss. Now you may say well isn’t it a release from stress. yes, but the side effects are mostly negative and outweigh the positives. Most of the tao writings recommend retaining the seed and many top fighters like tyson (5 years abstainent prior to his rise to world champion) and Paquiao who abstains for 2 months before a fight. Now you may say well isnt this basically increasing their testosterone which doesn’t nothing for hair loss. Yes part of the advantage for fighters is the increase in testosterone, but if you read the chinese writings there are 3 subtle energies that when depleted can resort in loss of life and energy. So basically the main negatives are A) increase in DHT. B) loss of energy (which may or may not lead to hair loss but has real value in terms of a persons self esteem, sense of well being etc. which indirectly lead to less stress and less hair loss)

      • Hey Dee — thanks for reading. I’m curious if you’ve tried — or have even seen success — with hair loss through abstinence.

        The DHT-masturbation is a bit complicated, because serum DHT isn’t associated with hair loss — at least in young men. One study even showed that young men with higher serum DHT appeared to be protected against AGA.

        However, tissue DHT is certainly associated with pattern hair loss (increased tissue DHT is found in balding scalps). So in order for me to believe in a masturbation-hair loss connection, I’d need to see evidence that masturbation increases scalp tissue DHT. I’ve done a lot of digging and haven’t found that yet — but I’m always happy to re-evaluate in light of new evidence.

        I know a lot of people have seen benefit in self esteem from abstinence — so I don’t want to discourage people from trying it — for their hair, or otherwise.

  67. Hey, Rob

    I was wondering if this skin product that my family has been using would potentially be a usable topical against hairloss. As mentioned, it is a skin product called “Optima pH” (https://optima-ph.no/), which is based on all natural, organic ingrediens, mainly organic acids (forgive me if any translation is incorrect; the product and I are both based in Norway). The product has an amazing healing effect on the skin against stings, skin irritation, sunburns, acne, and so on, and based on this fact and my own experience using this, I was wondering if it would have a positive effect against hairloss too, used together with dermarolling and the sorts?

    Could this be of interest?

    • Hey Benjamin — unfortunately my google translate isn’t picking up the page contents, so I can’t comment much. I encourage experimentation — so if you try this product, let us know how it goes for you.

      In general, it appears that oral finasteride outperforms topical finasteride — so my take is that for anything that acts as a 5-alpha reductase inhibitor, oral is likely better than topical. With that said, it all depends on the mechanisms of action of this spray.


  68. Would you say its possible you can re-grow your hair back from completely bald regions, without any wispy hair left just bald? Im rather desperate now that my widows peak is progressively getting worse as the days go by.

      • Hey Kieran — I focus my research efforts here on my site, and I feel uncomfortable reviewing other writers’ sites. As a broader note, a major reason why I started this site is because of the amount of misinformation being spread on other hair loss websites. But I’m not in a position to review the Hair Loss Revolution content regularly or sift through their articles and tell if you what they say is accurate. Rather, all I can do is focus on my content, and ensure its accuracy to the best of my ability.

    • Hey Kieren — there’s a case study inside the book of a 78-year old slick-bald man who accidentally regrew all of his hair after falling headfirst into a fireplace. So yes! It’s certainly possible.

  69. Hi Kieran

    Out of curiosity have you brought Rob’s Book ?

    The video should help. My widow’s peak began to receed in February / March time .

    However I persisted with the DT regimen,
    And in September my peak began to regrow to juvenile levels.

    This process is long and you have to be persistent.

    Tk care

    • Hi Paz,

      not just yet as saving for it, just looking around other websites etc too for info for now.

      Will get it soon though.

      I have to ask one more question though which is, when it comes to the receding areas or bald areas from recent thinning, is it a problem if the area is shiny? for me my receding hairline is shiny, i thought i heard somewhere that its a bad sign or something, i do need to get the book though.

