The Truth About Microneedling for Hair Loss: Why It’s Overrated and Potentially Risky
It’s time to revisit a topic I haven’t covered in a while: microneedling. I get asked constantly about which device to use—a derma stamp or a derma roller—what needle length is optimal, how often to do it, and whether to do it before or after applying treatments. The short answer is that you don’t need to bother with any of that. Microneedling is laughably overrated. And it’s no coincidence that the people who hype it the most are often the ones selling the devices or the programs that center around it.
It’s always struck me as strange and bewildering how finasteride gets so much hate despite being the most clinically proven treatment on the market, while microneedling—which is next to useless—gets universal praise from almost everyone. I’ve made my opinions clear before by going over the research on microneedling, and those insights still stand. Now, I know there are plenty of microneedling fanboys who swear by it, and that’s fine. I’m not here to make anyone feel stupid for using it. But the fact is that microneedling is not an effective treatment for androgenic alopecia. Whatever small benefit it might have as an adjunctive therapy is far overshadowed by the long-term deleterious effects it may have on your scalp health. If you don’t like what I have to say, you don’t have to listen. But I’m bringing up these problems because nobody else will.
The Lack of Real Evidence
I was reminded of this issue when a subscriber brought up a recent review by a researcher named Robert Englund. He’s supposedly a medical editor who specializes in brutal research, but I’d never heard of him before. What matters is that his team published a review of microneedling for hair loss. This isn’t original research—it’s just a summary of the existing studies. Englund spends time theorizing how microneedling might work, but he misses a crucial step: he never proves that microneedling actually works in the first place. What’s the point of explaining how something works when it’s still debatable whether it works at all? There are plenty of drugs on the market that work safely without us knowing why—minoxidil’s mechanism of action isn’t fully understood, but we know it works. If microneedling doesn’t work to begin with, then who cares about the theory behind it?
Microneedling has been around long enough for well-designed studies to test its efficacy. Yet there has never been any good outcome data demonstrating that it is effective as a hair loss treatment. Englund ends up coming to the same conclusion I did in my earlier videos: there is evidence that microneedling may be useful as an adjunct therapy, such as when used with topical minoxidil, but the data is low quality and more research is needed. So this study tells us nothing new and achieves nothing for hair loss academia.
In Englund’s review, he shows that microneedling may help slightly in potentiating minoxidil’s efficacy—which wasn’t really contentious. But when looking at microneedling used alone as a monotherapy, the data is extremely poor quality. Of the 22 studies he reviewed, only 105 subjects were tested using microneedling as the sole therapy; the other 536 subjects received microneedling combined with something else, usually minoxidil. There’s very little scientific data on microneedling alone. Another problem is the lack of standardization: different studies use different devices, frequencies, and numbers of sessions, making results inconsistent. Looking at the six studies that used microneedling alone for androgenic alopecia, three showed a beneficial effect and three showed no effect. In contrast, six out of seven studies that combined microneedling with 5% minoxidil showed improvement.
The theory behind why microneedling might enhance minoxidil isn’t controversial. Most likely, the punctures in the skin allow the drug to get closer to the hair follicles—it’s just simple logic. Other speculative theories, like enhancing the conversion of minoxidil to its active form or upregulating the Wnt pathway, are not supported by evidence. If microneedling truly upregulated a hair growth pathway, we would see stronger evidence for it as an effective monotherapy—which we don’t. The most plausible explanation remains increased drug absorption.
Englund mentions that the side effects of microneedling in the studies were mild—pain, scalp irritation, and redness. So his article gives a favorable view of microneedling as safe and probably effective when combined with minoxidil, but not proven on its own. That’s exactly what I concluded earlier. This review isn’t the only one; others go over the same data and reach similar conclusions. So thank you, Mr. Englund, for telling us what we already knew.
The Dark Side of Microneedling
You might be thinking: if microneedling helps with minoxidil absorption, why not use it? It seems like a no-brainer. If that were the whole story, I’d happily agree. But there is a dark side to microneedling that nobody talks about. Poking holes in your scalp repeatedly over many years and causing chronic inflammation may not be such a good idea. Chronic repeated injury to human tissue leads to fibrosis—scar tissue. And androgenic alopecia already causes fibrosis of the hair follicles. Using a technique that could produce fibrosis to treat a condition that causes fibrosis doesn’t make much sense.
