Why Are Hair Growth Drugs So Ineffective?

Rob Misc. Research 167 Comments

Read time: 15 minutes

Why This Article?

I was diagnosed with male pattern hair loss before graduating high school.  The prospect of being bald by my mid-to-late twenties terrified me. I spent the better part of a decade researching ways to reverse the condition. I bought every hair care product I could find. I used Rogaine for 7 years. I even tried laser therapy, albeit very briefly.

Reflecting back, I’m thankful for the diagnosis. It catalyzed a desire to better understand my body, my health, and why my hair was falling out.

This article discusses the reasons why hair loss drugs rarely (if ever) result in 100% reversals of pattern hair loss. And of the drugs that are somewhat effective, these might not be working via their intended mechanisms. For some people taking prescription hair loss drugs, the treatment can be worse than the disease.

DHT – The Cause Of Hair Loss, Or A Misunderstood Symptom?

If you’ve ever looked into the causes of hair loss, you’ve probably heard of dihydrotestosterone, or DHT. DHT is a hormone that comes from testosterone. DHT levels are higher in people with thinning hair.

Because of this connection, most hair loss surgeons say that DHT is the root cause of hair loss. Their explanation is as follows: for reasons not fully understood, higher amounts of DHT begin to bind to scalp tissues. The scalp’s hair follicles become sensitive to the elevated DHT and shrink over a series of hair cycles. This process eventually leads to thinner, wispier hair, until the hair disappears and follicles become dormant. Here’s a picture:

DHT Shrinks Hair Follicles

 

What’s wrong with that explanation? It’s only partially true. Yes, DHT is implicated in hair loss. But it’s just one of many symptoms observed in those with thinning hair. There are a variety of other factors that are largely ignored by hair loss surgeons. Some of these factors are:

  • Calcification of the scalp sutures
  • Calcification of blood vessels leading to the hair follicles
  • Fibrosis of the scalp skin and hair follicles
  • Collagen remodeling of balding scalp tissue

Interestingly, elevated DHT isn’t just observed in balding scalps… It’s also observed in inflamed body tissues. There’s also evidence that DHT actually helps regulate inflammation, and that in some tissues, DHT is anti-inflammatory.

Now let’s take another look at that list of conditions. Of the above factors, there are two major threads: fibrosis and calcification. What do both have in common?

If chronic inflammation leads to calcification and fibrosis, and elevated DHT is a response to inflammation, then DHT probably isn’t the root cause of hair loss. DHT is probably just a symptom of a chronically inflamed scalp.

Unfortunately, nearly all hair growth drugs are designed to block your body’s DHT production. But these drugs don’t address the inflammation. As a result, they aren’t very effective. They’re also dangerous, since DHT production is critical to sexual health, and inhibiting it can lead to erectile dysfunction and even impotence.

What Are Hair Growth Products, And How Do They Work?

The Big Three

Of the few FDA-approved hair growth drugs, these are the most popular:

  • Finasteride (branded as Propecia)
  • Dutasteride (branded as Avodart)
  • Minoxidil (branded as Rogaine)

Finasteride Prevents DHT Conversion

How does Finasteride work? Finasteride prevents testosterone from converting to DHT, so that less DHT collects on your scalp. Testosterone is converted to DHT by the enzyme 5-alpha reductase. Finasteride is a 5-alpha reductase inhibitor (or blocker). The conventional rationale is as-follows: by inhibiting testosterone’s conversion to DHT, less DHT gets to your scalp, so you lose hair less quickly. If enough DHT is blocked, you might even halt hair loss or experience minor regrowth.

Dutasteride Does The Same Thing

Dutasteride is very similar to Finasteride, but was never intended to treat male pattern hair loss. It was originally developed to reduce the size of enlarged prostate glands by acting as a 5-alpha reductase inhibitor. After realizing that the drug helped reduce the conversion of testosterone to DHT and in some cases reduce hair loss, it was later rebranded as a hair loss treatment.

Minoxidil Provides Blood Flow To Scalp

Minoxidil provides blood flow to the follicles. When applied twice daily, it can help reduce and sometimes stop hair loss by allowing a little more circulation to get to your hair. It doesn’t prevent the DHT build-up in the scalp. The mechanisms by which Minoxidil halts hair loss still aren’t fully understood.

What’s The Problem With Finasteride Or Dutasteride?

Finasteride & Dutasteride Can Ruin Your Sex Life Forever

The enzyme 5-alpha reductase plays a number of hormonal roles in the body, many of which aren’t yet fully understood. Finasteride & Dutasteride inhibit this enzyme, which yields unintended consequences. For example – in some men, taking Finasteride for a mere few weeks resulted in unresolved erectile dysfunction, even after stopping the prescription.

Fasteride & Dutasteride Use May Result In Prostate Cancer

In 2011, Finasteride and Dutasteride (eg, anything branded as Propecia, Proscar, Avodart, or Jalyn) were forced by the FDA to amend their warning labels after research suggested that prolonged use increased the risk of high-grade prostate cancer. Think about that. These drugs are intended to reduce enlarged prostate glands, but might give you prostate cancer in the process.

That doesn’t sound like a fair trade-off, especially when you’re the one paying for the prescription.

Finasteride & Dutasteride Reduce Your Sperm Count

In 2007, scientists found that Finasteride and Dutasteride reduced total sperm count by ~30% after 6 months of use. Sperm volume, concentration, and motility were also reduced. Because of this (and the other long-lasting hormonal changes these drugs induce), you can’t donate blood until you’ve stopped using Finasteride for 1 month and Dutasteride for 6 months.

Pregnant Women Aren’t Allowed To Even Touch Finasteride & Dutasteride

Why can’t women use either of these 5-alpha inhibiting drugs? Because Finasteride and Dutasteride can potentially mutate and inhibit the development of male fetus genitalia. Women are even advised to avoid touching the drugs’ capsules if they are pregnant.

Looking for more reasons to never touch either of these drugs? Feel free to dig deeper into the aggregated research here or here.

What About Minoxidil?

Rogaine’s Ingredients Are Banned In Other Countries

If you’re unconcerned about using Minoxidil, it’s worth mentioning that some of the ingredients in Rogaine Foam are banned outside the US because they are considered carcinogenic and tumor-promoting. This is a product you put on your scalp, everyday, twice a day. That’s pretty close to a few important things – your brain and your eyes to name a few. With each application, you roll the dice for cell mutation. It seems like quite a risk, especially when its efficacy is more limited to arresting hair loss, not necessarily reversing it.

Rogaine Kills Cats (Don’t Get Any Ideas)

For reasons not entirely understood, Minoxidil is also highly toxic to cats – so toxic that some have died just through unassuming skin exposure to the drug. Regardless of how you feel about cats, how can this be good for humans? Rogaine is to cats as insecticide is to insects, and cats are much closer in size to humans than insects. Are you sure you want this on your scalp everyday? (Update: please see the comments section for further explanation on this analogy.)

Minoxidil’s Ability To Stop Hair Loss Isn’t Even Understood

Similar to Finasteride, Minoxidil’s ability to slow hair loss also isn’t fully understood. I’m a firm believer that you should never put something unnatural into your body, especially if you don’t understand how it works. While the same level of research isn’t there, who is to say that Minoxidil isn’t capable of the similar unintended consequences as Finasteride or Dutasteride?

Then Why Do Some People See Regrowth With Finasteride, Dutasteride, And Minoxidil?

While Finasteride and Dustasteride are designed to inhibit DHT conversion, that’s probably not the mechanism by which these drugs help to achieve minor hair regrowth.

Aside from reducing DHT, Finasteride also downregulates MMP2 and MMP9. MMP2 and MMP9 are two protein coding genes that influence collagen modeling and remodeling. Collagen remodeling is on our list of conditions associated with balding scalps. There’s a good chance that much of Finasteride’s regrowth success is contingent on the effects it exerts on collagen.

As far as Minoxidil – we know that Minoxidil increases blood flow to the scalp. But how? Aside from opening potassium ion channels, new research indicates Minoxidil also increases Prostaglandin E2 (PGE2) at the sites where it’s applied. Increased PGE2 is associated with vasodilation, muscle relaxation, inflammation resolution, and even the anagen (growth) stage of the hair cycle. We know that calcification of the scalp sutures and blood vessels supporting hair follicles can significantly restrict blood flow at balding sites. If Minoxidil increases blood flow, it probably helps counteract (to a degree) calcification or fibrosis, and temporarily maintain hair – at least for however long it’s used.

In either case, the reason why we don’t see 100% recoveries from either drug is probably because they don’t target the causes of hair loss that are furthest upstream – inflammation – nor do they resolve the chronic, progressive conditions that chronically elevated DHT (in combination with other factors) can cause – calcification and fibrosis.

Without Addressing Inflammation, Fibrosis, And Calcification, These Products Will Never Be 100% Effective

Minoxidil may stimulate blood flow to the scalp, and Finasteride may help prevent the conversion of testosterone to DHT, but these are just band-aids to larger underlying causes of hair loss. They never actually strike the core of the issue, and so they’ll never really result in permanent reversals.

What’s worse, success rates for hair transplants aren’t very high because your healthy hairs are often transferred into calcified areas. It’s only a matter of time before they die out, too. That’s why you’re asked to use Rogaine or Propecia after a hair transplant – since you need all the help you can get.

