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What Happens If I Stop Microneedling?

Hair loss treatments usually require lifelong use to maintain their effectiveness. If a person stops using a hair loss treatment, their hair may return to its original state before treatment. However, is this also true for microneedling? In this guide, we will investigate whether minoxidil and finasteride continue to have an impact after treatment cessation, as well as the available research on the effects of microneedling after stopping treatment.

a standard Microneedling device or Dermaroller
A derma roller for at-home microneedling.

What is Microneedling?

Microneedling is a minimally invasive cosmetic procedure aimed at stimulating hair growth and improving the thickness and density of hair in individuals experiencing various types of hair loss, including androgenic alopecia (AGA). During the procedure, a specialized device equipped with fine, tiny needles creates controlled micro-injuries on the scalp’s surface.

The micro-injuries trigger the body’s natural wound-healing response, increasing blood circulation to the treated area and promoting the release of growth factors. As a result, hair follicles receive enhanced nourishment and signaling, potentially leading to stronger, thicker, and more abundant hair growth.

Microneedling can also improve the absorption of topical hair growth products, such as minoxidil, by creating micro-channels that facilitate their penetration into the scalp. While it may not provide permanent results, consistent microneedling sessions can help individuals achieve visible improvements in hair quality and density. However, there is limited information on what happens to your hair when you stop microneedling.

How Often Do I Need to Undergo Microneedling To See Effects?

You can find more information about microneedling frequencies here. Based on current research, it is generally agreed that microneedling devices with a needle length of 1.5 mm and 192-count needles are effective when used at intervals of 1-3 weeks. Furthermore, studies have shown that microneedling can double or even triple the efficacy of minoxidil, with one showing that microneedling using a 1.5 mm needle length every two weeks alongside twice-daily minoxidil treatment results in a 40% increase in hair count.[1]Bao, L., Gong, L., Guo, M., Liu, T., Shi, A., Zong, H, Xu, X., Chen, H., Gao, X., Li, Y. (2017). Randomized trial of electrodynamic microneedle combined with 5% minoxidil topical solution for the … Continue reading

Can I Undergo Treatment More Often?

It’s important to remember that microneedling can cause skin irritation and damage if done too frequently.

There is some promising evidence to suggest that you can microneedle your scalp more frequently (once weekly). One study showed that microneedling once weekly resulted in a 40% increase in hair count using a 1.5 mm needle length, alongside twice-daily minoxidil.[2]Dhurat, R., Sukesh, M.S., Avhad, G., Dandale, A., Anjali, P., Pund, P. (2013). A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study. International … Continue reading

However, as the data is limited, and there might be some other issues involved (like longer healing time), it is recommended to follow the 1-3 week treatment frequency.

Now that we’ve explored the effectiveness of microneedling for hair loss and the recommended treatment frequencies let’s delve into what typically happens when individuals discontinue this microneedling therapy. But before we do that, it’s essential to understand the usual outcomes when you withdraw from traditional hair loss treatments.

What Happens If I Stop Minoxidil?

There are typically two reasons why people stop taking minoxidil. Firstly, it may not be effective for them at all. Secondly, even if it works, they may discontinue its use due to the inconvenience of applying it twice daily for the rest of their lives.

What the Research Shows

In 1999, a study examined the consequences of discontinuing minoxidil after prolonged use. The results were quite intriguing. Not only did the group that stopped minoxidil experience hair shedding, but for a brief period, their hair counts dropped below the baseline levels they had before using minoxidil.

The researchers tracked four distinct groups over more than two years. These groups were administered either 2% minoxidil, 5% minoxidil, a placebo, or no treatment. The 2% and 5% minoxidil groups displayed increased hair counts at the three-month mark, which, as mentioned earlier, plateaued to some extent but remained higher than the hair counts observed in the placebo and control groups.

After nearly two years of continuous treatment, at the 96-week mark, the individuals in the 2% and 5% minoxidil groups had their treatments discontinued. This discontinuation can be pinpointed by examining the data on hair weights, which began to decline shortly after (Figure 1).

