Does microneedling work for women with hair loss, or is the evidence all from studies on men? A 2022 randomised trial from Beijing answered that question directly: in 120 women with female pattern hair loss, adding microneedling to 5% minoxidil tripled the hair density gain of minoxidil alone, and it beat minoxidil plus oral spironolactone, a prescription drug, with fewer side effects. For women weighing a daily oral medication against a needling routine, this is essential reading. If needling appeals, start with choosing an at-home microneedling device.
Study by Liang, Chang, Wu and colleagues, published in Frontiers in Medicine (2022). Summarised by Malcolm Smith, Founder of Hairgenetix. Medically reviewed by Dr. Esther Bodde, MD, Cosmetic & Plastic Surgeon. Last updated 2 September 2026.
Quick answer
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Microneedling plus minoxidil won on the primary outcome: hair density rose by 30.33 hairs per square centimetre over 24 weeks, versus 16.76 with minoxidil plus spironolactone and 9.95 with minoxidil alone (p<0.001 against both).
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95% of women in the microneedling group improved on the physician's assessment, versus 86.49% with spironolactone and 55.27% with minoxidil alone.
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The oral drug caused the most side effects: 45 adverse effects in the spironolactone group, including 15 cases of menstrual disorder, versus 24 with microneedling.
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The scalp itself changed only with needling: on scalp ultrasound, epidermal thickness and follicle diameter improved only in the microneedling group.
This article is part of our complete guide to microneedling for hair growth.
Why does this study matter?
Most of the landmark microneedling evidence comes from trials in men, starting with the Dhurat 2013 trial. Women have had fewer options to study: topical minoxidil is the only FDA-approved drug for female pattern hair loss, and it helps only about half of the women who use it. The common prescription add-on, oral spironolactone, is a daily antiandrogen with hormonal side effects and a strict warning against use in pregnancy.
Liang and colleagues ran the comparison women actually face in the clinic: keep using minoxidil alone, add an oral drug, or add microneedling. It tested microneedling against an oral medication head to head in women, with blinded evaluators and objective measurements, including scalp ultrasound.
What did the researchers do?
The team at Beijing Friendship Hospital recruited 120 non-menopausal women aged 18 to 45 with mild to moderate female pattern hair loss, normal blood hormone levels and regular menstrual cycles. They were randomised to three groups for 24 weeks: 5% topical minoxidil once daily on its own, minoxidil plus oral spironolactone at 80-100 mg daily, or minoxidil plus a microneedling session every 2 weeks, 12 sessions in total.
The microneedling protocol used an electric device at a depth of 0.7-1.0 mm, with 1 ml of 5% minoxidil applied at each session and pinpoint redness as the endpoint. Outcomes were assessed by three dermatologists blinded to treatment group: hair density and hair shaft diameter under a dermoscope, scalp structure under ultrasound, physician global assessment, and patient questionnaires. In total, 115 of the 120 women completed the trial.
What did they find?
| Outcome at week 24 |
Minoxidil alone |
Minoxidil + spironolactone |
Minoxidil + microneedling |
| Hair density gain (hairs/cm²) |
+9.95 |
+16.76 |
+30.33 |
| Women improved (physician assessment) |
55.27% |
86.49% |
95.00% |
| Total adverse effects reported |
27 |
45 |
24 |
The density row is the headline. All three groups gained hair by week 24, but the microneedling group gained about three times as much as minoxidil alone and nearly twice as much as the spironolactone combination (p<0.001 against both; spironolactone beat minoxidil alone at p=0.009). Average density in the microneedling group climbed from 99.68 to 130.00 hairs per square centimetre.
The scalp ultrasound findings explain part of the story. Epidermal thickness and average hair follicle diameter improved only in the microneedling group, consistent with needling doing something the drugs do not: triggering a wound-healing response around the follicle while the micro-channels ferry more minoxidil to where it acts.
The safety comparison matters just as much. The spironolactone group reported the most adverse effects, 45 in total, and the ones unique to that group were hormonal: 15 women had menstrual disturbances, plus single cases of raised blood potassium and limb swelling. The microneedling group had the fewest (24), mostly the scalp itching seen across all groups; one local infection settled quickly with an antibiotic ointment.
Limitations to keep in mind
This was a single-centre trial of 115 completers, restricted to women with mild to moderate hair loss and normal hormones, so the results do not automatically extend to severe or hormonally driven cases, where spironolactone may do relatively better over longer treatment. Participants knew which treatment they were receiving, even though the evaluators did not, and 24 weeks is a short window for a slow process like hair regrowth. The needling was also done in clinic on a fixed schedule; at-home routines should mirror that discipline rather than improvise.
