Clinical Efficacy and Mechanisms of Microneedling Alone or Combined With Drugs in the Treatment of Androgenetic Alopecia.

OBJECTIVE: To investigate the clinical efficacy, safety, and underlying mechanisms of microneedling alone or combined with drugs for androgenetic alopecia (AGA), so as to provide evidence for the standardized clinical treatment. METHODS: A total of 60 male AGA patients admitted to our hospital from January 2023 to June 2025 were enrolled and stratified into mild, moderate, and severe groups (20 cases each) based on the Hair Loss Severity Score (HLSS). The mild group received microneedling alone, the moderate group received microneedling combined with minoxidil, and the severe group received microneedling combined with a mixed solution of minoxidil and finasteride. All patients were treated with a pen-type electric microneedle at a needling depth of 1 ± 0.5 mm (tolerated by patients), once weekly. The treatment course was 8 weeks for the mild group, 12 weeks for the moderate group, and 16 weeks for the severe group. Efficacy was evaluated using HLSS, hair density detection, and patient satisfaction (Visual Analog Scale, VAS) before and after treatment, with adverse reactions recorded. RESULTS: Before treatment, significant differences in HLSS and hair density were observed among the three groups (all p < 0.001), showing a gradient distribution of mild group < moderate group < severe group (for HLSS) and mild group > moderate group > severe group (for hair density). After treatment, HLSS significantly decreased (all p < 0.001) and hair density significantly increased (all p < 0.001) in all groups. Intergroup comparisons revealed that HLSS was mild group < moderate group < severe group, while hair density was mild group > moderate group > severe group (all p < 0.001). The moderate group had the highest patient satisfaction (8.5 ± 0.8 points), with significant differences among the three groups (p = 0.004). No severe adverse reactions occurred in all 60 patients; only 3 cases (5.0%) developed mild scalp erythema and swelling, which resolved spontaneously within 24-48 h. CONCLUSION: Microneedling exerts therapeutic effects by regulating hair growth signaling pathways and promoting transdermal drug delivery. It is effective for mild AGA when used alone, and achieves more significant efficacy in moderate to severe AGA when combined with drugs, with high safety. Thus, it is worthy of clinical promotion. However, this study has limitations such as a small sample size and male-only participants, and further multi-center, large-sample RCTs are needed for validation.