Androgenetic     alopecia    (AGA)  is  the result  of progressive,   patterned  hair   loss  that occurs when genetically  predisposed   individuals   are exposed  to androgens.   The psychosocial    impact of AGA may negatively   affect  patient's  quality  of life and can lead  to personal    social   and  job• related problems  (I).   Also;  AGA can cause  indirect  physical   harm to some patients,   such as sunburn    as a result   of hair   loss  and exposure    to ultraviolet    light  <2).    Moreover;   AGA  is reportedly    associated  with   increased  incidence  of myocardial  infarction,    hypertension    and hypercholesterolemia     <3l.

Drug therapies  for AGA  approved  by the FDA are limited  to topical   minoxidil   and oral FIN  with efficacy  varies  between  40% and 60% <4l.   Multiple  factors  are implicated    in  the pathogenesis    of AGA  which involves   not only  DHT but also  inflammation,    genes,   signalling pathway,  stimulatory   pathways  like Wnt/B catenin,   and growth  factors  <5>.  The existing conventional  therapies  (i.e.   FIN and minoxidil)   fail to target  all of them <6>.

Microneedling   (MN)  is a relatively   new minimally  invasive   procedure  involving

controlled  puncturing  of the skin by rolling  with  miniature   fine needles  <1>.  It showed  efficacy  in some dermatological     conditions    including   post-acne  scars (Bl,  other scars <9>, pigmentary

disorders  (IO)'    and as a method  of drug delivery   <11>.

The demand  for new treatment  techniques  for AGA  is  growing,  various  procedures  like mesotherapy,    MN,  platelet   rich  plasma,  low  laser  light therapy,   and stem-cell   therapy  are under active   investigation    (12>.  MN creates  multiple  microchannels   and increases   transdermal

penetration   of drugs,  facilitating  higher  concentration   in  dermis  <13l.

Scalp  needling  also   stimulates    blood   flow  around  blood  starved  hair  follicles  and gently exfoliates   dead skin cells <14l.    Scalp  MN also  induces  hair  regrowth  by the following:   release   of growth  factors  through  platelet  activation   and skin wound  regeneration   mechanism,   activation of hair follicle  stem cells in the hair bulge  area under wound  healing  conditions   which is  caused

by MN,  and overexpression    of hair growth-related   genes,  vascular   endothelial   growth  factors,  P

catenin,   Wnt3a,  and WntlO  bas  documented  in animal  studies   <6>.

The use of MN in combination   with minoxidil   showed  promising    results   in  treatment  of AGA <6>.  Furthermore;  the addition   of MN to minoxidil   and oral  FIN improved   AGA  in  patients who were resistant  to minoxidil    and oral FIN <15>.  To the best of our knowledge;    the use of MN