    • It depends on each individual. In general, anything that contributes to chronic inflammation can problem chronic, excess androgen production in certain individuals. And androgens are one of the many drivers of oily skin (another are the bacterial colonies crawling on your skin). If gluten increases inflammation in your body, and your body has an androgenic response to that inflammation, then yes — gluten consumption could be connected to oily skin. But the research here is limited.

      In general, if you want to reduce oily skin, you need to reduce inflammation — and typically there’s more than one contributor (diet, lifestyle, etc.).

  70. Hi Wyatt

    It was difficult at first but I took the plunge on some of the recommendations.

    – I took cold showers by month 3
    Prior I had oily greasy hair due to over sebum production , due to thinning.

    This involved warm water then a cold rinse and slowly gradually colder Rinse. Take it slow.

    By month 4 my sebum began to improve , which is a huge sign of progress.

    – I stopped all shampoo and topical for about 10 months . Then start using essential oil and Avalon Rosemary natural shampoo ( free from the nasty chemical)

    – I Incorporated 4 min inversion or just hanging upside off bed egde in the morning.

    In terms of Diet

    – I reduced gluten intake ( especially wheat) when I say reduced, I mean once every other week or maybe once a week.

    – I included more anti inflammatory foods , such as salmon. Ate more avacados , fruits and vegetables. Porridge with seeds, nuts.

    – cutt down on fizzy sodas , and sugary foods like cakes.

    Generally more fruits and vegetables .

    I took tips from Rob’s book. But I stuck with the massages more than anything else.

    Other supplements worth mentioning

    Saw palmetto, pumpkin seeds, ashwaghanda, rhodiola, vitamin K2 , l reuteri,

    Don’t stress yourselves out over lifestyle and diet changes, I Incorporate them slowly if need be. I don’t know which worked better , but do them for many other bodily benefits.

    But stick to the massages and monitor your skin elasticity as months go by, and listen out for sounds such as cracking. This signifies progress .

    One thing I like to mention !

    I noticed that my skin elasticity would be tighter in the morning s in the regions ( hairline, vertex, sides) , this for me is a sign of healing.

    I would recommend oil / essential oils topical after 10- 11 months of DT . As they will be far more effective.

    Hope that helps and best wishes.

  71. Hi Julian.

    The reason I believe this to be part of the healing process , is to do with the nature of the massages.

    The skin is being stretched , pinched and pressed hard / moderately to make it more elastic.

    Then we have a day where the region is not touched and left to heal , reverting back to it’s elasticity before massage.

    I can only assume that this is part of the body reacting to wounding. Again I assume.

    It could also mean that when we sleep at night , the body still works, and blood flow may change when we sleep.

    However when it come to evening massages at least for me the skin is much more elastic.

    One more thing about shedding.

    Shedding depends on the type of loss. Thinning / diffused hair usually has cycle issues.

    Always check what you are shedding , it’s a good sign of progress. As the body is removing weaker hair which would fall out eventually. Hopefully it’s to be replaced by thicker stronger/ darker hair which I experienced.

    But this process take more than a year to see full results I believe.

    Id say

    1-5 month you will or should notice change ,ie sebum, skin elasticity.

    6-8 month thickening and small regrowth. And cracking sounds

    9-12 month further regrowth and thickening.

    12+ continued progress

    Hair regrowth is slow, but permanent.

    But any change should be positive, and an indicator to carry on.

    I would say this all based on Rob’s latest techniques in the 2016 book video.

    And I personally believe that the side massages and pinching the Galea could have an astounding effect.

    Hope that helps

  72. Oh sorry one more thing Julian.

    Where did you notice the crack sounds?

    I noticed them more at the front , and when they stopped I too noticed skin elasticity and then small hairline regrowth.

    Right now I’m noticing them more at the vertex , more than before

  73. Hey Rob,

    Thanks for al the info. I learn allot and you have some great ideas on hairloss.