What does this mean for your routine?
For women with mild to moderate pattern hair loss, this trial supports a clear hierarchy: a topical alone is the weakest option, and adding microneedling beat adding an oral antiandrogen on both effectiveness and tolerability. The evidence-backed pattern is a needling session every couple of weeks paired with a topical active, which is the format of our Copper Peptide Derma Stamp Set: the stamp creates the micro-channels at a controlled depth and the serum supplies the actives. The trial's parameters, roughly 1 mm depth and a session every 2 weeks, sit comfortably within the protocol our complete guide walks through. For how needle-based delivery in women has fared against another oral drug, see our summary of the Moftah 2013 mesotherapy trial.
Frequently asked questions
Does microneedling work for female pattern hair loss?
In this randomised trial, microneedling every 2 weeks combined with 5% minoxidil produced the largest hair density gain of the three treatments tested: 30.33 additional hairs per square centimetre over 24 weeks, about three times the gain of minoxidil alone.
Is microneedling better than spironolactone for women's hair loss?
In this trial, yes, on both counts: the microneedling combination grew more hair (p<0.001) and caused fewer adverse effects (24 versus 45). Women with severe or hormonally driven hair loss were not studied, so for them the balance may differ; discuss it with your doctor.
What microneedling depth and frequency did the study use?
An electric device at 0.7-1.0 mm depth, one session every 2 weeks, 12 sessions over 24 weeks, with 5% minoxidil applied at each session and used once daily throughout.
What were the side effects of each treatment?
Scalp itching was the most common side effect and appeared at similar rates in all groups. The spironolactone group had the most adverse effects, including 15 cases of menstrual disturbance found only in that group. The microneedling group had the fewest, with one local infection that resolved quickly.
Did the women in the study have hormonal problems?
No. The trial enrolled women aged 18 to 45 with normal blood hormone levels and regular menstrual cycles, so the results apply to typical female pattern hair loss, not hair loss driven by a hormonal disorder.
References
1. Liang X, Chang Y, Wu H, et al. "Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator Blinded, Randomized Trial." Frontiers in Medicine, 2022. PubMed 35899211.
2. Dhurat R, Sukesh M, Avhad G, et al. "A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia." International Journal of Trichology, 2013. PubMed 23960389.
3. Moftah N, Moftah N, Abd-Elaziz G, et al. "Mesotherapy using dutasteride-containing preparation in treatment of female pattern hair loss: photographic, morphometric and ultrustructural evaluation." Journal of the European Academy of Dermatology and Venereology, 2013. PubMed 22486925.
Microneedling vs Spironolactone for Female Hair Loss: the Liang 2022 Trial
Does microneedling work for women with hair loss, or is the evidence all from studies on men? A 2022 randomised trial from Beijing answered that question directly: in 120 women with female pattern hair loss, adding microneedling to 5% minoxidil tripled the hair density gain of minoxidil alone, and it beat minoxidil plus oral spironolactone, a prescription drug, with fewer side effects. For women weighing a daily oral medication against a needling routine, this is essential reading. If needling appeals, start with choosing an at-home microneedling device.
Study by Liang, Chang, Wu and colleagues, published in Frontiers in Medicine (2022). Summarised by Malcolm Smith, Founder of Hairgenetix. Medically reviewed by Dr. Esther Bodde, MD, Cosmetic & Plastic Surgeon. Last updated 2 September 2026.
This article is part of our complete guide to microneedling for hair growth.
Why does this study matter?
Most of the landmark microneedling evidence comes from trials in men, starting with the Dhurat 2013 trial. Women have had fewer options to study: topical minoxidil is the only FDA-approved drug for female pattern hair loss, and it helps only about half of the women who use it. The common prescription add-on, oral spironolactone, is a daily antiandrogen with hormonal side effects and a strict warning against use in pregnancy.
Liang and colleagues ran the comparison women actually face in the clinic: keep using minoxidil alone, add an oral drug, or add microneedling. It tested microneedling against an oral medication head to head in women, with blinded evaluators and objective measurements, including scalp ultrasound.
What did the researchers do?
The team at Beijing Friendship Hospital recruited 120 non-menopausal women aged 18 to 45 with mild to moderate female pattern hair loss, normal blood hormone levels and regular menstrual cycles. They were randomised to three groups for 24 weeks: 5% topical minoxidil once daily on its own, minoxidil plus oral spironolactone at 80-100 mg daily, or minoxidil plus a microneedling session every 2 weeks, 12 sessions in total.
