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First off I've been testing scalp massages as a way to promote hair growth, this method seems to be frowned upon and even ridiculed in some hairloss discussion sites. As you look into the mainstream hypothesis massages look less and less likely to do anything, it's all about androgens and DHT right? Well under the mainstream hypothesis minoxidil doesn't work, a lot of the write ups I read on it actually completely disregard minoxidil simply for the sake of the theory. Typically you hear "no one knows by which mechanism minoxidil works, it's a mystery to science."
It's easy to assume that minoxidil being a vasodilator, grows hair by increasing bloodflow to the follicles consistently over long periods of application. I've heard some hypothesize min actually has an effect on PGD2 and PGE2 but I believe the primary mechanism is as simple as bloodflow. After you break your arm and finally take the cast off you will notice the hair is longer and thicker there, this is from increased blood and nutrient supply to the area from the healing process. The same way in which microneedling regrows hair. So anything that increases bloodflow to the follicle should theoretically have a positive impact on hair growth.
Scalp massages work by two mechanisms:
Increases bloodflow to the scalp and follicles (this is a temporary boost to the follicles and it's unlikely to have much of a long term benefit)
Breaking up the fibrosis / relieving scalp tension (this is much more likely the mechanism in which scalp massages grow hair as it puts the scalp into a better condition where blood flow is more consistent and the balding process lessened, loosening of the scalp will also help stop DHT being used as an inflammatory response preventing fibrotic build up.)
When you consider how long you actually have to have minoxidil on your head, almost 24/7 it becomes hard to imagine something that would increase blood flow to the follicles over that period of time. Unless you are consistently massaging your head which is unrealistic it's unlikely you'd have much regrowth at all. You need a way to provide consistent blood flow to the actual follicle and not just the scalp. The fibrosis in the scalp is the main cause of inhibiting bloodflow killing off the follicles. They are chronically deprived and a short little boost of blood supply is unlikely to do much.
Fibrosis is found in the scalps of building men, under the hypothesis I believe DHT causes the fibrosis as an inflammatory response in relation to chronic scalp tension. There is a good little test that you can do to prove the validity of this, if you pinch the scalp in the areas which are bald you will notice the skin is both thicker and less pliable than areas of hair growth, this is due to fibrosis.
Minoxidil is actually rather ineffective alone and the fibrosis explains it, derma rolling dramatically improves the results of minoxidil and it's not because it increases absorption. You actually want quite the opposite since it can have some serious health effects if absorbed into the bloodstream. Aside from supplying the follicles with a consistent blood supply from the healing process derma rolling also likely partially breaks up and reverses the fibrosis present in the scalp allowing minoxidil to do its job to a better degree.
I've heard from a few people before getting a hair transplant the scalp is often derma rolled and massaged so it is in a suitable state to sustain the transplanted hair. The most recent of which is this guy who got a professional opinion on the options. I was surprised to find that his views on current treatments perfectly reflected my own based on my personal research.
My anecdotal experiences (Regrowth thread here)
So far I've had good results from scalp massages, folliculitis, scalp itch, excessive greasiness and shiny scalp qualities are no longer present and overall hair quality has seemed to improved, it seems to have more life, it's stronger, springy and can support its own weight as opposed to just flopping down. Also while massaging in the shower I've had a few healthy hairs accidentally rip from my scalp, what I found is that they were incredibly thick and about 3-4cm in length. I'm just going to call them super hairs and make a post about them in the future.