    I have been doing the massages and a couple of days in im noticing that my skin at the front (where my hair is becoming thinner) is showing flakes/ very dry skin. My normal skin is very oily, so its pretty weird for me.

    Does this mean that it is working?
    Can it be clogged up stuff in my hair?

    The skin where i do not have any hairloss doesnt have these flakes/ dry skin after the massages.

    • Hey Jack,

      Thanks for the kind words. And it all depends! There’s more information in the book about whether dandruff is a good or bad sign (it depends on other factors — like if hair loss has already stopped, how much hair is shed per massage, what kind of mechanical stimulation techniques you’re using, etc.). In general, dandruff isn’t a bad sign. It’s a myth that dandruff can clog up your hair. Dandruff is more often than not a symptom of chronic scalp inflammation — or acute injury (from massaging).


  74. Hello Rob and fellow hair-regrowers

    I’ve just come across a new gym where they offer a Collagen Cabin. It uses near-infrared light (633 nm) and what it does is empower the body’s fibroblasts to store the energy and generate collagen. My case is a diffuse thinning so there might not be as much fibrosis (collagen scarring) as in regular MPB, and I reckon that we require collagen from foods to actually create hair!
    Still, if fibrosis is somewhere I do not wish to exacerbate it.

    Anyhow, I would appreciate some debate here as always, your thoughts are more than welcome. That’s how we learn.

    @PAZ, sorry for the late reply mate, thanks so much for your commitment. I experienced the cracking on the hairline for the most part yet sometimes on the vertex and ridge. The seem to have stopped for the moment but my scalp feels really loose. I noticed thickening and regrowth to my amusement. Would you like to share pics of your progress Paz? I would!

    @JACK, glad you started with massaging, I still hace the same issues with flakes. Do not know the exact reason but I believe that it is a healing process from all the “damage” we are creating our scalps. Best wishes mate!

    Great evening to all. Keep up the regrowth!


  75. @Rob,

    Thanks for comming back to me. Very interested in your book and videos. Will get it with the next paycheck.

    I also dermaroll and use omega 3 and pumpkin seed oil. Pumpkin seed oil seems to work wonders for my face (skin). Skin feels soft and healthy.

    Never had allot of problems with acne but i do have more blackheads than i want. Especially on the nose. Maybe an oily skin has something in common with hairloss?

    • Hey Mike — I believe the survey we’re putting together should help give us insights here. Will email you within the coming days with the draft.


  76. These cracking sounds, I have not heard any myself, but where do they come from? Some say the skull sutures are rigid, other say they move a bit. But that can’t be it can it?

    For me I just hope the results from the survey will give some clues. Have not tried DR yet. I tolerate more DT than I did when I started over a year ago. So at least that is positive.

    • Hey Brent,

      Any light therapies likely won’t help relieve chronic scalp tension, since this tension is likely transmitted from involuntary muscular contract or skull bone broth. A better approach is likely botox injections in any galea aponeurotia-connected muscles — which would force the relaxation of these muscles and thereby relieve tension in the scalp.


    • Hi Ken,

      I think you’re referring to this study:


      The study suggests that lactate is necessary for the activation of hair follicle stem cells, and that the deletion of lactate dehydrogenase (needed for lactate production) prevents hair follicle stem cell activation.

      So the implication is actually that lactate is necessary for hair follicle stem cell activation, and not that lactate causes male pattern baldness.

      There are a few reasons why we shouldn’t apply this study to male pattern baldness:

      1) The study was done on rodents, not on men with pattern hair loss. As a result, this study is only measuring one single intrinsic factor necessary for hair cycle activation. Outcomes in rodent hair follicle studies tend to apply better to human body hair follicles and non-balding scalp hair follicles. Very rarely do they apply to balding scalp hair follicles.

      2) In men with pattern hair loss — thinning or bald hair follicles still have stem cells. What fails is their activation from stem cell to progenitor cell. Even if we activate more hair follicle stem cells, we still may have that failure step going from stem cell to progenitor cell at balding hair follicle sites.