Inflammation is further upstream to hair loss than DHT. Calcification and fibrosis are chronic, progressive conditions downstream to DHT, but by taking away DHT, you don’t take away the already-existing calcification and fibrosis. It’s my belief that this is why hair loss drugs targeting DHT are so ineffective and limited to slowing, not reversing, the condition. If you want to reverse hair loss, you should target calcification and fibrosis.

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Stop Googling "How To Regrow Hair" Until 3AM

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Comments 167

  1. Pingback: Men: Stop Thinking Your Hair Loss Is Due To High Testosterone — Perfect Hair Health

  2. Pingback: Part 1 of 3: The Exercise And Hair Loss Connection — Perfect Hair Health

  3. Pingback: Part 3 of 3: The Exercise & Hair Loss Connection — Perfect Hair Health

  4. So why does Test replacement therapy make hair fall out? By your explanation more testosterone would mean better and more hair (since the test:estro ratio would be better), but actually the oposite happens. Please explain

  5. Post
    Author

    Hey Alan,

    Thanks for reaching out. To answer your question, the body processes exogenous testosterone (ie: testosterone replacement therapy, or TRT) and endogenous testosterone (testosterone manufactured from your own body) much differently.

    While TRP is purported to increase your total testosterone, TRP can also decrease testosterone production in other parts of the body — specifically, the testes.

    http://www.amepc.org/tau/article/view/2249/3145

    Moreover, if you receive exogenous testosterone via TRT, it doesn’t always mean it remains as testosterone inside your body. Testosterone can be converted into estrogen via the enzyme aromatase. Aromatase levels are largely determined by your diet and lifestyle, so if you choose to do TRT but are living a lifestyle that perpetuates higher-than-normal aromatase levels, you’re likely going to convert a significant amount of the exogenous testosterone into estrogen. In effect, TRT might not increase your testosterone:estrogen ratio. In fact, it could make it worse. It’s why many doctors also recommend estrogen monitoring during TRT, and sometimes even prescribe aromatase inhibitors.

    The healthier, less costly, and more effective approach is to address t:e ratios and aromatase production with dietary and lifestyle changes.

    Two big factors associated with higher aromatase levels are 1) alcohol consumption and 2) prescription drugs.

    Alcohol:
    http://www.ncbi.nlm.nih.gov/pubmed/11163119

    Prescription drugs:
    http://www.hormonebalance.org/userfiles/file/Medications%20that%20increase%20aromatase.pdf

    Certain soy-based foods and cooking oils can also be problematic.

    To wrap this up — TRT might inject testosterone into your body, but if you’re otherwise unhealthy, it will 1) limit the production of testosterone in your testes, and thereby disrupt your endocrine system; and 2) convert mostly to estrogen, and thereby decrease your t:e ratio. Both of these factors are likely to yield hair loss in the long-run.

    Best,
    Rob

  6. There are clearly a lot of faults with the items listed here. I wont go into each and every one as there are a lot that are half-truths and not researched, but I found it funny that one of the arguments was “If minoxidil is bad for cats, it must be bad for humans also!”. Nuts, grapes/raisins, chocolate, coffee, etc all kill cats and dogs with very little amounts needed. Maybe we should all avoid those deadly substances as well…?

    1. Post
      Author

      Hey Tic,

      Let me clarify my position (as a former Rogaine user of 7 years). The mechanisms by which minoxidil works are very unclear. It’s speculated that minoxidil opens potassium ion channels, promotes collagen remodeling, and improves blood flow to the scalp. However, researchers don’t yet understand the relationship between minoxidil’s metabolic pathways AND its efficacy as a hair loss solution. Consequently, researchers also can’t explain some of the potential side effects (headache, chest pains, scalp irritation, or the development of bags under eyes).

      The cats/minoxidil reference isn’t meant to be paraphrased as a causal relationship that “anything bad for cats is also bad for humans.” However, it is supposed to highlight the mystery behind minoxidil’s metabolic pathway, and in the same light, a lack of understanding as to why it is poisonous to cats. Another example is insecticide. Most insecticides don’t kill humans, but I’m not going to put insecticide on my scalp everyday. Conversely, we understand why chocolate and grapes are toxic to cats and dogs. There are components within nuts that they either 1) can’t digest, or 2) digest much more slowly than humans.

      As far as any research points that are unclear, please let me know. I make an effort to provide links to any claims throughout each article, mostly primary sources. The makers of Finasteride and Dutasteride are in the middle of a class-action lawsuit for the same claims listed above. The last thing I want is for you to feel like I’ve told you a half-truth.

      1. I can explain two of those things.

        Scalp Irritiation: It’s the Propylene Glycol that causes skin irritiation and guess what? You have skin on your scalp.

        Development of bags under your eyes: People applying the product and then immediately going to sleep, causing the product to rub onto your pillow and subsequently your face (eyes). This is extremely obvious by the fact that the (eye bags) are not common and if you follow the instructions properly this will never happen.

        Also You “logic” on it’s bad for cats so must be bad for humans is so inherently flawed. Plenty of things are poisonous to humans but safe for animals and vice versa. Minoxidil is NOT poisonous to humans in anyway through normal usage, it wouldn’t be legal if it was, there would also be a lot of warnings on the bottle if it was poisonous in anyway to humans.

        Blocking DHT is definitely not the way to go as it’s extremely important for your body but Minoxidil simply increases blood flow to your scalp, from my experience it aids minor regrowth but mainly stops hair loss AND as I am not sensitive to Proplyene Glycol it causes me no irritation, much better then the burning/itching/pain from before I was taking it as my hair was thinning. Massage + Minoxidil will probably work wonders, maybe massage alone BUT Minoxidil is not dangerous unless you ignore the basic instructions, even then it’s not dangerous.

      2. Post
        Author

        Hey Ian – great points here. I’d like to clarify my position and keep the dialogue going.

        RE: Rogaine & bags under eyes–

        The latest research suggests that Rogaine (Minoxidil) partially helps in hair regrowth by activating PGE2 synthesis. There’s an association with PGE2 production and hair growth:

        http://www.ncbi.nlm.nih.gov/pubmed/17697149
        http://www.ncbi.nlm.nih.gov/pubmed/9008235

        But PGE2 synthesis also naturally increases with aging. In fact, it’s associated with age-related skin damage:
        http://www.ncbi.nlm.nih.gov/pubmed/25905589

        So encouraging PGE2 synthesis with Rogaine might help with hair growth, but it might also prematurely age your skin. Especially if you’re applying it before bed, resting your head on your pillow, washing your pillow sheets infrequently and allowing other parts of your face to come in contact with the residual Rogaine accumulation. This is probably why some people report bags under their eyes, that don’t go away, from long-term Rogaine usage. Some minoxidil is also probably absorbed systemically, which could lead to the same problem via another route.

        My guess is Propylene Glycol is probably a factor in the scalp irritation / bags under eyes, but very secondary to PGE2.

        RE: cats and Rogaine–

        I agree with you. My logic here isn’t very scientific. The statement was more to illustrate a point of comparison and in doing so I was a bit lax with the science. But since you mentioned it, I’m happy to discuss further.

        The research behind neurotoxicity and activation pathways between animals and humans is complex, and you’re absolutely right that for us humans, chemicals that are toxic to certain animals (like chocolate to dogs) pose much less a threat to humans. Why? Humans have the metabolic pathways to process chocolate – and specifically, the theobromine in chocolate – faster than dogs can, so our toxicity threshold is much higher.

        That way of thinking – that if we have the metabolic pathways to process something, then it’s fine for us – is becoming outdated. Much of this is due to the emergence in research in the microbiome, which constitutes, in total, just as many (if not more) cells than we have that are human.

        So how does our microbiome – the bacteria and other organisms that regulate up to 70% of our immune system – react to the presence of something like theobromine? It’s still being determined. But theoretically, not all our non-human cells have the metabolic pathways to process it. Which means there’s probably a lower threshold for toxicity for those cells, which means a higher potential for microbial die-off and thereby an impaired immune system.

        But again, we need to do more research. Until then, all we know is that Rogaine might be harmful to cats.

        All the best,
        Rob

    1. Post
      Author

      There’s a few layers to the answer. First, dietary and lifestyle changes will greatly help stop hair loss by reducing the scalp inflammation that’s associated with calcification, fibrosis, dandruff build-up, sebum overproduction, and consequently, increased levels of DHT. But for hair regrowth, using mechanostimulation to change gene expression in the scalp is absolutely crucial. It’s necessary not only to return the state of the scalp to healthy, but also to upregulate the genes associated with hair growth, and downregulate genes associated with hair loss.

    1. Post
      Author

      Hey Bill,

      I don’t use PayPal because their services don’t enable a sliding scale for payments. I want people to have access to the information regardless of financial circumstances, which is why I like the Pay-What-You-Want model. Gumroad offers sliding scale purchases, and they have the same encryption/security standards as PayPal. As a result, they better align with the intentions of the book and the site.

      There have been a few cases where an individual wants the book, but feels extremely uncomfortable using service providers other than PayPal. If you fall under this category, please email me. I do have a PayPal account for situations like this, but prefer to avoid going down this route. Using PayPal services as a Pay-What-You-Want model requires the following steps: 1) a person emails me the amount they’d like to donate, 2) I change the PayPal purchase price to match their requested donation, 3) that person downloads the book, and 4) I reset the price. It’s time-intensive and often a bit frustrating given the lag time between email exchanges, and overall, I think Gumroad provides a stronger service.