Graph showing hair weight and counts in men after minoxidil treatment was stopped.
Figure 1: Changes in hair weight and hair count in men with androgenic alopecia after application of 5% and 2% topical minoxidil, placebo, or no treatment. The line at 96 weeks shows the time when minoxidil treatment was stopped.[3]Price, V.H., Menefee, E., Strauss, P.C., (1999). Changes in hair weight and hair count in men with androgenetic alopecia after application of 5% and 2% topical minoxidil, placebo, or no treatment. … Continue reading

Three months later, at week 108, their hair loss had fallen well below the placebo group’s levels and even dipped below their initial hair counts. Three months later, at week 120, the 2% and 5% minoxidil groups had rebounded, ultimately returning to a level comparable to whether they had started before the study began.

It’s worth noting that any excessive shedding experienced during this transition is not typically permanent, and it will return to pre-treatment levels as the hair eventually adjusts to a new equilibrium without the presence of the drug.

What Happens if I Stop Finasteride?

While finasteride is widely considered to be the gold-standard medical therapy for AGA, there are still several reasons that someone might discontinue the use of finasteride.

  • Side effects. Some individuals may experience side effects while taking finasteride, which can include sexual side effects like reduced libido, erectile dysfunction, and reduced ejaculate volume. These can be concerning and uncomfortable, leading to discontinuation. These side effects will generally stop within a few weeks after stopping finasteride, and they tend to occur only in a small number of individuals. There are also ways to potentially mitigate the side effects of finasteride with topical formulations.
  • Lack of efficacy. Five-year placebo-controlled clinical studies show that finasteride can slow, stop, or partially reverse hair loss in 80-90% of the men who use it.[4]Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ. Finasteride in the treatment of men with … Continue reading With that said, for some people, finasteride doesn’t work. If a person does not see the desired result regarding hair regrowth, they may choose to stop taking the medication.
  • Fear. Misconceptions about finasteride, especially when spread online, can lead some individuals to stop using the medication based on unfounded fears or concerns. Some of the biggest concerns surround a condition known as post-finasteride syndrome. Researchers are torn as to whether post-finasteride syndrome exists, and if it does, what its true incidence is. Our opinion is that it does exist, but that its incidence is incredibly low and the risk of development can be mitigated with formulation changes. Nonetheless, when online forums echo anecdotal experiences of this condition, it can strike fear in those using the medication without side effects, thus causing them to quit.

What the Research Shows

The Propecia (branded finasteride) package insert suggests that within 3-12 months of stopping finasteride, hair loss resumes, and hair counts return to where they were before starting the drug. The evidence supporting this is based on scientific support derived from the original Phase II and Phase III clinical trials that were pivotal in obtaining FDA approval for finasteride’s use in treating androgenic alopecia.

Quitting Finasteride Leads to a Reduction in Hair Count after 12 Months

Within these trials, a subset of finasteride users was administered the drug for an entire year. Subsequently, they were unknowingly switched into a group that received a placebo (a sugar pill) during the second year, which corresponds to months 12-24 of the study.

The researchers tracked and documented changes in hair counts for these participants from the beginning (month 0) through the entire 24-month period. They then compared these changes with those who continued using finasteride throughout the study and those who consistently received the placebo.

Results

The findings revealed that discontinuing finasteride use and transitioning to the placebo group led to a return to hair counts equivalent to the levels observed at month 0 or, in some cases, even slightly below the baseline counts after 12 months of discontinuation (Figure 2).

Graph showing mean hair count change before and after finasteride use.
Figure 2: Hair count mean change from baseline. Fin – Pbo = the group who initially took finasteride and then were unknowingly switched to placebo. A notable decrease in mean hair counts was observed from months 12-24 in the Fin – Pbo group.[5]Kaufman, K.D., Olsen, E.A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., Price, V.H., van Neste, D., Roberts, J.L., Hordinsky, M., Shapiro, J., Binkowitz, B., Gormley, G.J. (1998). Finasteride … Continue reading

But what about if you’re only planning to take a break from finasteride to reduce your drug exposure but maximize hair gains?