Every time you microneedle, you break the important skin barrier that protects us from germs and toxins. A case report demonstrated this when a woman using a microneedling device inadvertently spread a herpes zoster infection (shingles) to her face. Anything applied to the skin or scalp can be absorbed more readily through the broken barrier. In another article, three women developed severe allergic reactions after microneedling their faces for skin rejuvenation. They had applied different serums, and the microneedling effectively tattooed these substances into the skin, resulting in ugly allergic reactions. The rashes didn’t appear immediately—one developed two weeks later, and despite steroid treatment, she worsened with fever and joint pains for three more months. Another woman treated for acne developed a rash a few days later, which worsened over two months, and she also developed joint pains. Both continued to have the face rash for nine months despite various treatments. The third case resolved after three weeks of oral steroids and antibiotics.
Yes, these women weren’t microneedling their scalps, but many people use various hair treatment products on their scalps, and microneedling could inadvertently push allergenic substances directly into the skin, causing similar reactions. The authors of that case series believe that numerous similar adverse reactions are happening and going unreported. And there are more reports: two sisters who received microneedling under a doctor’s supervision with sterilized devices developed severe reactions including swollen lymph nodes, redness, prolonged bleeding, and headache. Antibiotics didn’t help. After two weeks, one sister developed a rash all over her body and swelling in the face, requiring hospitalization and steroids. The reaction may have been due to an allergy to nickel, since the needles contained 8% nickel. These cases highlight risks including infections from non-sterile devices, allergies, needle breakage, and excessive needle penetration from improper length or force. Nobody talks about these risks because most promoters of microneedling are selling devices or drug-free hair loss programs.
The Potential Long-Term Danger: Skin Cancer
There’s another theoretical concern that might be the most dangerous yet. Scar tissue caused by repeated microneedling could lead to skin cancer. It’s known that ultraviolet light increases skin cancer risk, but scar tissue is also a risk factor. One study found that basal cell carcinoma was common in patients with injuries and scar tissue, with cancers forming adjacent to healed scars. Specifically, wounding hair follicles can cause tumors. Basal cell carcinoma is thought to originate from hair follicle cells because the cancer cells resemble those of hair follicles. Normally, hair follicles don’t turn cancerous, but this study showed that wounding can trigger that transformation. The authors concluded that even small incisional wounds can recruit oncogene-expressing stem cells from the follicle, and that the formation of human basal cell cancers may be temporally removed from the provoking injury—meaning it can take years to appear. Small puncture wounds from microneedling could potentially result in skin cancer. This isn’t proof that microneedling causes cancer, but it’s worrisome data. There are no long-term follow-up studies of people who do a lot of microneedling, so we simply don’t know the long-term effects.
I’m not saying this to scare you, but it’s important to balance the overly optimistic reports with sobering data. The only reason I’m telling you this is because nobody else will—almost everyone promoting microneedling has a conflict of interest. I don’t sell anything, and I have nothing to gain financially from whether you follow my advice.
A Safer Alternative to Microneedling
So what’s my advice for people who want an adjunctive therapy to improve minoxidil’s efficacy without the risks of microneedling? There’s a good alternative: tretinoin. Tretinoin is a synthetic retinoid that, when applied daily to the scalp, can upregulate the sulfur transferase enzyme—the enzyme that converts minoxidil into its active form, minoxidil sulfate. This is especially helpful because about 40% of people are genetically deficient in this enzyme, which is why only around 60% of people get good results with topical minoxidil. Tretinoin can effectively turn a minoxidil non-responder into a responder. I’ve made a video about using tretinoin to improve minoxidil results.
Another option is to use a stronger concentration of topical minoxidil, like 10% or 15%. But I should warn you that these stronger concentrations only work better in people who are non-responders to 5% minoxidil. Strangely enough, in people who already respond to 5% minoxidil, 10% or 15% actually work worse. Sometimes more isn’t always better.
So that’s my take on microneedling. You can take it or leave it. I don’t mean any offense toward hair loss YouTubers who support microneedling. I just hope you now understand why I’m not enthusiastic about it and why it’s important to have a balanced view of the data. Remember: there is no emotion, there is peace. There is no ignorance, there is knowledge. There is no passion, there is serenity. There is no chaos, there is harmony. There is no death—there is finasteride. Thanks for watching, and God bless.