      Best,
      Rob

  7. Hello Rob,

    [1]I was planning to take bodybuilding suppliment (ZMA) that is supposed to increase testosterone levels in the body. Will this increase hair fall?

    [2] I am taking a medicine for hair growth (Andronagen by Croatia). This medicine has saw palmeto that blocks DHT? Is it safe to use this kind of medicine.

    Please advise

    1. Post
      Author

      Hey Rajesh,

      In general, I’d say save your money and avoid supplementation.

      RE: ZMA–
      The supplement is essentially differing forms of zinc, vitamin B-6, and magnesium. In the US, people usually have significant magnesium and zinc deficiencies, but by tweaking your diet, you can avoid supplementation. The testosterone-raising effects of ZMA can probably also be achieved just through dietary changes. And the absorbability of the forms of zinc and magnesium in ZMA are also debated.

      RE: Androanagen–
      The benefits of saw palmetto as a topical is questionable (versus oral consumption). As a product, Androanagen also contains minoxidil, which can be problematic when used in the long-run.

      https://perfecthairhealth.com/why-are-hair-growth-drugs-so-ineffective/

      I’d avoid both of these products and invest the money saved into diet.

      -Rob

  8. What are your thoughts on magnesium oil for de calcifying the scalp ie regrowing hair because of the massaging as well as mag oil??

    1. Post
      Author

      Anecdotally, some people find magnesium oil very helpful. As far as magnesium as a topical (or magnesium baths), it seems to be more effective at reversing deficiencies versus oral supplementation. Magnesium deficiencies are very prevalent, especially in the US.

      As far as a direct link between topical magnesium and hair regrowth, I haven’t seen it yet. I view adequate magnesium intake as just one of the many things people need in a “hair” support system. Magnesium oil is great, but in the majority of cases, I don’t think it will make the difference between regrowth and no regrowth. With that said, it definitely won’t hurt!

  9. hello rob i am a mioxidil user and i found your article intresting and i agree with you partially.use of finastrade will cause series side effects is right.but i disagree about minoxidil scientific study doesnot know the exact side effects but the proper usage of minoxidil will reverse hair loss because i am a victim of bladness at 28.but after using minoxidil for six months and with a good supplement with saw palmetto revers bladness and hair thinning and i have about 80% recovery and stooped minoxidil after 6 months.now i am on a strict diet for 5 monts and no more huge hair loss. every one is different but i gurantee you with a good doctor you can reverse bladness below 40.

    1. Post
      Author

      Hey Amil,

      If you’re experiencing an 80% recovery rate with saw palmetto + minoxidil, that’s great! And I totally understand if you disagree about the potential long-term side effects of minoxidil. I’m of the belief that in the long-run, minoxidil does more harm than good. But not everyone agrees, and I respect where you’re coming from. Just as a note — a lot of long-term users claim to develop lingering bags under their eyes, myself included. So, if you start using minoxidil again, keep an eye out for these a year or two into use. It’s not something most people like dealing with.

      Best,
      Rob

      1. Hi how are you just a few questions how long was it before you saw results? also do you think the more hair loss you have the longer it will take to see the results? p.s have you any before and after photos?

      2. Post
        Author

        Hey Phillip – it took ~10 months for me to see results I was happy with, but I’ve continued to experience thickening beyond that point (up through ~2 years of massaging now). The process takes commitment. As far as photos – I will share some on the site soon! Best, Rob

  10. Hi Rob,

    I have started your program with hopes of regaining some of the lost ground on my scalp over the years. I just have one question, do you have any before/after pics of your own hair loss. You have quite the head of hair from what I can see and I just want to see how you started out, as to temper my expectations.

    Thanks,

    Andrew

    1. Post
      Author
  11. Hi Rob,

    Female Hairloss

    I’ve read your article and i’m wondering, how do you know when a person has calcification and scalp fibrosis?
    Also, I am having excessive hair loss and haven’t found a way to stop it as yet.
    I have never tried any of those hair loss products except hair loss shampoos and argan oil shampoos. Now I’ve switched to an organic shampoo called “Mii”. None worked.
    I am afraid to try things like mioxidil because of the very reasons you discussed. I was diagnosed with endometriosis and doctors said that this is not related to my hair loss, but that pcos is, however I don’t have any symptoms of pcos except hairloss but the endocrinologist insisted that is my problem and prescribed metformin. I don’t believe this will help although I haven’t started the metformin as yet.
    But here’s the strange thing….I had 6 months of a drug called zoladex last year for my endometriosis, this injection takes away estrogen from your body in order to lessen the effects of estrogen on the endometrial tissue. One of the side effects is hair loss because obviously estrogen is not present again. (Please note I had my hairloss long before using zoladex). Surprisingly enough, when I used this zoladex, during the last 2 months or so of the 6 month period my hairloss eased alott and almost stopped!
    So my question is, do you have any idea if my hairloss is linked to DHT being trapped and why when estrogen was removed, hairloss eventually eased, but within a matter of months when the zoladex was stopped, hairloss came back with a vengeance!??
    I have 1/3 the amount of hair that I used to have.
    Please note my estrogen levels and progesterone levels are fine.

    Thanks for your time and sorry for this long message but ill be looking forward for a reply!

    1. Post
      Author

      Hey Michelle,

      Thanks for reaching out. It’s interesting you had the opposite of the expected reaction to Zoladex. It’s a hard question to answer, because it’s almost impossible to track all of the hormonal interactions these kinds of drugs have within the body. Are you a diffuse thinner, or is your hair falling in a specific pattern? Calcification and fibrosis play a role in almost all types of hair loss, unless the fall-out is due to something like an autoimmune condition, traction alopecia, or cancer treatments. A lot of this can be determined with the pattern of loss. If you’re losing hair in patches, that’s different for women than if you’re diffuse thinning and noticing a decrease in the density of your ponytail.

      Best,
      Rob

  12. I’m a Teen of 18 years old. Im suffering from frontal hair loss but not much. Im afraid of getting bald.

    1) I’m using 10% Minoxidil
    2) Is it safe?
    3) what are the other ways to regrow frontal hair?

    1. Post
      Author

      Hey Dijo,

      I don’t think Minoxidil is safe long-term. The above article discusses a few reasons why. On a personal note, I used Rogaine for seven years, continued to lose my hair, and eventually developed huge bags under my eyes (a side effect of long-term use). After stopping use for years, these are only just starting to fade.

      There are plenty of safer ways that help with hairline regrowth. I’d look into mechanotherapy, mechanostimulation, and any other recommendations in the eBook. Check out detumescence therapy.

    1. Post
      Author
  13. Hey Rob,

    I’m going to buy this e-Book with whatever money i got left tomorrow (I’m a poor student). I like your website and all the articles. I like the way u accept payment.
    Will your e-Book go into (scientific/theoretical) detail about how it can come to calcification in the first place? or how it can come to hairloss in some people and not others in general?

    Thank you.

    1. Post
      Author

      Hey Nate – please don’t feel like you need to pay anything extravagant for the book, especially if you’re struggling. Yes – there’s a lot of science behind hair loss, thyroid health, hormonal pathways, etc. But as far as the exact mechanisms as to how calcification develops.. that’s something much more multi-faceted. It’s addressed in a few sections, but the fact of the matter is – the science isn’t yet there to determine which exact mechanisms cause calcification build-up. It seems to be some sort of combination between diet, heavy metal (iron) overload, and perpetuating hormonal imbalances. The microbiome might also play a critical role due to its influence on epigenetics and even hormone regulation. But to answer your other question – yes, there are a few theories as to why some people lose hair and others don’t, and those are addressed in the book.

      Best,
      Rob

  14. hi im intersted in your ebook… dont matter if it is a scam or not im desperate I know a guy that did scalp exercises to promote bloodflow and other guys having success with it.. anyway your theory isnt all bad at all.. I want to buy the ebook I dunno how on his page.. you dont accept paypal ? I pay you right now 1 million dollars haha jk.. seriously I want your ebook so I can get more INFO on the matter…I know a shit ton of things about hairloss and all methods and treatments been glued to my screen everyday for years…some say vitamin k2 helps with calification or how u spell it..also apple cider vinager..but ya I want more info about all this thanks how do I go about getting ur ebook?

    1. Post
      Author

      Hey Daniel,

      You can now use PayPal to buy the book! After you type in your donation amount, you can choose the “Use Paypal” option and pay through their service. You can pay whatever you want for the book – I don’t mind. Just click on any of the Buy Now links on the main page.

      Best,
      Rob

    1. Post
      Author
  15. the most important is to find exactly in natural food ,what is going to to help 5AR , we must find the solutions to avoid side effects or surgery ,most of desease solution in front of our eye but we do not see it well

  16. Hi Rob,
    I just discovered your website and am very interested in reading your e-book. But I don’t understand why you don’t show us your before/after pics. Although I see you provide scientific evidence to back your claims, a picture is still worth a thousand words.

    Another thing that I don’t understand is that you say parietal and frontotemporal regions’ scalp get calcified and as a result vessels passing through foramens to reach scalp get narrower so blood flow to scalp decrease. But shouldn’t this also be the case for women? What is the difference between two sexes regarding this point of view?