Finasteride Can Exert Its Effects for Several Weeks After Quitting

Because finasteride has a terminal half-life of 5-7 hours and it takes about 4-5 days for the drug to fully dissociate from the tissues, its biological effects on hormone profiles can persist up to approximately 30 days after discontinuation.

In practical terms, this means finasteride can continue to have a therapeutic impact in reducing scalp levels of dihydrotestosterone (DHT) even several weeks after a person stops taking the medication (Figure 3).

Graph showing serum finasteride after quitting.
Figure 3: Serum dihydrotestosterone (DHT) concentration before and after quitting finasteride treatment.[6]Clark, R.V., Hermann, D.J., Cunningham, G.R., Wilson, T.H., Morrill, B.B., Hobbs, S. (2004). Markes Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual … Continue reading

Alternative Finasteride Dosing Schedules: Exploring the Possibilities

One study investigated whether a daily dose of 1 mg was necessary for maintaining hair regrowth. The researchers initially placed a group of men on a daily 1 mg finasteride regimen for a year. In the second year, they divided the men into two groups: one continued to take finasteride daily, while the other group adopted a 30 days-on, 30 days-off dosing schedule.[7]Kim, K.H., Park, S.M., Lee, Y.J., Sim, W.Y., Lew, B.L. (2020). Similar efficacy of maintenance treatment of finasteride 1 mg every other month compared with finasteride 1 mg daily in Korean men with … Continue reading

Results

The intriguing finding was that both groups experienced comparable improvements in hair parameters during the second year, despite the second group using finasteride for only half the time (i.e., a total of 6 months as opposed to 12 months).

The underlying hypothesis was that finasteride’s pharmacokinetics might allow for dosing schedules that alternate monthly. This approach could potentially accommodate those who wish to reduce their drug exposure or take breaks from the medication without significantly compromising their hair gains.

What If I Need To Stop Taking Finasteride For Any Other Reason?

When pausing finasteride use for an extended period exceeding 30 days, there’s a higher risk of hair loss resuming due to the dissipation of the drug’s effects on scalp DHT levels. Both clinical withdrawal studies and anecdotal reports from finasteride users support this phenomenon.

Hair loss may not immediately return for many individuals but might become noticeable around the second or third month after quitting. To maintain the benefits of the drug on hair health, it’s advisable to keep the withdrawal period beyond 30 days as short as possible.

If you want to learn more about the pharmacokinetics of finasteride and how you can maximize your treatment usage, you can follow these links!

What Happens If I Stop Microneedling?

Unlike the minoxidil and finasteride data above, there is less evidence determining whether you can maintain hair gains after stopping microneedling for hair loss.

However, it is possible that results from microneedling last longer after ending treatment.

What the Research Says

The only clinical study evaluating this question is a 2020 study comparing the effects of minoxidil vs. microneedling vs. minoxidil + microneedling.

71 male participants with AGA were split into three groups:

  • 5% minoxidil twice daily for 24 weeks (n=23)
  • Microneedling only every 3 weeks for 8 treatments (n=23)
  • Combination treatment for a total of 24 weeks (n=25)

Changes in hair density and diameter were evaluated before and after treatment every three weeks, and patients were followed up at 6 months after the final treatment.

Results

Three weeks after the last treatment, all groups showed significant increases in non-vellus hair density, with group 3 (minoxidil plus microneedling) showing the highest increase in non-vellus hair density (56.45±7.82 roots per cm2), compared to ~28 in the minoxidil group and ~32 in the microneedling group. 

These results are to be expected, especially after the Dhurat paper that first showed that microneedling can improve the efficacy of minoxidil.[8]Dhurat, R., Sukesh, M., Avhad, G., Dandale, A., Pal, A., Pund, P. (2013). A randomized evaluator blinded study of the effect of microneedling in androgenetic alopecia: a pilot study. International … Continue reading

It’s what the researchers did next that captured our interest and indicated a potential for the lasting effects of microneedling.

