Scalp Massage, Mechanotransduction and Hair Growth

I have covered scalp massage, scalp exercises and mechanotherapy for hair growth a number of times on this blog. During the past year, I have had a few people e-mail me about Mr. Robert English and his hair loss treatment protocol. Mr. English owns the perfecthairhealth website. His regimen primarily entails mechanotransduction and scalp massage therapy.

If you do not want to read this entire post, click on the below listed names to go to their approximate sections. I have also covered most of the below people in separate posts in the past.

Important note: I do not believe that any of the below methods can possibly regrow hair on totally bald areas of the head. At best, these scalp massage and related mechanotransduction techniques may make existing thinning hair become thicker. This better quality hair is then less likely to atrophy and progress to baldness.

Also note that even as far back as 1942, a scientist by the name of Frederick Hoelzel made some of the same observations as will be discussed in this post. He came out with a “baldness and calcification of the ivory dome” observation and theory. Make sure to read my post on bald scalps being tighter and thinner.

Scalp Massages and Mechanotransduction

Robert English

Robert English has written two interesting papers on hair loss during the past one and a half years:

  1. The limitations of just focusing on DHT reduction in dealing with hair loss (February, 2018).
  2. Survey results from self-assessments of standardized scalp massages for androgenic alopecia (March, 2019).

Neither of the journals that published Mr. English’s papers seem to be prestigious. However, his medical and scientific writing quality is very good. Mr. English does not hold a Phd, and does not seem to have any biology or science background as far as I can tell.

Mr. English mentions the concept of “mechanotransduction” a few times in his first paper. This term encompasses scalp massages and many other forms of mechanical stimulation. I discuss some of these in greater detail in the second half of this post.

A 2016 study from China concluded that:

“Mechanics such as pressure, compression, friction, traction, stretch, shear, and mechanical wounding can influence hair loss or growth.”

Besides improving scalp blood flow and oxygenation, mechanotransduction can alter scalp skin and hair at the genetic level. It can theoretically also reduce hair follicle inflammation, improve nutrient delivery and increase growth factors. Some of these effects seem to occur via Wnt signaling changes. The adverse effects of dihydrotestosterone (DHT) and androgens can be prevented via scalp massage.

A 2016 study from Japan (with Dr. Rei Ogawa as a co-author) concluded that:

“Stretching forces result in changes in gene expression in human dermal papilla cells. Standardized scalp massage is a way to transmit mechanical stress to human dermal papilla cells in subcutaneous tissue. Hair thickness was shown to increase with standardized scalp massage.”


It seems like Mr. English’s methodology can only be accessed by joining his membership community and getting his e-book. I have not tried to do either myself. However, someone by the name of JD Moyer wrote a detailed testimonial in 2014 that is worth a read. It looks like Rob English’s method involves: 1) Daily scalp massage; 2) Dietary changes; and 3) Avoidance of using shampoos when washing hair.

Scalp massage during shampooing.
Scalp massage during shampooing.

I have heard the last mentioned piece of advice many times in the past. I do not believe that shampoos can directly cause scalp hair loss. Otherwise, you would also see body hair loss near your wrists, where the shampoo touches during each scrubbing of the head. Or loss of facial and chest hair, since the shampoo drips down to those areas after rinsing.

Mr. English seems to be saying that the chemicals in shampoos could alter your hormones, which makes some sense. I try not to use my dermatologist recommended dandruff shampoos more than twice a week.

Scalp Exercises, Massages and Mechanotherapy

This post covers the positive hair growth effects from scalp massages, scalp exercises and scalp wounding. Related terms and concepts include mechanotherapy, mechanotransduction and microneedling. Such techniques and treatment that involve direct prolonged contact and manipulation of the scalp are worth linking together in one post. Maybe I should also add Botox injections into the scalp for hair growth into this list.

Scalp massages, stretching and wounding can all perhaps reverse or slow down further progression in scalp calcification and scalp skin fibrosis. Note that the key word here is “perhaps”. I trust the veracity of some of the studies that support these techniques. However, I also have major doubts.

Hair loss is much harder to reverse once calcification and fibrosis pathogenesis have progressed too far. So anything that can reverse or slow down these processes is worth looking into. Scalp tension via the galea aponeurotica is also known to be greater in those suffering from androgenetic alopecia. A number of papers and theories suggest that mechanical stress is involved in male pattern hair loss.

On a side note, there have been many anecdotal reports of people in casts and bandages reporting greater body hair once the cast is removed after several months. Perhaps this is also due to mechanotransduction type reactions?