    Thank you

    1. Post
      Author

      Hey Edhel,

      Thanks for your comments. The before / after photos were reserved initially for those who requested them by email, but I’ll make them along with other readers’ photos available on the site soon. As far as the calcification process in the scalp and why it doesn’t occur in men versus women, there’s definitely a hormonal component involved. Men produce more testosterone and thereby more serum and tissue DHT than women on average. As far as why the calcification process begins earlier for men and predominantly in the scalps, no one is really sure. The research is still ongoing. The idea is that in a calcified scalp, less blood flow means fewer nutrients in and out, including scalp tissue DHT. By addressing the underlying issues associated with hair loss (a calcified scalp) instead of just treating the symptom (hair loss), the chances for hair regrowth and maintenance dramatically increase. Best, Rob

  17. Am so eager to buy the ebook. Please dont expect much from me as am just a student living on my pocket money 😛 But i will give as much I can. Can you please provide me the link of your paypal or whatever may the way be 😀

    Thank you so much.

  18. Hi Rob, I’d love to know your thoughts of combining lllt with the scalp massage. I’m wondering if it may speed up the hair growth process.

    Thanks,

    Paul

    1. Post
      Author

      Hey Paul — we’ve spoken about this at length via email, but it should be fine so long as you reduce the length / number of massage sessions leading up to each LLLT session and after. The idea is to allow for enough of a recovery period between all forms of treatment so that there’s a balance between inflammation generation and wound healing.

  19. Hey Rob
    On the average, How long do think it should take to see any results?
    And if possible, could you send me before and after pictures.

    1. Post
      Author

      Hey Yarray – before / after photos will be up on the site soon. As far as time until results — this is mixed. Some people respond relatively quickly (a few months); others are seeing continued thickening / regrowth still even 1.5 years into the techniques. It’s definitely a long game, but was well worth it for myself and others. Best, Rob

  20. Dear rob,

    Do you think a full baldness will reverse, and if yes how long will it take, does the genetical make up will affect the reverse, let’s say the therapy will increase the blood flow around the hair follicles/ scalp but what if the blood flow goes beyond the normal flow, will it increase an wanted hair production/ over production or I mean does the excess flow have effect ?

    1. Post
      Author

      Hey Eul – the research suggests that dormant follicles can regrow from vellus to terminal and that full recoveries are possible. As far as an overproduction of hair, these techniques are centered around returning the scalp to a healthy state so that those dormant follicles can regrow. That’s the difference between stem cell therapies and this — whereas stem cell therapies focus on implanting new hairs into this skin, these techniques are centered around awakening what’s already there. So promoting blood flow shouldn’t encourage new follicle proliferation beyond what’s already available, but rather return the scalp skin / hair to its original state before thinning began.

  21. I am a diffuse thinner and my hair has been thinning so alarmingly that my scalp can be seen.. Its just between 4 years that I developed this kind of hair thinning. I am 31+ . I tried finasteride, it was working but I felt the side effects. . and Rogaine gave me eye bags and a little pronounced wrinkels around my eyes which I did not like. Recently I went to a doctor.. he was nice and advised me Bioexidil leave on lotion ( Capixyl ) to apply once in the night. I am more than 2 months on into this treatment but seeing no improvements.. Though I know I have to wait. .. But problems lies elsewhere. Using Bioexidil I am feeling increasingly tired, muscle loss, pain in the arm and back… thats devastating… I could not take it anymore. Bioexidil (Capixyl )does the same on scalp as dutasteride does in the blood. It blocks both types of 5AR in the scalp, probably in the blood.. Am I thinking rightly Rob? Can I get out of this balding? Its depleting my confidence so badly…

  22. Hey !
    What would you say about H2O2 for scalp Decalcification? Since it is said to also clean up calcifiaction in the rest of the body why not in the scalp ?
    If you are not familiar with the H2O2 therapy it may sound a little odd to take it orally ,but there are thousands of people that successfully used it over years , do some digging 😉
    Thanks.

    1. Post
      Author

      Hey Moritz – I’ve looked into it in the past, but had reservations ever trying it orally based off the reactivity of H2O2 with foods, gut microbes, etc. As far as your comment about H2O2 and decalcification, there was an interesting paper that came out not long after you left this post about just that, albeit on rats:

      http://www.ncbi.nlm.nih.gov/pubmed/27300444

      But hydrogen peroxide also plays a role in oxidative stress and possibly atherosclerosis:

      http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2397455/

      I haven’t researched this enough to form an opinion, but I do have significant reservations about oral ingestion.

      Best,
      Rob

    1. Post
      Author

      Hey Sam – massages are a good place to start. Check out Detumescence Therapy. Make lifestyle changes that support the thyroid. Eat an anti-inflammatory diet (I currently subscribe to a moderate carbohydrate paleo diet). That should get you started.

  23. Sorry but no. Your armchair doctor nonsense doesn’t add up to tried and true science.

    “Doctors are wrong but I’m Right” is typical from blogs like yours who prey on victims with hairloss.

    Transplanted hair moved to balding areas stays there permanently. Hair from the back of the head is immune to the effects of DHT. It’s not scalp calcification or whatever new lie hairloss blogs have blamed it on next.

    Finasteride and Monoxidil are clinically proven. When combined the results can be much better than Rubbing Exercises: http://www.belgraviacentre.com/success-stories/

    Especially Monoxidil (rogaine) when combined with Derma Rolling: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3746236/

    You’ve simply stumbled on a placebo effect exersize and are trying to market it around for money. Not bad but still, please don’t infect the internet with this nonsense.

    That’s probably why you had to halt sales of your ebook. Due to high chargeback rates your credit card processor probably dumped you.

    1. Post
      Author

      Hey Chris,

      I re-read my article after reading your comment and I understand your response. It’s not my intention to come off as an armchair doctor, and it’s definitely not my intention to prey on hair loss victims. I’m speaking from my own research and my own personal experience. But I do want to clarify parts of your comment so that we’re on the same page.

      RE: transplanted hairs staying forever in balding regions–

      A while back there was a paper about hair transplants and what you’re referencing. Researchers took thick healthy hairs from non-bald regions in the back of the scalp and transplanted them to balding regions. These hairs continued to grow normally for the duration of the study, and so the conclusion was that these hairs would continue to grow in perpetuity because they were protected, for reasons unknown, from MPB. This became the basis of support for all hair transplant surgeries, but the study didn’t run long enough.

      Transplanted hairs weren’t tracked over a series of hair cycles, but rather for relatively short periods of time. During this time, it was concluded that transplanted hairs weren’t miniaturizing at the same rate of other hairs in the same region, so the transplanted hairs must be protected from MPB. This turns out to be a misleading conclusion. In actuality, transplanted hairs do begin to miniaturize and eventually fall, but the process takes longer because the transplanted hairs are so healthy to begin with.

      Anecdotally, I’ve spoken to a lot of people with hair transplants. Of the group who received them 5-10 years ago, almost all of them claim that most of their transplanted hair is already gone. I have a friend with a hair transplant who’s experiencing the same problem right now. So at least from everyone I’ve talked to, that paper doesn’t add up with the anecdotal evidence.

      This is also why hair transplant surgeons ask you to go on finasteride and minoxidil after a transplant (in hopes it will address some of the conditions of the MPB-affected scalp). They also ask you to join a hair club, and some now even mandate massages to promote elasticity (you can find YouTube videos of doctor demonstrations on this).

      The idea I want to present is that transplanted hairs don’t survive because they’re transplanted into inflamed tissues wrought with calcification, fibrosis, etc.

      RE: Finasteride and Minoxidil–

      You’re absolutely right that they are clinically proven to help with hair loss. But if DHT were the main culprit, we’d expect 100% reversals using the drugs that reduce them (like Finasteride). Instead, we see only modest regrowth, plus a host of unintended side effects, like impotence. With that said, the Minoxidil + Derma Rolling study is an interesting one and already mentioned in the book.

      I’m not saying Finasteride and Minoxidil aren’t effective. I’m saying their efficacy is limited because of issues beyond DHT, and that there can be unintended consequences to using these drugs.

      RE: Belgravia Centre photos–

      They’re great photos. But the majority of those photos highlight hair transplants. Hair transplantation isn’t hair regrowth – it’s hair rearrangement.

      RE: postponing downloads due to chargebacks–

      This isn’t true. In the year that the book was available, I had two refunds. The book was also pay-what-you-want, so you could choose to pay $0.

      Best,
      Rob

  24. Dear Rob, can I please buy your ebook?
    My hair loss is causing me anger and ruining my confidence (I am in my twenties).
    I don’t need any email support, if that helps?

    Very best and really appreciate this.

    1. Post
      Author

      Hey James – this will all be a part of the book update! I’m planning on re-releasing it in two months time.

      1. Glad to hear this! I’ve been checking back for months and months now.

        Almost all the hairloss I’ve experienced was back in high school, in my opinion due to malnourishment and stress.

        Cut to 16 years later and I’ve not really lost any more at all, still looks pretty much the same.

        Would like to reverse it for sure.

        Again, def glad to hear this update. 🙂

  25. Rob,

    So….what do you say of all the people that eat clean organic foods and exercise regularly, people who live a healthy lifestyle yet still experience hair loss. And people who live a completely opposite life and have no hair problems. Homeless people who whose hygene is very different from other people, yet have no hair loss, or in prison where the population pretty much has the same diet…..some suffer hair loss others dont. Its all genetics and the end of the day…right? Ive heard about dermarolling your scalp and chemical peeling your head and blood flow, then why is there a pattern in male baldness? If dht is not the problem then why are people just loosing hair up top and not on the sides. Wouldnt calcification happen all over your head??