Six Months After Treatment

Six months after the last treatment, participants were returned for new hair evaluations. It was observed that in the minoxidil-only group, 90% of the participants experienced a loss of all the newly gained hair six months after discontinuing the treatment. This is not surprising – and aligns with the minoxidil study above. However, in the microneedling-only and minoxidil-plus-microneedling groups, 70% of participants retained some new hair, and 20% retained all new hair growth (Figure 4).

Photos of hair regrowth after 3 different treatment combinations.
Figure 4: The effect of a) minoxidil-only, b) microneedling-only, and c) minoxidil and microneedling on hair regrowth during the initial 24 weeks of treatment, and a further 24 weeks after treatment.[9]Bao, L., Zong, H., Fang, S., Zheng, L.i, Y. (2022). Randomized trial of electrodynamic microneedling combined with 5% minoxidil topical solution for treating androgenetic alopecia in Chinese males … Continue reading

This shows that microneedling, alone or in combination with minoxidil, has a more sustained impact on hair maintenance even after treatment discontinuation, compared to minoxidil alone. Furthermore, the combination effect indicates that microneedling might enhance the staying power of minoxidil, even after both treatments end.

What Might Be Giving These Treatments Staying Power?

Exploring the underlying mechanisms that contribute to the staying power of microneedling treatments is key to understanding how these benefits persist even after cessation of the therapy. These can include increased growth factors, enzyme activity, and tissue remodeling, which can give us insights into why microneedling may have a more enduring impact on hair health compared to other treatments. Let’s take a look at these elements to uncover how they collectively contribute to sustaining hair growth improvements over time.

Increase in Growth Factors and Proteins

Microneedling results in short-term increases in growth factors and proteins. These may help to initiate the growing (anagen) stage of hair growth.[10]Kim, Y.S., Jeong, K.H., Kim, J.E., Woo, Y.J., Kim, B.J., Kang, H. (2016). Repeated Microneedle Stimulation Induces Enhanced Hair Growth in a Murine Model. Annals of Dermatology. (28)5. 586-592. … Continue reading

Increased Sulfotransferase

Microneedling leads to an increase in sulfotransferase. This is the enzyme that activates minoxidil, leading to minoxidil sulfate and minoxidil’s positive effects on hair follicle growth.[11]Sharma, A., Surve, R., Dhurat, R., Sinclair, R., Tan, T., Zou, Y., Ramos, P.M., Wambier, C., Verner, I., Kovacevic, M., Goren, A. (2020). Microneedling improves minoxidil response in androgenetic … Continue reading In theory, more sulfotransferase should mean more minoxidil activation and, therefore, an enhanced response to the drug.

However, the effects mentioned above may only last as long as the treatment is given.

Tissue Remodeling

The longer effects of microneedling may be due to its tissue remodeling effects, including improved angiogenesis and reduced scarring. These can potentially contribute to longer-lasting results.[12]Alster, T.S., Li, M.K.Y. (2020). Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up. Plastic and Reconstructive Surgery. 145(2). 358-364. Available at: … Continue reading,[13]Wang, Y., Zhang, N., Gao, W., Hu, Y., Cao, S., Li, Z., Huang, Z., Zhang, J., Xu, W., Cheng, R., Chen, C. (2017). International Journal of Clinical and Experimental Medicine. 10(2). 2874-2881.

Starting or Stopping Microneedling

Because of the limited data, we do not recommend throwing away your hair loss treatments and expecting to maintain your hair gains. However, there is a possibility that microneedling can potentially extend the hair gains from minoxidil even after stopping the drug.

Additionally, when used alone, microneedling may result in hair regrowth lasting 6 months or longer even after discontinuation. Future research should further help us to understand this and may enable a shift in how we treat our hair loss.