Of importance, before there was Robert English, there were many others who have discussed similar concepts. Among the main ones that I have covered on this blog in the past include:

Hagerty, Foote, Ogawa and Dhurat

  • Tom Hagerty

    The first one that I heard about was Tom Hagerty. He owns one site on scalp muscle control techniques and hair growth; and another site on face shaping exercises. Mr. Hagerty must be close to 80 years old by now and is still active on his forums. Me and Mr. Hagerty first emailed each other over 15 years ago. His recent videos seem to be done by a younger person:

  • Stephen Foote

    Around the same time or shortly thereafter, I started reading posts from Stephen Foote on various hair loss forums. In 2019, I wrote a post on Stephen Foote and his hydraulic theory of hair loss. His original paper was published in 1995. Mr. Foote makes no income from selling his ideas or any products. He is just a citizen scientist who is now into his 60s.

  • Rachita Dhurat

    Then came various findings from around the world in recent years that concluded that microneedling and wounding benefit scalp hair growth. Perhaps the most famous scientist associated with microneedling and wounding is Dr. Rachita Dhurat from India. Both microneedling and massaging can effect some identical hair growth related pathways and signaling.

  • Rei Ogawa

    Then came Dr. Rei Ogawa and his mechanotherapy theory of hair regeneration. Dr. Ogawa and his Japanese co-researchers have published a number of well regarded papers on scalp massages and mechanotherapy. They seem to have proven that scalp massage can change gene expression at the hair follicle level. I covered both Dr. Rei Ogawa and Mr. Tom Hagerty in a combined post in 2014.

Detumescence Therapy of the Scalp

Hyon-Sook Choy
Head shape, detumescence therapy and hair loss.
Head shape, detumescence therapy and hair loss.

One person that I never mentioned in the past is Dr. Hyon-Sook Choy. In 2012, he wrote an extremely interesting paper on detumescence therapy of the scalp for hair regrowth. It has some funky photos in there that are well worth a look. After reading Dr. Choy’s work, you might start staring at the shapes of the scalps and foreheads of strangers! I never really thought much about dome shaped heads before reading this paper.

Note: If none of the above works, there is always ligature of the scalp arteries to prevent further hair loss. FYI — I am being sarcastic.

66 thoughts on “Scalp Massage, Mechanotransduction and Hair Growth”

  1. I’ve read Rob English’s book and he makes a very strong case for scalp tension and AGA. One big thing in his favor is his interview with a well-respected cosmetic surgeon who supported the use of Botox to halt hair loss due to its inhibition of scalp tension. One study said it was as effective to twice as effective as finasteride, without the risk of side effects, of course.

    I would be lying if I said his book did not have one big Achilles heel, which is his endorsement of dubious concepts like “non-celiac gluten sensitivity” and the notion that standard thyroid panels are inadequate. However it would be fallacious to assume that, because he got one (basically unrelated) thing wrong, his primary thesis is without merit. I think he tacked this second part on to cover his bases in the event that people who have a shedding disorder moan that his method doesn’t work because scalp tension only covers AGA.

    All in all, if you don’t want to spend the money on his membership, I’ll give you the quick version: find a plastic surgeon who is willing to inject Botox into the scalp. They need to know what they are doing and demonstrate they have read the literature. Dr. Nicholas Vendemia in NYC and Dr. Simon Ourian in LA are known for doing this procedure. If you can spare $1000 or so per year, it might be worth it, especially if you add in any or all of microneedling, minoxidil, caffeine, Trinov, etc.

    1. Trust me when i say non-celiac gluten sensitivity is an extremely real thing. Anecdotal, sure but if i eat a few pieces of bread or have a few beers the effects are very, very clear and very, very real.

      1. I believe that you have those symptoms, but I would look into wheat or even general grain allergies before concluding something that only tends to be advocated by naturopaths and the squirreliest MDs.

  2. Oh, I should add that there is not a single up-sell after you purchase a membership to Perfect Hair Health. He’s not hawking any products beyond that, as far as I can tell.

    1. An excellent video. We can easily see why previous attempts in the 80s and before would have been futile knowing what we know now.
      But scientific progress has increased exponentially since the Internet and the donations to the scientific community by Bill Gates and Paul Allen after their fortunes made in Microsoft, plus others. Look at the phones we had only 7 years ago. You would get laughed at if you still had one.
      Exponential scientific progress will only get faster with the rise of China. Same purchasing power of the US but without the ethical constraints. And why not? Over half of the world’s inventions came from China, why not a hair loss cure?