    Regards

    1. Post
      Author

      Hey Dave,

      Great points. The comment about homeless people and hygiene is actually addressed in the book. The gist is that for those who are chronically dirty / exposed to the outside (read: certain demographics of the third world, homeless, etc.), there’s a higher propensity for these people to be exposed to bacteria, viruses and parasites that may inform our immune function development as we age, and help shape it.

      One great example of this is in helminths – or hookworms – which are present in up to 40% of the population globally but are completely eradicated in the first world. Hookworms leach blood from our small intestines, and in order to ensure their survival, they must trick your immune system into making it appear as non-threatening. They do this by suppressing certain behaviors of our T cells, which would normally identify and attack the invading hookworms.

      http://www.ncbi.nlm.nih.gov/pubmed/22398370

      In doing so, the helminths ensure their survival but also modulate our immune reactions to similar aggressors. People with lifelong, non-threatening helminth infections have almost a zero incidence of allergies and auto-immune disease. It’s why researchers are now testing human helminths for the treatment of multiple sclerosis, IBS, allergens and beyond. Early results are promising but more studies need to be done.

      http://onlinelibrary.wiley.com/doi/10.1002/ana.21438/abstract;jsessionid=534C758BFA62C5D83A6EC0A39663ADB9.f04t02?userIsAuthenticated=false&deniedAccessCustomisedMessage=

      Couple that with an even more beneficial thing helminths do… blood depletion. Now if you’re over-infected, helminths deplete too much blood, which is a bad thing for obvious reasons. But across the first world, iron overload is a very prevalent problem in men. And there’s no way to deplete iron aside from blood letting (donation, phlebotomies, helminths).

      Just look at some of the research summarized about iron overload and aging here:

      http://roguehealthandfitness.com/iron-accelerates-aging/

      So when we talk about homeless populations or the third world being less healthy than us, we have to keep in mind the context of the Old Friends Hypothesis, the Hygiene Hypothesis, and the microbiome. There are even bacteria that eat cholesterol and help inhibit arterial calcification.

      http://www.france-science.org/A-cholesterol-eating-bacteria-in.html

      Scalp calcification is a factor in hair loss, and it’s possible the absence of certain bacteria could be a part of why the first world appears to bald faster than the third.

      So in short, it’s complicated. Genetics definitely plays a role in an individual’s susceptibility to hair loss. But does genetics determine destiny? I think epigenetics and the emergence of the importance of the microbiome refutes that idea.

      As far as the pattern formation of MPB, there are a few theories (Gravity Theory, Scalp Expansion Theory) that I’ll link below. Some of these tie into the idea of calcification, but the research is still ongoing:

      https://www.sciencedaily.com/releases/2013/10/131030092856.htm
      http://www.ncbi.nlm.nih.gov/pubmed/18789604

      Best,
      Rob

  26. Hi Rob,

    Thanks a lot for providing this information. I was wondering if I could buy a copy of your book. I used finasteride for years until I discovered it’s terrible side effects.

    I’ve tried everything imaginable including laser therapy with little success. I was considering a hair transplant until I read the posts. Thanks for that.

    I hope I can figure it out before it’s too late and it’s all gone.

    Thanks a lot.
    Ty

    1. Post
      Author

      Hey Ty – thanks for the message. The updated book should be available in about two months. In the meantime, you can check out JD Moyer’s blog posts about hair to get a head start on the process. I advocate for a moderate carbohydrate paleo diet (with some tweaks), lifestyle changes to support thyroid health, and massages (Detumescence Therapy) for addressing calcification and the other localized symptoms of male pattern hair loss.

  27. HI rob… Your article is the last hope in getting my hairs back… I m waiting your ebook.. Please send it to me or help me in buying.. Whatever is the solution… I have less time in my marriage and before that I want to get my hairs back… So please provide me your ebook

  28. Rob, I am interested in your book. Sounds fascinating. I read the Detumescence Study. Can you open up another spot so I can download it?

    1. Post
      Author

      Hey Shashi,

      Aside from being a 5-AR inhibitor, Finasteride also helps address some of the symptoms associated with MPB by down-regulating two protein coding genes – MMP-2 and MMP-9…

      http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0084757

      What this means is that finasteride likely helps remodel collagen in scalp skin. But collagen remodeling and calcification are two different factors in MPB.

      With that said, androgens probably play a role in calcification…

      http://www.ncbi.nlm.nih.gov/pubmed/19176322

      …But whether DHT (an androgen) is the driver of that calcification is unclear. The reason why is we see men with similar testosterone levels suffering from different levels of male pattern hair loss, and some not suffering at all. We’ve observed calcification of the scalp in those with MPB, so we know calcification is a factor. But because two men with the same testosterone level can be either totally bald or with a full head of hair, it doesn’t make complete sense that androgens, or DHT levels, drive the balding process entirely.

      Based on what we know, I think hormonal ratios (testosterone to estrogen) drive more of this process than androgens alone. But the research is still ongoing! As research shifts away from MPB drug testing and more toward MPB pathology, we will know more.

      Best,
      Rob

  29. Hi Rob. When will the book be available again. I’ve been looking every day in the hope it will come back. Can we not download it and not ask questions if you’re too overloaded. I just need to get more info asap. Thanks

    1. Post
      Author

      Hey Richard – we spoke via email already, but I’m shooting for a book update and release in two months. I’ll keep you posted with timing.

  30. Hi Rob

    Not sure this is the right place to be posting but i’ve been struggling trying to contact you.
    I recently discovered your methods to halt and regrow hair through J.D Moyer’s blog, I was desperate to purchase your ebook, but after speaking to him I learnt that you had stopped to release of it so that you could focus on helping people who have already purchased it which I can completely understand.
    However, I’m only 19 and my mpb is getting to the stage where I can’t even hide it anymore (temple points gone, crown thinning, hair on top getting lighter etc.) I was wondering whether there was a way that I could still purchase and access your ebook so that I could to benefit from it… Or if not then perhaps you could let me know when it would be available again’m very reluctant to use minoxidil and propecia but at the same time I can’t just do nothing

    Thanks in advance

    1. Post
      Author

      Hey David,

      I’m in the process of updating the book with readers’ before/after photos, a new demo video, a follow-along video, video interviews with the best responders, transcripts, and an FAQ. I’m shooting to finish everything in two months time. If you’re signed up to receive more information, I’ll be sure to send you an email.

      All the best,
      Rob

    1. Post
      Author

      Hey Bart,

      I’m planning on releasing a book update in about two months, so everything will be back online then!

      Best,
      Rob

  31. Hi Rob,

    Eagerly awaiting the updated book, after reading JD Moyer’s blog I started doing pretty intense massages but I’m not sure if I’m doing them right so I’m looking forward to being able to get some guidance and videos from you!
    In the meantime is there any chance you could email me your before and after pics?

    Thanks for all you do!

    1. Post
      Author

      Hey Alex – my plan is to put the before/after pictures on the site. I’m still waiting on permission from readers, so when that’s ready I’ll let you know! As far as the massages, JD Moyer’s blog is a great starting point, as are the comment sections of his / these articles. Otherwise there will be plenty of videos and demonstrations in the new update.

  32. Hey dude I’m a 17 year old kid. My dad started balding at 13 years old. I am not balding. My question is can I prevent baldness for a lifetime by preventing calcification. Is eating a paleo style diet really a preventative to baldness

    1. Post
      Author

      Hey John – diet is helpful but not always enough – at least in ALL cases – to prevent the calcification process. I’d recommend regular massages in conjunction with the diet. That seems to be more effective.

  33. The study concerning sperm counts concludes “that the decrease in DHT induced by 5ARIs is associated with mild decreases in semen parameters that appear reversible after discontinuation.”. It doesn’t ‘destroy’ as the article suggests.

    1. Post
      Author

      Hey Zulu – thanks for the comment. I’ll be sure to be more specific with my phrasing in future articles. To clarify, I should’ve also referenced a link to the post-finasteride syndrome support groups, of which many members’ semen parameters don’t recover even after discontinuing use:

      http://www.pfsfoundation.org/resources/

      Best,
      Rob

  34. Its scary how you can so calmly print such misinformation for the sole purpose of self promotion and profit. In the early days of “modern” hair loss research there were many hypothesis’ on the mechanism of hair loss, some of what is still not fully understood since there are more androgens at work other than just DHT. So I will agree with you on one point, DHT is not the sole reason for androgenic alopecia. Having said that, there has been extensive research spent on this pore blockage theory. Nothing you mention in your cunning attempt to undermine conventional medicine addresses the hair loss process on a cellular level. Your claims, though sounding quite plausible and having tiny elements of truth to them have negligible overall effects on someone’s hair. Finastedride alone is far more effective than any topical, massage, laser or any other esoteric process used to invigorate blood circulation, as well as scalp dht blockers and pore cleaners. This is something that cannot even be argued.