When I stopped massaging
Around the very start of August I was growing rather happy with my regrowth and I thus became more lazy. Hairloss was consuming too much of my life and I managed to get a lot of study for my future in and I slowly did less and less scalp massages. It went from a few minutes a day, to a couple to just 30 seconds and then I stopped completely. Everyone was rather dismissive my regrowth was actually a result of scalp massages and attributed it to nizoral and derma rolling. During this period I continued those and stopped fish oil, scalp massages and exercises as I was losing faith with everyone's dismissal, my sleep pattern went downhill severely and there was 2 days which I skipped showers. What I noticed was that my scalp itch was coming back and so was some of my dermatitis, this sort of sent me into an alert state as typically the itching is accompanied by shedding in my experienced so I doubled down on Nizoral and my dermatitis and itch continued. I tried to get back to doing scalp massages but every time I'd start my hair would start shedding quite a lot so I was too scared to lose my gains but the itch and dermatitis was slowly getting worse.
Eventually I decided to stop Nizoral application and just use scalp massages. Interestingly my scalp itch and dermatitis disappeared although on the day of the massage I shed a couple of hundred hairs just in the shower alone. My hairline and the top front middle of my head took a hit, my vertex was as thick as ever though. Interestingly I never massaged or micro needled my vertex often as it's difficult getting back there which could also mean the regrowth experienced there wasn't as reliant on massages/wounding. Currently my hairline is back to regrowing, a few days ago it looked like I had tons of blackheads with all the hairs sprouting back out. During this whole period vellus hair seemed to be unaffected and was as healthy and as long as ever. I also reintroduced Nizoral which led to a minor shed which was interesting. As of now I'm no longer shedding hairs again and I typically only lose 5-10 per massage in the shower.
The regrowth isn't likely sustainable
Despite growing any hair you're not actually stopping the balding process so finasteride would likely still need to be used anyways, I've tried looking into natural alternatives and there simply isn't anything quite like finasteride in terms of effectiveness. I've heard positive things about topical finasteride which gets around the potential sides. Currently I'm not using finasteride but I'm considering finasteride for the future if I lose any ground. If your balding slowly it's possible the regrowth could outpace the balding.
I've heard some positive things about essential oils such as castor oil, peppermint oil and rosemary oil. Out of those castor oil has no scientific backing but peppermint and rosemary do, most notably rosemary oil also being a vasodilator was found to be equivalent to minoxidil 2% in hair regrowth. That's not too bad for a natural alternative although there simply isn't enough information on those oils for me to commit spending money on them. I struggle to find much about how often to apply and if it needs to be left in, I don't really want to spend money on an inferior minoxidil if I have to leave it on my head for 8 hours. Additionally the limited information means that any potential side effects aren't known.
Studies:
The main study around scalp massages (detumescence) which found that 20x minute massages daily resulted in 90% regrowth isn't credible and most likely untrue as it's published in a predatory open access journal by a publisher (OMICS) known for accepting fraudulent papers.
Luckily however there is one legitimate study that has been done, it found that 4x minute scalp massages daily increased follicle width although density was unchanged. Gene expression was also changed via the massages. Now if we think about the actual balding process the hairs don't completely die out initially, they get weaker and weaker, eventually turn to vellus hairs and slowly fade away into almost nothing. Boosting the strength of an individual follicle would increase its overall health and lifespan and could possibly bring back some of the healthier vellus hairs to a terminal state.
The main hypothesis I believe, it's worth noting that literally every theory in the hairloss world is a hypothesis as male pattern baldness isn't something that has been solved yet.
There is a link between the balding pattern and chronic tension on the scalp. This most likely plays a part with androgens and DHT in the actual balding process. Under the hypothesis I believe DHT is used as an inflammatory response to chronic scalp tension in people that have the necessary genes. this leads to fibrosis in the scalp which inhibits blood and nutrient supply to the follicle.
I could only find a single study which only used microneedling as a control group, it was found to be more effective than minoxidil alone in terms of regrowth. This is quite promising for mechanical stimulation as a means to regrow hair.
Regrowth 24weeks:
Minoxidil only 18.8/cm2
Microneedling 23.4/cm2
Microneedling + Min 38.3/cm2
I know this is a mouse study but I actually only just found this study when looking for why moles grow darker and thicker hairs Blood Vessels Hold Key To Thicker Hair Growth, the interesting part is that it states "The discovery that increasing blood flow to the scalp helps stave off baldness may be old news to many barbers. For years, they have been advising clients to massage their scalps as way of stimulating circulation and hair growth." I actually had no idea this information had been around for so long, it's not entirely relevant but it definitely points at the fact of blood flow equates to hair growth.