    2. I found the video vague and lacking any new or helpful information. I assume the host had real hair, which is a possible reason for his lack of passion or digging into any new information. It almost seemed like the video was intended to lessen hope for a near-term cure so that guys will continue being content with spending money on existing partial remedies (recurring payments). Who would have such a motivation?

  3. Hair cloning and hair multiplication are the only “cures”.


    In vitro hair.

          1. They should have an update out in December as they said in an interview earlier this year. But with an operation the size of theirs I don’t think whether or not they’re legit is the question but just where they are in their development process.

  4. It works. I think words like detumescence or mechanotransduction conjure up images of science fiction from the late 1800s. It’s just scalp massage.

    But scalp massage if properly done can get a very good result. Just imagine a “best-case PRP response”, and its somewhat better than that, and for many it is good enough.

  5. Admin have you heard any update from the Doctor who wrote you about using Botox on his scalp? Very curious about his results thus far

    1. No he replied to others several times (one of those might have been in a non-Botox post) and emailed me before that he would update after a few months. He is definitely legit as I checked his email, IP etc… “FightForBlonde” also recently posted that he got Botox injections to his scalp in the UK. I think he will update us regularly :-)

      1. Yep, still here! I’ve taken my ‘starting’ photos using a couple of soft boxes and a DSLR. I’ve kept everything in place so I can take photos again at a later point with the exact same setup.

        I’ve had no complications or pains or the like so far. I think I’ve experienced less shedding, but it’s hard to say if that’s just placebo. I’ll be checking back with the doctor in February at which point I’ll have to decide whether to get more injections or not. I’m leaning towards doing so but after three months I don’t think any miracle treatment would show significant progress by that point due to the time hair cycles take to change.

  6. I have been massaging my scalp for about 3 years now. No regrowth but it has cured my scalp inflammation, crawling feeling and reduce my dandruff considerably. I would get that scalp pain and ant crawling feeling that would drive me nuts. After a week of scalp massage my scalp is feeling great, loose and like it’s breathing….hair strands probably thicker but not too sure. It works for the itch and inflammation for sure. I also lean my head back for 10 mins off the side of my bed. That actually makes my thicker for a good hour. The fact that the scalp tingling went away made me feel 10000x better. Bad enough to lose hair but to have that crawling burning feeling was aggrevating.

    1. @MJones At a minimum, it should thicken the strands. Probably the most important thing at Rob’s site – which one might not get from just lurking – is the importance of peripheral massage as part of the routine. That has been the difference between responders and non-responders. Once added, you might get a better result.

        1. Sides, back of head, and forehead – wherever the muscles are underneath. The reasons why that’s necessary are debatable, but it’s required for it to work.

      1. Hi Ben, what do you mean by “peripheral massage” ? You mean massaging the sides and the edges of the scalp also ? Thank you

    2. I do have that tingling sensation near my bald spot too. What could be the reason behind it, could it somehow link to baldness. It feels like an open wound, if you touch on it, it tingle, but by human eye examination, the site seem to be okay.

      And also I recently had my PRP done, and I notice at the site of the bald spot (Corner of my right frontal) it hurts when the needle hit and seem like the skin there is really tight as compare to the area where I have hair.

      It has to be link together in someway.

        1. So what companies stand to rivet out something in 2020. Even stabilize at 20% regrowth. I remember coming here in 2k17, and the optimism for 2019 was huge.

          I might try Topical fin…but can’t see clear results based on lack of ppl doing it.

          1. If you don’t mind 18% regrowth, try getting a scalp Botox injection. As long as you’re willing to shell out $1000+ per year until something more permanent comes along, that should do you.

  7. I enjoy reading Rob’s articles, but I wish people (including Rob) would stop referring to the dome shape theory and stop taking this horrible study seriously. This is the most unscientific study I’ve ever seen and it’s published in an unknown journal, it is literally a joke of a study with jokes of pictures.

    People must understand that the quality of the journal matters since there are innumerable journals out there where anyone (you, me, any random 13 years old) can pay and publish his/her article with no peer review and no scientific evidences required.

    PLEASE let’s stop giving this study a stage.

      1. @admin yeah actually Rei Ogawa’s study is a good one, I think that scalp massage has its benefits.. It’s just the ‘dome shape’ study which is taken seriously by people that is the problem. I’ve seen youtube videos of someone literally trying to flatten his scalp with some sort of tibetan massage stick (I think), it was painful to watch..

