Androgenic alopecia is a condition in which the hormone dihydrotestosterone interferes with hair growth and regrowth. It doesn’t exactly cause hair loss; it causes the thick hairs of your head and eyebrows to become more like the vellus “mammal” hair that grows on the less hairy parts of our bodies. Because hormonal balance is different in men and women, the hair thinning manifests differently: in men, it looks like a receding hairline and thinning at the crown of the head, and in women it contributes to overall thinning hair.
The FDA recognizes two treatments for androgenic alopecia: minoxidil (popularly known as Rogaine, available to men and women) and finasteride (only works for men and only works on the top of the head, and rarely appears in the research).
This post will give an overview of three studies regarding microneedling and minoxidil, and offer some conclusions and best practices for its use in the home setting. If you want to skip right to the protocol, you can learn how to use a dermaroller to regrow hair here.
What does the research say?
We’re going to look at three papers: Dhurat et al (2013), which compares the efficacy of minoxidil alone to minoxidil with microneedling, Dhurtat and Mathapati (2015), which describes the cases of several men who saw no improvement with minoxidil alone but who were successfully treated with minoxidil plus microneedling, and Shah et al (2017), which compares minoxidil alone with minoxidil plus microneedling with platelet-rich plasma.
First, Dhurat 2013. Two randomly selected groups are set up, and both use 5% minoxidil twice a day. One group also receives one microneedling treatment with a dermaroller once a week (they skip their minoxidil the day of and the day after the treatment). The microneedling group exceeded the minoxidil-only group on all three measured metrics. They grew more than four times as many new hairs. 80% of the microneedling patients showed ‘moderate’ or ‘marked’ (the highest possible) improvement, and 100% of the microneedling patients showed some improvement, as opposed to the 64% of minoxidil patients who showed ‘mild’ improvement (and 36% showed no improvement). Patients agreed–36% of the microneedling patients felt that they had seen 75-100% improvement, while no members of the minoxidil group reached that level.
An additional finding of this study that I want to come back to later is that in addition to achieving better results, the microneedling group saw them faster, on average–6 weeks after starting treatment rather than ten weeks after.
A later study that also had Dhurat as lead researcher (this is the second study linked above) describes four men who had not responded to previous treatment with minoxidil. This is representative of a lot of men–the paper places the efficacy of minoxidil between 30 and 60%. In order to qualify for inclusion the men had to have attempted minoxidil for at least two years, and as many as five.
All four of these cases received the same treatment: four weekly microneedling sessions, and then twenty-one weeks of microneedling every other week. During and after these sessions, they continued their use of minoxidil. All four men were rated by evaluators as either ‘moderate’ or ‘marked’ improvement. Three of the men rated their own improvement as 75% or greater improvement, and one rated his as 50% improvement at the six-month mark. After they finished the microneedling sessions, they stopped improving, but they did maintain the results that they had achieved when researchers checked back on them a year later. You should click through and look at this study, because it groups the photos of all of the participants so that you can look at each guy’s progression through and after the study. Here’s one:
Finally, Shah et al compare minoxidil alone to minoxidil plus platelet-rich plasma (PRP). For this study, one group used minoxidil twice a day, and the other group used minoxidil twice a day and then, once a month, had a microneedling session where their own blood plasma was worked back into the scalp. Microneedling with PRP outperformed minoxidil alone, but it came in comparable to minoxidil and microneedling (without PRP) in the Dhurat study. Since they used the same rating scale, we can draw some conclusions by comparing the outcomes directly. Let’s compare: with PRP resulted in 64% moderate improvement and 28% excellent improvement, and without PRP resulted in 44% moderate improvement and 36% excellent improvement.
These sample sizes are small, and because the microneedling sessions were spaced differently we can’t draw any concrete conclusions. I would looooove to see an RCT that matched minoxidil + microneedling up to minoxidil + microneedling + PRP. But, working from what we’ve got, it appears that it’s the microneedling and not the addition of PRP that changes the game.
What does this mean for me?
First: none of these studies used any women. For a lot of other conditions that use a dermaroller this might not matter, but since androgenic alopecia is hormonal, there is always the possibility that a woman might experience this differently. There is nothing inherent in a dermaroller that works on your hormones, but I am still reluctant to make any recommendations for women. (With that said, if you are a woman with alopecia who tries this, get in touch and let me know how it goes!)
The research indicates that microneedling can help improve the effects of minoxidil for someone who is seeing some results from it, and that it can make minoxidil work for someone for whom it hasn’t worked previously. From what we see in this research, it appears that the improved efficacy continues as long as the microneedling does–if there is eventually a ceiling on how much an individual is going to improve, that ceiling is further out than the six months of improvement documented in the Dhurat (2015) study. An individual who isn’t participating in a study can continue microneedling (at home or in an office) until either his hair is restored or he reaches a plateau in his improvement.
More discussion of alopecia and a protocol based on this research tomorrow. You can find all posts on this topic by clicking the ‘alopecia’ or ‘hair loss’ tags below.