    1. Post
      Author

      Hey Htk – You are entitled to your opinion, but I do want to clarify that I don’t subscribe to the pore blockage theory. There are a variety of conditions observed in the scalps of those with pattern hair loss — fibrotic tissue, calcified vessels, calcified scalp sutures, excessive dandruff, excessive sebum — that are either under-addressed or unaddressed by drugs targeting the inhibition of DHT via type II 5-AR, like Finasteride. There’s evidence to suggest that these symptoms are the result of prolonged, chronic inflammation in the scalp and surrounding tissues. My argument is that without addressing these underlying factors, drugs like Finasteride are only partially effective at best, and impotent-rendering at worst. In the next few weeks, I will update this article to make the argument more specific (elaborating on serum DHT, tissue DHT, DHT’s role in inflammation signaling, etc.). In an effort to keep the writing concise, I didn’t address these components. Based on your comments, I will make the revisions. As far as spreading misinformation — that is not my intention. I’d actually argue the opposite of you — that drug companies like Merck (the owners of Propecia) are the ones spreading misinformation about the causes of hair loss for their own “self promotion and profit.” The methods I use for hair regrowth are free, which is the irony here.

  35. Pingback: Men: Stop Thinking Your Hair Loss Is Due To High Testosterone — Perfect Hair Health

  36. hi body… i want to ask, do you believe that hair follicles die?

    I lost %50 of my hair 4 years ago. i guess it was telogen effluvium. what do you think about this, can i have hair back? is 4 years long time for “dormant” hair follicles?

    thank you!

      1. Post
        Author

        Hey Kurco,

        I don’t believe hair follicles die. The balding process takes a hair follicle from thick and terminal to thin and vellus. In more advance stages that follicle doesn’t even break the skin and might become trapped in fibrotic tissue. But the stem cells for the follicle are always there, and so the follicles remain “dormant.”

        Even in cases of hair loss like androgenic areata (AA), we’ve still seen individuals make full recoveries and even after years of baldness. So I think hair always has the potential to be recovered. Pattern hair loss (MPB) is a different kind of hair loss with different scalp conditions that precipitate the loss of hair, but in general, the same is true in both AA and MPB.

        As far as telogen effluvium – if that’s what caused your hair loss, usually that’s stress related and temporary. I would expect those hairs to have returned four years later, so if you never recovered them, you might want to look into AA or MPB.

        Best,
        Rob

  37. Hi Rob,
    I am a 17 years old male and my hair on the top and side of my head has thinned out quickly in the last three months, is this male pattern boldness? I have been massaging on and off over the last month, would that contributed to the thinning of the hair? My final question is how can i massage the top of my head if i don’t want to pull out hair prematurely?

  38. Helo dude, i have been with a falling problem from my schooling as far as i know since 2004. Even i dnt know anything wat is going on i used to shave my head frequently thought that is only thing escape frustrated .but i know even it was a small strands too fallout regularly.months passed it was so virulous falling i can saw lots of hairs was falling on my pillow at morning. thats really devastated.
    However later i realized it was a dirty dandruff patches so wildly. I honestly saying i dnt take much care about my hair on school days earlier. Dont wash frequently and always do hard brush on scalp too whenever i felt it was itchy.might be the cause.at now So i had been visit lot of doctors steps, websites basically i dont want unnatural things as much as i can.one point I had get 50% of my hair after some dandruff treatments in a familiar saloon in india after a boy work there said to me it was dandruff only and can get rid off. So by compulsion with strong hope on himself i did that and feel astonishingly new strong hairs in the process. I was so happy i aever been then. After a year but the problem started and continue.but this i dnt have that nasty dandruff. Because i came to know the significance of head washing.now i continue hardly washing even hairs falls.
    I have no idea what is the real cause and willing to know the root cause and hardly trying to address it. iam 30 i trust i will get rid if it as earlier. Sorry for the unfair history. Just want u know the path i crossed.
    How can i contact you ?
    There is no mail id / contact overe here. Can u helo to get over thus please ? I had such a blossom hair . Hope to get back but dont know how ?

    1. Post
      Author

      Hey Raja, thanks for writing in and commenting. I think a good course of action is for you to read through others’ comments and the articles on this site. I think you’ll find the answers to your questions above (and the questions asked in your other comments) answered there. As far as my contact information – I don’t list that on the site. However, if you sign up for more information (either on this page or on the front page), you’ll receive an email from me in the next few weeks announcing the launch date of the new book. Then you can email me back.

      Best,
      Rob

    1. Post
      Author
  39. I am eagerly awaiting your ebook. But i just need to know where i have to purchase it from? And how i will know when its here?

    1. Post
      Author

      Hey Akeel – if you sign up on the home page, I will email you when the book update is ready for release. I’m shooting for sometime in mid-September. Best, Rob

  40. I had some regrowth with finasteride, in parts of the bald scalp where there previously were only miniaturized hairs. I wouldnt worry about the sperm count, i had a big reduction in sperm VOLUME when using finasteride that continues to this day despite being off finasteride for 2 years. The good thing about spermcells is that theres so many millions in each load, a really massive overkill, a 30% reduction isnt going to reduce your ability to make babies, i know it didnt for me.

  41. My doctor prescribed dutasteride (at my request) for off-label use to treat hair loss. I can attest that DUTASTERIDE WORKS. I get my haircut every 2 weeks to get a skin fade (hair at the top which gradually fades to skin at the ear level). This cut makes hair growth very easy to notice. Since I am obsessed with my hair line, I noticed that my receding hair was reversing. I was on finasteride for 16 years, and it gradually lost its efficacy. I also noticed that my chronic seborrheic dermatitis (dandruff due to excessive sebum) has subsided significantly (the itching and flaking). I read that attempts to market Avodart as a treatment for hair loss were ceased for an undisclosed reason. I can only guess that it involves corruption among the pharmaceutical companies. It is a travesty, because dutasteride really works. Don’t listen to what this guy says.
    Also, the only side effect I’ve ever noticed was decrease in semen quantity. A small price to pay for a full head of hair, in my opinion. And I truly doubt that men care more about sperm count than their hair. I often wondered if it was men who cared about that or their wives. Anyway, it’s the only treatment that’s worked for me. If you have any doubts, just google dutasteride and read the studies.

    1. Post
      Author

      Hey David – that’s great that you’ve found a regimen that works for you and without significant side effects. There are genetic and epigenetic factors that determine dutasteride’s efficacy for each individual. It works for many people. For others, it works with side effects. For some, it doesn’t work, and the side effects are severe and long-lasting.

  42. Pingback: The Exercise And Hair Loss Connection — Perfect Hair Health

    1. Post
      Author

      Hey Akeel – I’m shooting to release everything within the next three weeks. When I have a date locked, I’ll email everyone who’s signed up for more information. So if you’ve signed up on the front page, you’ll be the first to know.

    1. Post
      Author

      Hey Alec – my hope is to have everything released within the next three weeks. If you’re signed up for more information (either on the front page or on the right side of this page), then you’ll be the first to hear about the launch date.

    1. Post
      Author
  43. Hi Rob,
    I am 19 and have been using detumescence therapy for 3 months now. My scalp feels astronomically looser now and I have seen a few vellus hairs in the front. No significant regrowth yet. Just wondering if I should keep going. How was your progress around this time?

  44. Hi Rob,
    thanks for the info you’re sharing here.
    I’d like to know whether in the ebook you’re about to publish we’re going to find useful information on how to cope with calcification/fibrosis/inflammation.
    I look forward to hear from you
    Nicholas

    1. Post
      Author

      Hey Nicholas – yes, the book will absolutely focus on calcification, fibrosis, and inflammation. Calcification and fibrosis are the two big hurdles of pattern hair loss. They’re downstream of increased tissue DHT in the scalp, and they’re chronic, progressive conditions. DHT blockers often slow fibrosis and calcification’s progression, but they don’t reverse what’s already accumulated. That’s why drugs like Finasteride are more or less limited to arresting hair loss, not reversing it.

  45. Hey, Rob. Sorry for the somewhat confusing post. I copy pasted what i wrote on another blog, & forgot to alter a few sentences here & there, that’s why my comment may seem a bit unrelated, but related to hair loss nevertheless. Had it not been for this sudden onset of violent itchiness for the past 7 years, i’d have no hair loss at all. Extreme itch, burn & piercing sensations just appeared out of nowhere several years ago, & extreme hair fall coincided with that. If i ran my hands up & down through my head over the basin, the basin would be filled with lots of hairs.

    1. Post
      Author

      Scalp itch is also something I (and many others) experience when hair loss begins and progresses. As far as its source – it might be a symptom of a decrease in blood flow, or an overproduction of sebum, though I’m not 100% (no one is).

  46. Rob,

    I’ve been following JD Moyer’s massage regime for close to a year and have observed reduced shedding but little other progress, and possibly some further thinning.

    I’m signed up so eagerly await you eBook.

    My question surrounds the technique – when I massage hard and deeply as described by JD, my scalp, in the especially thin and calcified areas becomes inflamed and sore. If I try to do this twice a day it becomes systemically sore. If I leave it or massage only gently for a couple of days then the inflammation dies down, by then I question the efficacy of the lighter massage – I’m not really rearranging the tissue to any great extent.

    Can you advise on the what is the best approach?

    Many thanks

    1. Post
      Author

      These are tough measurements to gauge (pressure, intensity, recovery, etc.), and even harder to describe through writing. The new videos and follow-along videos are the best resource I can offer on this. Otherwise, try following this rule of thumb: by the beginning of your second massage session of the day, your scalp should feel 95% recovered from the first session. That’s just the slightest increase in feeling. Not necessarily painful.