How to do the massages -
This video more or less describes it well enough.
The technique isn't entirely important as long as you are breaking up the fibrosis and promoting blood flow to the follicles. To do this you need to go quite deep and forceful into the scalp. If you are doing the massage correctly after some time you will hear an odd crunching sound. I made a thread about this awhile ago. I can only assume this is the fibrotic tissue in the scalp being broken up, the more you massage the less and less of this crunch you will hear although it slowly comes back if you stop doing them. This is the best way to gauge how much you need to massage as opposed to massage x minutes daily. Typically I massage around 5 minutes a day, in the early days you should massage a bit more. Perhaps 15-20, just however long it takes to break the fibrosis up, after it's mostly broken up it's primarily maintenance from there so you can reduce the massage time and just not let it get back to that state again.
Conclusion
I can't say definitely that scalp massages will regrow hair but based on my research I see zero reason why they wouldn't have some benefit. A lot of the science behind it makes a lot of sense and it connects well into the mainstream hypothesis along with chronic scalp tension and androgens etc. I honestly can't find a single reason why scalp massages wouldn't have some beneficial effect on hair growth. Regardless of hair growth it definitely had a positive effect on my overall scalp health and condition which is a good enough reason to trial it out for yourself.
edit. I reached out about the scalp massages to someone who is much more educated than I, it was the creator of this hypothesis. They don't have a definite answer to the crunches but here was their take.
"Thanks for reaching out. It’s a great question, and one that’s not always the easiest to answer. I think the evidence tends to suggest that the crunches we sometimes hear from massaging are more likely edema (swelling), and less likely the breaking up of fibrotic tissue. This is mainly because morphologically, fibrotic tissue doesn’t typically detach from healthy tissues and produce noise when manipulated. Rather, it’s the acute inflammation from the massages that promotes anagen-associated growth factors which then help attenuate / metabolize part of that fibrotic tissue as the skin remodels."
It's easy to assume that minoxidil being a vasodilator, grows hair by increasing bloodflow to the follicles consistently over long periods of application. I've heard some hypothesize min actually has an effect on PGD2 and PGE2 but I believe the primary mechanism is as simple as bloodflow. After you break your arm and finally take the cast off you will notice the hair is longer and thicker there, this is from increased blood and nutrient supply to the area from the healing process. The same way in which microneedling regrows hair. So anything that increases bloodflow to the follicle should theoretically have a positive impact on hair growth.
Scalp massages work by two mechanisms:
Increases bloodflow to the scalp and follicles (this is a temporary boost to the follicles and it's unlikely to have much of a long term benefit)
Breaking up the fibrosis / relieving scalp tension (this is much more likely the mechanism in which scalp massages grow hair as it puts the scalp into a better condition where blood flow is more consistent and the balding process lessened, loosening of the scalp will also help stop DHT being used as an inflammatory response preventing fibrotic build up.)
When you consider how long you actually have to have minoxidil on your head, almost 24/7 it becomes hard to imagine something that would increase blood flow to the follicles over that period of time. Unless you are consistently massaging your head which is unrealistic it's unlikely you'd have much regrowth at all. You need a way to provide consistent blood flow to the actual follicle and not just the scalp. The fibrosis in the scalp is the main cause of inhibiting bloodflow killing off the follicles. They are chronically deprived and a short little boost of blood supply is unlikely to do much.
Fibrosis is found in the scalps of building men, under the hypothesis I believe DHT causes the fibrosis as an inflammatory response in relation to chronic scalp tension. There is a good little test that you can do to prove the validity of this, if you pinch the scalp in the areas which are bald you will notice the skin is both thicker and less pliable than areas of hair growth, this is due to fibrosis.