    1. If you are young and want to take a risk try propecia or avodart to prevent further hair loss.
      There is a big chance we will be talking about minox and other current treatments in 2030s.

  8. I’ve been doing twenty-minute daily scalp massages for four months, and dermarolling every two weeks, and I can say that my hair has been improving. I believe that mechanotransduction have been underrated for alternative treatment. An important factor for it to work is to take care of not having a deficiency of some vitamins and minerals, especially vitamin D if it almost does not go out in the sun.

  9. We are about to see the End of AIDS as medicines will cure it within 10 years. We are about to send more people back to the moon after 50 years then onto Mars. Yet, the massage to regrow hair was a funny episode of the tv show from the 1950’s, I Love Lucy. Where she puts a huge machine on Ricky’s head in order to massage it After all these years, and Nothing Real that works. Minoxidol aka peach fuzz at best is a joke along with the other available treatments (I try to actually put those words in as there is no real treatments NONE).

    1. That’s because way more money is being poured into AIDS and the moon than hair loss. AIDS is a deadly illness and landing on the moon had untold sums of money dumped into it by desperate governments. Hair loss sucks, but it doesn’t strike the kind of fear that a gruesome death by immune failure or communist takeover does.

      Besides, AIDS is an infectious disease, which humanity has been slowly succeeding against since the 18th century or earlier. Curing hair loss requires the growth of organs. A hair follicle is no less complex than a heart, but a heart is needed to live and thus way more money is spent on growing those… and even that hasn’t found its way into clinical practice yet.

      So take heart. The cure is on the way, but if you want it to come faster, crack open anatomy and biochemistry books and join the fight. Or go the political route and lobby for more progressive FDA policies that streamline the approval of drugs and therapies.

      1. Do you know why it does not get the attention from the government? To get elected as President you have to have almost all of your hair (Trump is the rare exception). Obama, Clinton, Bush, Reagan all had lots of hair for being in their 50’s to them baldness is a non issue. Look at what Bill Gates said paraphrasing, why spend any money on hair research. At the time he had most of his hair and being ultra rich he has no affects from hair loss while other people have society issues to deal with everyday.

        If we had just a few billion put into it we could get our cure. Aclaris just about went under just trying to treat 30 people. It’s dead money to put funds into hair loss research thus only pennies are put into research, very few pennies.

        1. There are plenty of rich bald guys. The fact that recent presidents have had hair is not why we don’t have a cure.

        2. It doesn’t get attention from the government because it’s not a government problem!
          Government problems are management of resources, ensuring there is gas at the gas station, keeping the lights on, keeping the traffic moving, preparing for weather extremes, running the hospitals, ensuring there is enough youth in the military, keeping us safe from criminals but also monitoring the police, tax collection, road maintenance, sewage systems, etc, etc.

          There is not a minister for beauty! Not yet anyway. I would not put it past America to do that.

        3. I agree with nasa. There hasn’t been a bald president since tv and film were invented. At least in the USA. Other countries aren’t as superficial when it comes to balding as the usa.

            1. No Scott. They don’t want a bald president. Not a coincidence lol. Will have a woman president for sure. We almost did.

  10. Hello there, everyone.

    I’ve been reading about Tissuse and Smart Hair Transplants. On this site, and elsewhere.

    For me, this is one of the most exciting potential treatments. Does anyone else agree? Or am I missing something?

    1. Paul, I think pretty much the whole community agrees. I mean I can only speak for myself but it is definitely one of the more exciting upcoming cloning treatments that has a pretty short timeline.

  11. Admin, any chance you could bring back the monthly updates? I know that’s a ton of work so even quarterly update would be very appreciated. Or maybe an overall pipeline for main potential new cures instead? I’ve been watching this site for over 3 years and still get confused with all the different companies and potential cures that are going through their trials.

    1. I second this motion. Or at the very least, a year end post that summarizes this year’s claims vs. the year end’s actual results from the different companies. And a layout of the different companies and what their timelines are again adjusted for the next year. That would be very helpful.

  12. FYI Someone pointed out on one of the other sites the change in wording on Follica’s website where the description on Sept 25, 2019 was “Device & Existing Drugs” and this has now changed to “Device plus Drug” & “CAUTION: Investigational device and new drug.” Speculatively good news for those hoping the treatment involves something other/more than minoxidil.

  13. PinotQ,

    The Follica report said: “Use of proprietary Follica RAIN minoxidil under IND” (pg. 48).

    IND stands for Investigational New Drug and is submitted when—and this is from the FDA—A physician might submit a research IND to propose studying an approved drug for a new indication or in a new patient population.