      3) The tissue environment of a balding scalp is completely different from the environment of the back of a rodent. For instance — balding scalps also have perifollicular fibrosis, increased PGD2, etc. These factors are also linked to the explanation of why stem cell to progenitor cell activation at balding hair follicle sites fails. As such, it would be short-sighted to imply that the rate-limiting factor of hair recovery is exclusively due to a lack of lactase.

      I hope this helps.


  77. Hi Rob,

    First off, just wanted to say great job on your articles and e-book. Highly informative and backed with excellent research.

    I bought the e-book a couple months back and have noticed improvements in the way my scalp looks and feels. Haven’t experienced any regrowth yet, but feeling optimistic given the scalp improvements. While I’m going to continue following the regimen that you outline in your e-book, I like trying to tackle this problem from multiple angles. The study you mentioned in this article, involving the scalp tension reliever apparatus, caught my attention. I read through the findings, but have not been able to find any similar devices on the market. So just wanted to know if 1) you would recommend using a similar device in conjunction with your regimen, and 2) if so, do you know where a product like this might be available?

    Once again, thanks for all the time and effort you’ve put in to this site and the e-book.

    Take care,

    • Hey Matt,

      Thanks for the kind words. To answer your questions–

      That apparatus has been off-market for years! I ended up buying a used one on eBay (from the UK), just so that I could better understand its mechanisms and how it felt on the scalp. It’s a great solution, but only if you have around two hours daily to wear it. I’d highly recommend it if you can get your hands on one and are willing to make the time investment. Here are a few photos from the study, after only 3-12 months of use:

      Takeda Medex

      Takeda Medex


  78. There is NO significant regrowth of hair during gender transformation. It’s simply a LIE.
    Do you know what you see on that before/after photos?
    I tell you: A simple COMBOVER. Yes, it’s just a combover.

    There is NO WAY to regrow your lost hair.

    You have only the following chances:
    – prevent your hair loss taking finasteride regularly BEFORE your hair loss (Its brand name is Propecia, but there’re generic finasteride pills as well);
    AFTER your hair loss:
    – surgical hair transplant, which is much less effective as advertised (You have to have several sessions for remarkable outcome);
    – surgical scalp reduction, which is essentially surgical resection of your bald scalp area and the approximation of your hairy scalp lobes.

    Example: transsexual woman Sona Avedian, who went from bald macho soldier to blonde beauty, lost her hair early during her male years, and after that, as a female, she have to wear constantly a wig or a beanie.
    Check it:

  79. Ok, I am a MTF patient, 8 weeks into 5mg Finasteride daily and Estradiol patches 2 times a week. I am bald and have been for a long time. I will let you know if I get any regrowth although I could honestly say I believe there be a fuzz over my scalp that wasn’t there before but I could be mistaken and this could be due to the fact I am massaging my scalp a number of times a day with coconut oil.
    I find the scalp tension aspect interesting and will continue to try to relieve this by kneading the area with my fingers, anyway, if it works I’ll let you know but I remain skeptical.

    Also, I have just ordered some Biotin tablets, they might help.