Minoxidil is actually rather ineffective alone and the fibrosis explains it, derma rolling dramatically improves the results of minoxidil and it's not because it increases absorption. You actually want quite the opposite since it can have some serious health effects if absorbed into the bloodstream. Aside from supplying the follicles with a consistent blood supply from the healing process derma rolling also likely partially breaks up and reverses the fibrosis present in the scalp allowing minoxidil to do its job to a better degree.
I've heard from a few people before getting a hair transplant the scalp is often derma rolled and massaged so it is in a suitable state to sustain the transplanted hair. The most recent of which is this guy who got a professional opinion on the options. I was surprised to find that his views on current treatments perfectly reflected my own based on my personal research.
My anecdotal experiences (Regrowth thread here)
So far I've had good results from scalp massages, folliculitis, scalp itch, excessive greasiness and shiny scalp qualities are no longer present and overall hair quality has seemed to improved, it seems to have more life, it's stronger, springy and can support its own weight as opposed to just flopping down. Also while massaging in the shower I've had a few healthy hairs accidentally rip from my scalp, what I found is that they were incredibly thick and about 3-4cm in length. I'm just going to call them super hairs and make a post about them in the future.
When I stopped massaging
Around the very start of August I was growing rather happy with my regrowth and I thus became more lazy. Hairloss was consuming too much of my life and I managed to get a lot of study for my future in and I slowly did less and less scalp massages. It went from a few minutes a day, to a couple to just 30 seconds and then I stopped completely. Everyone was rather dismissive my regrowth was actually a result of scalp massages and attributed it to nizoral and derma rolling. During this period I continued those and stopped fish oil, scalp massages and exercises as I was losing faith with everyone's dismissal, my sleep pattern went downhill severely and there was 2 days which I skipped showers. What I noticed was that my scalp itch was coming back and so was some of my dermatitis, this sort of sent me into an alert state as typically the itching is accompanied by shedding in my experienced so I doubled down on Nizoral and my dermatitis and itch continued. I tried to get back to doing scalp massages but every time I'd start my hair would start shedding quite a lot so I was too scared to lose my gains but the itch and dermatitis was slowly getting worse.
Eventually I decided to stop Nizoral application and just use scalp massages. Interestingly my scalp itch and dermatitis disappeared although on the day of the massage I shed a couple of hundred hairs just in the shower alone. My hairline and the top front middle of my head took a hit, my vertex was as thick as ever though. Interestingly I never massaged or micro needled my vertex often as it's difficult getting back there which could also mean the regrowth experienced there wasn't as reliant on massages/wounding. Currently my hairline is back to regrowing, a few days ago it looked like I had tons of blackheads with all the hairs sprouting back out. During this whole period vellus hair seemed to be unaffected and was as healthy and as long as ever. I also reintroduced Nizoral which led to a minor shed which was interesting. As of now I'm no longer shedding hairs again and I typically only lose 5-10 per massage in the shower.
The regrowth isn't likely sustainable
Despite growing any hair you're not actually stopping the balding process so finasteride would likely still need to be used anyways, I've tried looking into natural alternatives and there simply isn't anything quite like finasteride in terms of effectiveness. I've heard positive things about topical finasteride which gets around the potential sides. Currently I'm not using finasteride but I'm considering finasteride for the future if I lose any ground. If your balding slowly it's possible the regrowth could outpace the balding.
I've heard some positive things about essential oils such as castor oil, peppermint oil and rosemary oil. Out of those castor oil has no scientific backing but peppermint and rosemary do, most notably rosemary oil also being a vasodilator was found to be equivalent to minoxidil 2% in hair regrowth. That's not too bad for a natural alternative although there simply isn't enough information on those oils for me to commit spending money on them. I struggle to find much about how often to apply and if it needs to be left in, I don't really want to spend money on an inferior minoxidil if I have to leave it on my head for 8 hours. Additionally the limited information means that any potential side effects aren't known.