  47. Hi Rob,
    I’ve been doing the massages a few weeks now, as well as head stands and vigorous brushing. My questions:

    1.what does scalp calcification actually feel like? I haven’t noticed any hard parts on the scalp, I’ve just noticed some parts are much thicker and harder to pinch I.e. The temple skin is very thin and malleable but the skin on the top of the head is su0er thick and hard to grab.

    2. also, even though I’m really getting in there and kneading, pinching, pressing etc all I get is a generally oily sensation on my fingertips but never do I actually see ‘stuff’ on my fingertips. Should I be seeing more stuff, like squeezing a pimple? Nor do I see dandruff.

    3. Sorry last question: mostly until now, mainly my baldness was in my temples receding. But it seems like my temple skin in the absolute thinnest and easiest to pinch on my whole scalp. Shouldn’t this mean they have the best blood supply? I don’t get it.

    Thanks for all your info.

    Ps I would also love a copy of your own before and after pics if possible.

    Thanks,

    Jim

    1. Post
      Author

      Hey Jim,

      1. You can rarely actually feel calcification of the vessels / sutures supporting the follicles, but you can feel its symptoms. Look for tighter, thicker scalp skin. Another factor is fibrosis of the scalp skin – this doesn’t always result in visual changes, but in advanced stages, it can give your scalp an added shine. Just look at the comparison of a balding scalp to the hands of a scleroderma patient. Both conditions are driven through fibrosis and excess collagen.

      2. During the massages, sebum release isn’t always reported, and isn’t always necessary to experience for regrowth. As such I’m no longer telling people to look for it. I saw a lot of sebum release, as did many others, but it’s just not something everyone getting results reports. Same with dandruff. They’re usually just indicators of strong enough intensity.

      3.Another person asked this question, and you can find the answer in the comments section here: https://perfecthairhealth.com/why-i-stopped-using-shampoos-and-conditioners-forever/ Just search for “Dante” or “Hic-5”.

  48. Hi again Rob,

    For me, another huge question about something that troubles me deeply about this whole detumescence thing: why is dr. Choy’s paper so poorly presented? There are basically no photos to show the results he claimed to have. Did that not put you off? There are a couple of photos, sure, but they seem ridiculous and unclear to say the least. If he regret hair in 100% of subjects then why not document it better?

    It’s worrying.

    Ok LAST THING; surely, surely, not all bald men have dome heads. ??? And surely a lot of full hair people have some shaped heads under the hair??

    1. Post
      Author

      Hey Jim – all of this is addressed in the new book. The short answer is, even without the Detumescence Therapy study, there’s an overwhelming amount of evidence that wounding / healing promotes regrowth through mechanisms that DHT blockers cannot perform. Angiogenesis, collagen remodeling, a reversal of fibrosis, and potentially helping break down calcification in the vessels supporting the follicles. The presentation of Choy’s study isn’t perfect by any means (I think it’s been translated), and the photos aren’t so scientific either. I’m the type of person who won’t leave any stones unturned, so I started DT with an open mind and low expectations. I wasn’t necessarily worried about anything, though. If I didn’t see results – I would’ve been in the same place as I was before I tried it. Not the end of the world, and worth the experiment.

      DT is also just one study. We need repetition of methods and results with multiple studies before we can say whether one study is replicable. That’s the basis of research. But based on related fields’ work — Rei Ogawa’s work with stretching, mechanostimulation, perfect wound healing, massage, and hair loss — and the supporting literature of wounding, collagen remodeling, and even derma rolling and hair loss — I’d say the evidence tips in the DT study’s favor. To summarize — even if the DT study were never done, it wouldn’t matter.

      You definitely don’t need to have a dome-shaped head to suffer from hair loss, or much change in scalp shape for that matter. Just look at Kelly Slater. Minimal scalp shape change over the last twenty years, but near complete baldness. I think DT got the methods right, but not the theories behind why they work. Again, this is all addressed in the new book in greater detail than I can type in the comments, but wanted to give you an answer in any case.

  49. Hi rob,
    What does sebum look like? I don’t see anything come out after a massage. Does this mean sebum isn’t my problem? If so what else could my problem be then, a blood flow issue alone? Thanks

    1. Post
      Author

      Hey Greg – not everyone reports sebum release when doing the massages. Sebum is usually clear and feels like oil residues. Sebum isn’t necessarily the problem – it’s a symptom of the chronic progressive conditions (calcification of blood vessels supporting follicles, fibrosis of scalp skin) that precede hair loss. So whether someone has excess sebum or doesn’t, doesn’t necessarily mean anything. It’s just one way of expressing symptoms.

  50. Rob,
    I’ve been doing the massage technique for 3 months now. I have had some minor progress and a few vellus hairs along the hairline, nothing major yet. I have expelled a lot of sebum and my hair has been very greasy (in a good way). How was your progress around 3 months. My hair honestly does not feel or look that different but I can tell my scalp is MUCH thinner and more flexible now. How long do you think until I see regrowth? 5 months? 6 months? Also awaiting your ebook very eagerly. Do you give links to any studies in your book? There seems to be no literature on this technique and I have been researching intensely and haven’t found much.

    1. Post
      Author

      It’s tough to say as everyone’s different. I’m not necessarily the person you want to benchmark against — I massaged incorrectly for 2-3 months before uncovering techniques that worked for me. The book is filled with hundreds of links to studies and I always cite my sources. The massage techniques in the book and video are based on the techniques that brought me success, and the commonalities in techniques of other readers who experienced the most regrowth.

  51. One day i had a full head of hair. Thick, straight. Literally the next day (night to be exact) after washing my hair in the shower, large clumps of hair appears in the drain. I look in the mirror, bam, 3 patches of thinning, right then & there my hair became nappy too. So much nappiness. What a difference a day makes. Itchiness that woke me up at night. A red scalp, little white balls of skin under my finger tips. Etc. Etc. So these are all symptomatic of MPB… Thanks Rob

  52. Just out of curiosity, in the advanced stages of doing detumescence how pinchable does the previously thick parts of scalp become? I.e, will the top,of my head be as loose and thin as my temples?

  53. When you talk about pinching and pinchability of the scalp I can hardly relate… I’m a 36 yo female, within the last 4 years I lost 1/4 of my hair and they stopped growing in the front and on my temples. Temples are covered with tiny tiny hair but they never grow in length anymore. I massage my scalp with fingertips and my knuckles, but pinching is not possible anywhere on my head, I seem not to have that much skin, I don’t think I ever had it much looser. Is this normal? Is there any chance for me?

  54. Let me add that when I massage my head I feel there’s only a thin skin layer and right underneath it the skull bone, I don’t feel anything in between.

  55. Hello, you should consider a Spanish translation of the book in the future because people like me who speak Spanish you might not understand some things.
    Similarly if the English is correct and videos are intuitive we will make it easy to understand XD.

    Another thing that would be good is to do a group official facebook for those we buy the book and so we can share our photos and experiences.

    Thanks for considering.

    1. Post
      Author
    1. Post
      Author
  56. If calcification and fibrosis are the primary factors in hair loss, then shouldn’t substances like vitamin k2 and magnesium (critical in calcium placement), and glycine and taurine (which have shown the ability to prevent hepatic fibrosis) be useful treatment tools?

    As for the collagen remodeling, what options are there other than massage and dermaneedling? I know glycine, vitamin c, and a host of other substances are important for collagen synthesis, but I don’t know if they’d induce remodeling. There should be something like Finasteride, without the anti-androgen effects, than can influence the remodeling genes.

    1. Post
      Author

      Hey Matt – yes! All of the things you’ve mentioned should be helpful. I opt for food sources over supplements to obtain them (raw shellfish, chicken liver, fruits, bone broths, etc.) but occasionally supplement with K-2 (natto source) and magnesium.

      As far as options that encourage collagen remodeling outside of the substances you listed, derma rolling, and massage – it’s hard to say. What’s interesting is that every protein / fatty acid that’s been shown to be associated with hair loss — prostaglandin d2, transforming growth factor, BMP2, BMP4, etc. — all double as calcification inducers.

      We know that androgens + androgen receptors are required for calcification and fibrosis to occur, and not just androgens alone:

      http://www.nature.com/articles/srep24807

      We also know that tissue DHT encourages hair growth in the body and face, but also hair loss in the scalp. Interestingly, in the scalp, body, and face, both androgens and androgen receptors increase near hair follicle sites. In the scalp, we also see an increase in fibrosis and calcification that precede hair loss. But surrounding hair-bearing body and facial tissues, we see neither.

      This leads me to believe that in order for calcification and fibrosis to occur in our scalps, we need all three factors:

      1) Increased DHT
      2) Increased androgen receptors
      3) Imbalanced calcification regulators (the proteins / fatty acids that either inhibit or induce calcification)

      So my research right now is focused on that third factor. I’m really curious to see what dermarolling + a topical transforming growth factor beta blocker would do for the hair. My guess is that that combination might answer your question… It might be more effective than finasteride and without the anti-androgenic effects. I haven’t tried this since I saw success with the massages alone, but I figured I’d pass along the thought since you asked the question.

      All my best,
      Rob

  57. Hi Rob,
    any estimate on the release date of the book ? Do you still recommend avoiding grains and legumes as you did in your previous book ?

  58. Hi Rob:

    So, almost unbelievably to me, Ive managed to loosen up even the really thick parts of my scalp i.e. the top centre ridge, and forelock area. Still not as plyable as other areas, but i can actually pinch them now.