The microneedling protocol used an electric device at a depth of 0.7-1.0 mm, with 1 ml of 5% minoxidil applied at each session and pinpoint redness as the endpoint. Outcomes were assessed by three dermatologists blinded to treatment group: hair density and hair shaft diameter under a dermoscope, scalp structure under ultrasound, physician global assessment, and patient questionnaires. In total, 115 of the 120 women completed the trial.
What did they find?
The density row is the headline. All three groups gained hair by week 24, but the microneedling group gained about three times as much as minoxidil alone and nearly twice as much as the spironolactone combination (p<0.001 against both; spironolactone beat minoxidil alone at p=0.009). Average density in the microneedling group climbed from 99.68 to 130.00 hairs per square centimetre.
The scalp ultrasound findings explain part of the story. Epidermal thickness and average hair follicle diameter improved only in the microneedling group, consistent with needling doing something the drugs do not: triggering a wound-healing response around the follicle while the micro-channels ferry more minoxidil to where it acts.
The safety comparison matters just as much. The spironolactone group reported the most adverse effects, 45 in total, and the ones unique to that group were hormonal: 15 women had menstrual disturbances, plus single cases of raised blood potassium and limb swelling. The microneedling group had the fewest (24), mostly the scalp itching seen across all groups; one local infection settled quickly with an antibiotic ointment.
Limitations to keep in mind
This was a single-centre trial of 115 completers, restricted to women with mild to moderate hair loss and normal hormones, so the results do not automatically extend to severe or hormonally driven cases, where spironolactone may do relatively better over longer treatment. Participants knew which treatment they were receiving, even though the evaluators did not, and 24 weeks is a short window for a slow process like hair regrowth. The needling was also done in clinic on a fixed schedule; at-home routines should mirror that discipline rather than improvise.
What does this mean for your routine?
For women with mild to moderate pattern hair loss, this trial supports a clear hierarchy: a topical alone is the weakest option, and adding microneedling beat adding an oral antiandrogen on both effectiveness and tolerability. The evidence-backed pattern is a needling session every couple of weeks paired with a topical active, which is the format of our Copper Peptide Derma Stamp Set: the stamp creates the micro-channels at a controlled depth and the serum supplies the actives. The trial's parameters, roughly 1 mm depth and a session every 2 weeks, sit comfortably within the protocol our complete guide walks through. For how needle-based delivery in women has fared against another oral drug, see our summary of the Moftah 2013 mesotherapy trial.
Frequently asked questions
Does microneedling work for female pattern hair loss?
In this randomised trial, microneedling every 2 weeks combined with 5% minoxidil produced the largest hair density gain of the three treatments tested: 30.33 additional hairs per square centimetre over 24 weeks, about three times the gain of minoxidil alone.
Is microneedling better than spironolactone for women's hair loss?
In this trial, yes, on both counts: the microneedling combination grew more hair (p<0.001) and caused fewer adverse effects (24 versus 45). Women with severe or hormonally driven hair loss were not studied, so for them the balance may differ; discuss it with your doctor.
What microneedling depth and frequency did the study use?
An electric device at 0.7-1.0 mm depth, one session every 2 weeks, 12 sessions over 24 weeks, with 5% minoxidil applied at each session and used once daily throughout.
What were the side effects of each treatment?
Scalp itching was the most common side effect and appeared at similar rates in all groups. The spironolactone group had the most adverse effects, including 15 cases of menstrual disturbance found only in that group. The microneedling group had the fewest, with one local infection that resolved quickly.
Did the women in the study have hormonal problems?
No. The trial enrolled women aged 18 to 45 with normal blood hormone levels and regular menstrual cycles, so the results apply to typical female pattern hair loss, not hair loss driven by a hormonal disorder.
References
1. Liang X, Chang Y, Wu H, et al. "Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator Blinded, Randomized Trial." Frontiers in Medicine, 2022. PubMed 35899211.
2. Dhurat R, Sukesh M, Avhad G, et al. "A randomized evaluator blinded study of effect of microneedling in androgenetic alopecia." International Journal of Trichology, 2013. PubMed 23960389.
3. Moftah N, Moftah N, Abd-Elaziz G, et al. "Mesotherapy using dutasteride-containing preparation in treatment of female pattern hair loss: photographic, morphometric and ultrustructural evaluation." Journal of the European Academy of Dermatology and Venereology, 2013. PubMed 22486925.