    They are filing the IND for their cartridge, listed as: Proprietary Minoxidil cartridges for use with “Smart Dropper” (pg. 46).

    They are also filing an ANDA which is an Abbreviated New Drug Application, granting them permission to sell a generic version of a pre-approved drug. And lastly, they have a 5% Female version with an 505(b), NDA. (also pg. 46).

    This was all laid out in the REGULATORY STRATEGY section (pg. 42):

    — 1 IND to cover investigational use of new minoxidil cartridge
    — 2 ANDAs for topical minoxidil (men 5% – vertex only; women 2%)
    — 1 505(b)(2) for topical minoxidil (men 5% – whole scalp; women 5%)

    And if that’s not clear enough proof, on page 39 they have an illustration with their smart dropper open exposing a minoxidil cartridge labelled: minoxidil. And the page is titled: Our Lead Program: Skin disruption + minoxidil.

    See for yourself. Document here:

    If they are lying and hiding a brand new unapproved molecule or something ‘more than minoxidil’ from the FDA they are in serious legal trouble! No?

    P.S. I believe Follica updated their website (Investigational device+New Drug…) as a legal requirement because the recent study used the cartridge (see IND). I also believe they have no sense of urgency releasing this treatment so all these years of delays are more a business strategy —like they are staggering their release schedule, ‘pipeline prioritizing’. (side note: pg. 44 hints they may stagger the release of the female version).

    (Copy this info if you want people to know)

  14. Tocatta, Your assumptions may be correct. I am not really taking a position on the meaning of these changes and delays because all I can do is speculate about the possibilities like everyone else. But there are certainly other possibilities. That document has a date of 9/20/2016 and based on Follica’s research and testing at that time, it would seem they would have moved quickly forward as they had all the pieces in place, as outlined in the document, to do so. In June of 2019, 3 years later, Follica finally announces they are moving forward with their pivotal study and Daphne Zohar says: “The interim analysis showed a robust response to Follica’s proprietary treatment” At about this same time Follica increased their percentage of ownership and now the website changes to replace “existing drug” with “new drug”. On the other side of the coin, Follica has probably refined the art of scalp disruption down to the finest detail so this process along with the tweaking of their device could have continued to take years. Either way, I think it will be a plus although I am hoping it turns out to involve more than minoxidil.

  15. Don’t worry guys! Just 5 more years…

    …just five… …more… …years…

    2025 comes.

    Don’t worry guys! Just 5 more years!

  16. The document is late-2016 in preparation of a 2017 ‘Registration Study’ FOL-004. The study was presented in the 2018 annual report… in 2019. That’s how you eat up 3 years.

    See Page 40 — RAIN system + minoxidil 2017 FOL-004 registration study. The graph also labels “DISRUPTION + MINOXIDIL” alongside it’s prediction line.

    Each new iteration seemed to advance the FOL number. FOL-001/002 tested types of disruption alone, 003 was a Phase 2b study using a “drug combination” (lithium-treatment?) (pg. 24). FOL-004 was Minoxidil (pg. 40). FOL-005 is for Skin Rejuvenation. There is no FOL-006 so we’re stuck with FOL-004 as the latest iteration that we know.

    The new trial (Q4 2019?) is set to ‘establish therapeutic parameters, including the optimal duration and frequency of treatment.’ It doesn’t mention testing any new formulations.

    In 2008, Zohar said “What’s so beautiful about the approach, [Zohar] says, is that translating it into a treatment for humans involves only devices and drugs that are already on the market.” —See their patent.

    Puretech have also said all of the following: “small molecule drugs”, “topical compound”, “pharmaceutical compound”, “active agents” “next-generation proprietary compounds.” But this assumes a type of compound that isn’t mentioned at all in any of the previous trials (001-004). How could you legally and ethically justify withholding the most important discovery from clinical research, investors, and actual FDA regulation!

    What could it be? The 2008 patent mentions an enormous list of potential candidates, one being: “the small molecule EGFR inhibitor is gefitinib or erlotinib and the additional biologically active agent is a channel opener selected from minoxidil, diazoxide, and phenytoin” …8 years later and no mention of anything outside of just minoxidil for the study. Why?

    I personally don’t want it to be 5% minoxidil, but in light of their clinical summary, I come up empty thinking logistically, this late in the game (entering phase 3), how it could be otherwise. (new compound on my x-mas list tho : )

    Anyone reading this working for the FDA or Puretech or Follica wanna set the record straight? Now’s the time…

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