    Does this kind of loosening up precede new growth? Or are they not related? My whole scalp is like 60% looser than when i started.

    1. Post
      Author

      Hey Jim – increasing scalp elasticity is necessary for regrowth. 100% of the people who report regrowth also report improved scalp looseness. It precedes regrowth by at least a few months. So it sounds like you’re on the right track!

  59. So you can reduce inflammation, calcification and fibrosis in the scalp by daily scalp massages aswell as a better diet plan? and that will stimulate regrowth?

    I just gave myself a good 20/30 minute massage and my scalp tingled all over the top, is this good?

    1. Post
      Author

      Hey Steve – more or less yes. The whole 250 page book explains why (and how), so it’s a bit hard to summarize here. But yes, massaging helps reverse the two chronic, progressive conditions that precede hair loss (fibrosis and calcification), and diet helps stop those conditions from recurring.

  60. Pingback: The Case Against A Hair Transplant — Perfect Hair Health

    1. Post
      Author

      Hey Ahmad – that’s right. This article explains the shortcomings of conventional hair loss drugs, and what we need to focus on to make them most effective (fibrosis and calcification).

  61. My experience with Finasteride contradicts some claims in this article. I started on it at age 55 – only because I hadn’t heard about it before then. My hairline was in decline for nearly 10 years and I had lost a great deal of my hair. But in just 3 months of using Finasteride 1mg, not only did hair fall stop I started growing hair where only skin used to show on my scalp. I am into my 4th month of usage and I just can’t say enough of this product. It is a miracle for men.

    1. Post
      Author

      Hey Jay – that’s great to hear. For some men, Finasteride is effective at stopping hair loss and even for partial hair recovery. As long as you’re not experiencing any side effects, it sounds like you’ve found a regimen that’s working!

  62. Hi Rob,

    I’ve just finished reading your book. Thank you for all the info, that was a great read. Most of the diet info I already applied, thanks to the perfect diet book by Paul Jaminet (highly recommended should you not know it yet).

    About the massages: what do you think of scalp massager devices? There is one called the pure therapy scalp massager that seems to really get the blood flow going. Have you ever tried something like that?

    1. Post
      Author

      Hey Pablo,

      Thanks for the comments – and that’s great to hear! I’m not a fan of massage devices for a few reasons. The first is that massage devices often create a lot of friction against the scalp skin, rather than manipulating the scalp skin itself. This can cause shedding. The second is that the massages are dynamic – meaning as your scalp becomes more elastic, the intensity of your massages should also increase. Massage devices can’t really adjust for that like your hands can. And the final reason is that I’ve never found a massage device that can pinch, press, and stretch the skin as effective as your hands. With all that said, I know some readers use massage devices when their hands hurt as a supplement to the actual massages, and that some say they really enjoy this.

      Best,
      Rob

  63. Nope wrong , I had flap surgery 20 years ago , and the hair is as thick as the day the operation happened . No thinning or loss . Come on your own theory does not add up .

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  64. STOP USING SHAMPOOS & CONDITIONERS WITH SULFATE AND PARABENS IN THEM AND YOU WILL STOP LOSING YOUR HAIR. I MADE THIS DISCOVERY WHEN MY HAIR STARTED FALLING OUT IN CHUNKS. CETYL ALCOHOL AND OTHER ALCOHOLS IN SHAMPOOS ETC ARE THE MAIN CAUSE OF THE DHT PROBLEM. I STARTED USING SULFATE AND PARABEN FREE SHAMPOOS & CONDITIONERS AND MY HAIR STOPPED FALLING OUT & IS NOW GROWING BACK. DONT BELIEVE ME? TRY IT. I RECOMMEND DELON SHAMPOO & CONDITIONER. YOU CAN GET IT AT GROCERY OUTLET FOR 3.99 EACH. THERE ARE 4 DIFFERENT ONES. A RED, BLUE, GREEN OR YELLOW BOTTLE. I AM USING THE GREEN ONE. ALSO THERE IS A A SHAMPOO YOU CAN GET AT FRED MEYERS FOR 6.99 CALLED BAMBOO COCONUT WATER SHAMPOO BY RENPRO THAT IS EVEN BETTER IF YOU CAN AFFORD IT. PROPENCIA IS CRAP AND WHAT IS MAKING YOUR HAIR FALL OUT IS THE DHT PROBLEM. STOP USING SULFATES AND PARABENS AND YOULL CURE THE DHT PROBLEM AND YOUR HAIR WILL START GROWING BACK.

  65. Hi Rob,

    I have severe hair thinning evenly on the top of my head for the past 3 years. I’ve tried laser and minoxidil but that just made it worse. Recently I shed excessively every morning and my hair is minimally thin now.

    But I realised it might not just be dht causing my hair loss, I have noticed that for the past 3 years my scalp has been very itchy, probably dry, and I wake up with dandruff every morning. Do you have a detailed solution of what I can do.

    Thanks so much

    1. Post
      Author

      Hey Daniel – the best resources I can offer is the book I just finished rewriting. But you can also get a lot of information just by reading these articles. You could also sign up for the free email course on the front page. In short, I think scalp mechanical stimulation exercises plus the right diet / lifestyle are synergistic for hair regrowth.

    1. Post
      Author

      Hey James – diffuse thinning is a part of pattern hair loss. And since the book targets to stop and reverse pattern hair loss, diffuse thinning is included in this. If you’d like to read more about diffuse thinning, I mention it in this article. Best, Rob

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  72. Hi Rob,

    I came across an article that talked about genetics of hair loss, and how there was an experiment that implanted hair from the head to the arm and the hair on the arm continued to miniaturize in sync with the neighbouring hair on the head.

    What is your view on this?

    regards,
    Andrew

    1. Post
      Author

      Hey Andrew,

      It’s a great question. The study that you mention suffers from a major pitfall, and conflicting findings from two other studies:

      1) The hair follicles transferred were likely also transferred alongside the follicle’s surrounding tissue — meaning that any perifollicular fibrosis (scar tissue) constraining blood flow to those follicles was also carried to the arm (which would explain the continued rate of thinning).

      2) There’s another study showing that when balding human hair follicles are transferred to rats, the hair regrows and regenerates in a matter of weeks.

      3) There’s another study that concludes that transplanted hairs have a “donor dominance” — or in other words, that transplanted hairs take the form of the hairs to which they’re most closely transplanted. On the average, arm hair is much thinner than healthy scalp hair. So it would be expected that a thinning scalp hair transplanted to our arm would continue to thin until matching the volume and density of the hairs to which it surrounds.

      Overall, the results of the study on transplanted hairs continuing to thin are explainable through other studies. But more importantly, these other studies override the idea that “genetic sensitivity to DHT” is what drives pattern hair loss.

      I wrote a little more about genetics and transplanted hairs in these two article:

      https://perfecthairhealth.com/the-case-against-a-hair-transplant/

      https://perfecthairhealth.com/genes-and-hair-loss-not-so-simple-anymore/

      Best,
      Rob

  73. I was thinking about your course but my understanding is once follicles are suffocated they are pretty much dead and will never produce hair again. Is this true?

    Also, why do transplanted follicles thrive in the same location, without succumbing to the fate of the old ones? Maybe some hair follicles are resistant to this type of damage?

    1. Post
      Author
  74. Why did you leave out the idea that people with male pattern baldness have hairs that are genetically designed to be more sensitive to DHT. There is a reason its a heredity problem. The calcification stuff you mention is not male pattern baldness. You are most likely lying about what you did to regrow you hair. There’s a high chance that you were never balding in the first place. A person with male pattern baldness cannot use a diet and lifestyle changes to change the androgen receptors on their scalp and hair follicles.

    1. Post
      Author

      Hey Tom,

      1) The idea that hair follicles above the galea aponeurotica are more sensitive to DHT – and thereby miniaturize in the presence of DHT – has never held any scientific merit. It’s a gross mischaracterization that most hair transplant surgeons use to simplify hair loss pathology for curious patients. The DHT-sensitivity hypothesis doesn’t explain 1) why DHT arrives to those hair follicles in the first place, 2) how DHT miniaturizes hair follicles, or 3) why DHT simultaneously encourages hair growth in secondary body and facial hair tissues. I encourage you to read more here:

      https://perfecthairhealth.com/the-ultimate-hair-loss-flowchart-why-we-lose-our-hair/

      https://perfecthairhealth.com/the-leading-theories-of-pattern-hair-loss/

      2) Fibrosis and calcification are likely involved in the pathogenesis of AGA — with either perifollicular fibrosis, dermal sheath thickening, or other scarring-related tissue changes observed in all AGA-affected tissues. For now, please refer to the links above for more information. I have a paper currently in its final rounds of peer review that attempts to clarify a new AGA pathogenesis model, and once that becomes available, I’ll share it on this site.

      3) I don’t advocate — exclusively — for dietary and lifestyle changes to reverse hair loss. At best, diet and lifestyle changes slow or (very rarely) stop hair loss — depending on whether you’re suffering from AGA, telogen effluvium, or alopecia areata. I would never tell someone that simply changing their diet and lifestyle will fix their hair problems. That’s short-sighted and unsubstantiated.

      4) My pattern hair loss diagnosis from 2007 is posted all over this website.

      I’m happy to clarify anything else, but please substantiate your claims with peer-reviewed research before calling me a liar or mischaracterizing the treatments I advocate.

      Best,
      Rob

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