Studies:
The main study around scalp massages (detumescence) which found that 20x minute massages daily resulted in 90% regrowth isn't credible and most likely untrue as it's published in a predatory open access journal by a publisher (OMICS) known for accepting fraudulent papers.
Luckily however there is one legitimate study that has been done, it found that 4x minute scalp massages daily increased follicle width although density was unchanged. Gene expression was also changed via the massages. Now if we think about the actual balding process the hairs don't completely die out initially, they get weaker and weaker, eventually turn to vellus hairs and slowly fade away into almost nothing. Boosting the strength of an individual follicle would increase its overall health and lifespan and could possibly bring back some of the healthier vellus hairs to a terminal state.
The main hypothesis I believe, it's worth noting that literally every theory in the hairloss world is a hypothesis as male pattern baldness isn't something that has been solved yet.
There is a link between the balding pattern and chronic tension on the scalp. This most likely plays a part with androgens and DHT in the actual balding process. Under the hypothesis I believe DHT is used as an inflammatory response to chronic scalp tension in people that have the necessary genes. this leads to fibrosis in the scalp which inhibits blood and nutrient supply to the follicle.
I could only find a single study which only used microneedling as a control group, it was found to be more effective than minoxidil alone in terms of regrowth. This is quite promising for mechanical stimulation as a means to regrow hair.
Regrowth 24weeks:
Minoxidil only 18.8/cm2
Microneedling 23.4/cm2
Microneedling + Min 38.3/cm2
I know this is a mouse study but I actually only just found this study when looking for why moles grow darker and thicker hairs Blood Vessels Hold Key To Thicker Hair Growth, the interesting part is that it states "The discovery that increasing blood flow to the scalp helps stave off baldness may be old news to many barbers. For years, they have been advising clients to massage their scalps as way of stimulating circulation and hair growth." I actually had no idea this information had been around for so long, it's not entirely relevant but it definitely points at the fact of blood flow equates to hair growth.
How to do the massages -
This video more or less describes it well enough.
The technique isn't entirely important as long as you are breaking up the fibrosis and promoting blood flow to the follicles. To do this you need to go quite deep and forceful into the scalp. If you are doing the massage correctly after some time you will hear an odd crunching sound. I made a thread about this awhile ago. I can only assume this is the fibrotic tissue in the scalp being broken up, the more you massage the less and less of this crunch you will hear although it slowly comes back if you stop doing them. This is the best way to gauge how much you need to massage as opposed to massage x minutes daily. Typically I massage around 5 minutes a day, in the early days you should massage a bit more. Perhaps 15-20, just however long it takes to break the fibrosis up, after it's mostly broken up it's primarily maintenance from there so you can reduce the massage time and just not let it get back to that state again.
Conclusion
I can't say definitely that scalp massages will regrow hair but based on my research I see zero reason why they wouldn't have some benefit. A lot of the science behind it makes a lot of sense and it connects well into the mainstream hypothesis along with chronic scalp tension and androgens etc. I honestly can't find a single reason why scalp massages wouldn't have some beneficial effect on hair growth. Regardless of hair growth it definitely had a positive effect on my overall scalp health and condition which is a good enough reason to trial it out for yourself.
edit. I reached out about the scalp massages to someone who is much more educated than I, it was the creator of this hypothesis. They don't have a definite answer to the crunches but here was their take.
"Thanks for reaching out. It’s a great question, and one that’s not always the easiest to answer. I think the evidence tends to suggest that the crunches we sometimes hear from massaging are more likely edema (swelling), and less likely the breaking up of fibrotic tissue. This is mainly because morphologically, fibrotic tissue doesn’t typically detach from healthy tissues and produce noise when manipulated. Rather, it’s the acute inflammation from the massages that promotes anagen-associated growth factors which then help attenuate / metabolize part of that fibrotic tissue as the skin remodels."
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