  80. OK so I’m coming up to 10 weeks into the treatment and I have noticed the fine vellus hairs (that everyone says are essential if you are to regain your hair) have appeared everywhere on my scalp and I mean everywhere, now I’ve been seriously bald for over 10 years and have been down to the razor for most of that time and until about 3 days ago I was certain that I had the ‘Shiny Bald’ areas that were beyond all hope but not so, on Sunday I got really depressed because the ‘Fuzz’ only seemed to be in the areas where I still had a few sparse hairs But, and I mean this, this is my gods honest testament that there are definitely short white spikey hairs in the areas that were shiny bald. I have been massaging in Coconut oil daily but that’s really more of a lubricant for my fingers and I’ve also started to apply Lemon juice and vinegar as its easy and very cheap (so why not?), yes I do know that it’s just an old wives tail but it does seem to make the hairs feel stronger. Now the big question here is can these Vellus hairs become Terminal? As they are very white and translucent, this causes them to not be visible in strong light and they contrast with the darker hair so still giving the appearance of a bald head but they are there, I swear it, in places where I lost all hope. I dn’t think I have been in treatment long enough to have the physical effects that you have detailed but at this stage my Testosterone and Estrogen Levels must be nearing female equivalents if not quite fully (I think 3 months is the kind of watershed for that) but I have activity, definitely, so much so that I have used the attachment on my clippers so that all the hairs are same length. Can this go to the next level? I can only wait and find out but I never expected this result, so far so good.

    • OK, I’ve been for a long walk and thought about this, what has happened in my opinion is that the Lemon Juice/Vinegar mixture I applied has broken down the oils that kept the vellus hairs stuck to the scalp, these near translucent hairs are completely invisible if they are lying flat against the skin, so that is why I experience the Eureka moment the morning after. So it is impossible to say whether these hairs are new or have always been there but it does shed light as to why the myth exists that this mixture grows hairs, it doesn’t, it frees them. So there is no more evidence of positive results although I am greatly relived to find that I do not have any shiny bald areas as I believed earlier.

      • Rob,

        I have to say now beyond ALL DOUBT I have major hair regrowth on my scalp, it sounds too good to be true and a month ago i was very bald indeed and had been for a long time (10 yrs+) but now I have an almost complete covering of white hairs on my scalp, so much so, I have bleached my darker old hair to match and the effect is shocking, I actually go out with what appears to be full coverage. I really think my baldness was due to hormone imbalance and not normal MPB but it is truly remarkable. I doubt it was due to the Finasteride alone but the hairs are white, curly and beginning to matt together to form solid mass. There is no doubt that this is true, this is life changing stuff and feels like a miracle to me.

      • Lee — this is GREAT news! Congratulations!!! Keep us posted, and I’m happy to hear about your progress so far!

  81. Hey Rob,

    ¿What are your thoughts on Diindolylmethane (DIM) for balancing estradiol and thus regrowing hair?



  82. hey rob, is this means tht hair loss in men is cause by scalp tension? is there anyway to cure it? Im 23 and i notice im losing my hair volume. I started notice it 5 years ago and it slowly progressing.

  83. hello – I know you are not a doctor and this forum is primarily for MTF but I am really really hoping you may have some advise for me? I am a woman (born that way) and losing hair for a year now. I am 40+ years old. I have inflammation of scalp (itching, burning and hair loss where it itches/burns). Most probably, my body went into hormonal imbalance due to the high stress I was experiencing at that time.

    I started HRT in May and then my doc recently increased my dosage of Estrogen + Progesterone and that has made my hair stronger, thicker and shinier but not stopped my hair loss… any advise? PS : I also got stomach issues the time my hair loss started…Thank you for taking the time to read my comments. I LOVED your article!

  84. Hi Jane , until rob answers in more detail.

    Have you checked your thyroid levels ?

    A good approach would be a pro thyroid diet and an anti- inflammatory diet.

    Also cold water on scalp in shower may help inflammation levels.

    It seems a lot of female hair loss is down to , thyroid, hormones, and gut health.

    Best of luck


  85. Would love to hear what you have to say on preventing/reversing balding in female-to-male trans people (FTMs). Going bald is a big fear of many who start taking testosterone hormone therapy.

  86. Great article, this sex change issue could be interpreted as this:

    1. If we look at this situation in the context of MPB being a a determining factor in female sexual selection:

    the sex change simply results in a hormone profile of a female, in which it’s no longer biologically necessary to send a signal to the opposite sex that the person is not hormonally ideal as a sexual partner. Therefore, prostate heallth, sperm health, and MPB would be inversely related, in which they actually appear to be.

    This could be a reason why females don’t like bald men, but are ok with grey haired men.

    Here’s a study supporting this idea: “Assessment of semen quality in patients with androgenetic alopecia in an infertility clinic” (https://www.sciencedirect.com/science/article/pii/S1027811715000737).

    And the reason for the decreased blood flow in the scalp comes from the idea that “DHT programmed miniaturization” occurs ON PURPOSE because blood flow to the area is no longer needed.

    This may seem kind of silly though because from a survival standpoint, a man should want to try to reproduce until he’s dead, and signaling to the opposite sex that his sperm sucks is not a good way of doing that, but it does help in FEMALE SELECTION. There is a theory in biology that states the survival of a species as a whole comes first, and that’s why life is not immortal. This is why aging is programmed into our DNA and there’s a “biological clock” that can’t cross a certain threshold (put at around 120 years for a human I believe). In that way, life is not meant to be selfish. We’re born, we quickly reach reproductive age and reproduce, we age and we die.

    This idea would hold true regardless if there were skull growth or not, but it would be influenced by how long a person stays in a specific hormonal balance/state, which may not necessarily be a favorable balance. Remember, testosterone and estrogen decrease in men as they age while DHT, I believe, stays the same or increases, and this precious balance influences bone, muscle, and fat formation; cognition, and sexual function.

    In a nut shell, it could just be aging, accelerated aging, a hormonal imbalance as the result of aging or being unhealthy. This is not what people would really wanna hear, but there’s a strong case to be made for this argument.

    The solution to MPB, whether it’s purely hormonal or not, is the same: be healthy and be young.

    Calcification, fibrosis, and, in general, epithelial health is influenced by how healthy a person is and whether they have elevated risk factors for heart disease such as obesity, metabolic syndrome, living a sedentary lifestyles, not getting enough sunlight and exercise.

    A case can be made that early onset MPB could be an early sign of metabolic syndrome, which itself results in blood vessel damage and endocrine disruption. Just go on PUBMED and look up male pattern baldness (or AGA) with insulin resistance. There’s clearly a connection. For example, High levels of very low density lipoprotein (VLDL) are associated with androgenic alopecia. VLDL carry triglycerides (converted energy from carbs and fats) and LDL carry cholesterols.

    I also want to point out that exogenous androgens increase blood glucose levels, so this could be the mechanism of action involved in arterial calcified lesions and fibrosis in the heart tissues of rats injected with androgens, and is also why steroid users have accelerated hair loss.

    Rob, I’m also wondering what you believe would be the benefit of skull growth resulting in MPB, or do you believe it’s purely pathologic?

  87. Hey Rob, any idea if taking a very minute dose of E2 is worth trying? If you were to try a dose what would you reckon would give you no sides (primarily permanent breast growth is my main concern – ie gyno).

  88. I am on Trans HRT and I have massive hair regrowth after almost a year, I began with Finasteride and Estrogen back in March last year and started to gain little white hairs after a nasty period of shedding which lasted a couple of months. I started with Regaine in July and in October last year I got a real surge of growth, it was about this time the changes really started to kick in with the Estrogen and I panicked and stopped my medication, by late November I started to shed all my gains, I panicked again and started to retake everything in late November and over Christmas I had the most awful time of shedding again and it really hurt emotionally, I mean really hurt but now its back to where it was in October, maybe even better. I had previously been completely bald for almost 20 years. This is the Gods honest truth and I have a timeline of Photo’s to prove it

  89. Hello Rob! Interesting theory, I’ll going to buy your course, but a have question (maybe somebody already
    asked this question, but I did no found answer).
    So, if fibrosis and calcifications it is happened, why after hair transplantation hair growing up after this on this place of scalp?
    How can grow hair in place on scalp, where fibrosis and calcifications?
    I herd, that in 10 years after transplantation hair began thinning (maybe it connect with your theory)?

    Thank you.