References

References
1 Bao, L., Gong, L., Guo, M., Liu, T., Shi, A., Zong, H, Xu, X., Chen, H., Gao, X., Li, Y. (2017). Randomized trial of electrodynamic microneedle combined with 5% minoxidil topical solution for the treatment of Chinese male androgenetic alopecia. Journal of Cosmetic and Laser Therapy. 22(1). 1-7. Available at: https://doi.org/10.1080/14764172.2017.1376094
2 Dhurat, R., Sukesh, M.S., Avhad, G., Dandale, A., Anjali, P., Pund, P. (2013). A Randomized Evaluator Blinded Study of Effect of Microneedling in Androgenetic Alopecia: A Pilot Study. International Journal of Trichology. v.5(1). Available at: https://doi.org/10.4103/0974-7753.114700
3 Price, V.H., Menefee, E., Strauss, P.C., (1999). Changes in hair weight and hair count in men with androgenetic alopecia after application of 5% and 2% topical minoxidil, placebo, or no treatment. Journal of American Academy of Dermatology. 41(5.1). 717-721. Available at: https://doi.org/10.1016/s0190-9622(99)70006-x
4 Kaufman KD, Olsen EA, Whiting D, Savin R, DeVillez R, Bergfeld W, Price VH, Van Neste D, Roberts JL, Hordinsky M, Shapiro J, Binkowitz B, Gormley GJ. Finasteride in the treatment of men with androgenetic alopecia. Finasteride Male Pattern Hair Loss Study Group. J Am Acad Dermatol. 1998 Oct;39(4 Pt 1):578-89. doi: 10.1016/s0190-9622(98)70007-6. PMID: 9777765.
5 Kaufman, K.D., Olsen, E.A., Whiting, D., Savin, R., DeVillez, R., Bergfeld, W., Price, V.H., van Neste, D., Roberts, J.L., Hordinsky, M., Shapiro, J., Binkowitz, B., Gormley, G.J. (1998). Finasteride in the treatment of men with androgenetic alopecia. Journal of the American Academy of Dermatology. 39(4.1). 578-589. Available at: https://doi.org/10.1016/S0190-9622(98)70007-6
6 Clark, R.V., Hermann, D.J., Cunningham, G.R., Wilson, T.H., Morrill, B.B., Hobbs, S. (2004). Markes Suppression of Dihydrotestosterone in Men with Benign Prostatic Hyperplasia by Dutasteride, a Dual 5alpha-Reductase Inhibitor. The Journal of Clinical Endocrinology & Metabolism. 89(5). 2179-2184. Available at: https://doi.org/10.1210/jc.2003-030330
7 Kim, K.H., Park, S.M., Lee, Y.J., Sim, W.Y., Lew, B.L. (2020). Similar efficacy of maintenance treatment of finasteride 1 mg every other month compared with finasteride 1 mg daily in Korean men with androgenetic alopecia after taking finasteride 1 mg daily for 1 year. Journal of the American Academy of Dermatology. 83(6). Available at: https://doi.org/10.1016/j.jaad.2020.06.828
8 Dhurat, R., Sukesh, M., Avhad, G., Dandale, A., Pal, A., Pund, P. (2013). A randomized evaluator blinded study of the effect of microneedling in androgenetic alopecia: a pilot study. International Journal of Trichology5(1). 6-11. Available at: https://doi.org/10.4103/0974-7753.114700
9 Bao, L., Zong, H., Fang, S., Zheng, L.i, Y. (2022). Randomized trial of electrodynamic microneedling combined with 5% minoxidil topical solution for treating androgenetic alopecia in Chinese males and molecular mechanistic study of the involvement of the Wnt/β-catenin signaling pathway. Journal of Dermatological Treatment. 33(1). 483-493. Available at: https://doi.org/10.1080/09546634.2020.1770162
10 Kim, Y.S., Jeong, K.H., Kim, J.E., Woo, Y.J., Kim, B.J., Kang, H. (2016). Repeated Microneedle Stimulation Induces Enhanced Hair Growth in a Murine Model. Annals of Dermatology. (28)5. 586-592. Available at: https://doi.org/10.5021/ad.2016.28.5.586
11 Sharma, A., Surve, R., Dhurat, R., Sinclair, R., Tan, T., Zou, Y., Ramos, P.M., Wambier, C., Verner, I., Kovacevic, M., Goren, A. (2020). Microneedling improves minoxidil response in androgenetic alopecia patients by upregulating follicular sulfotransferase enzymes. Journal of Biological Regulators and Homeostatic Agents. 34(2). 659-661. Available at: https://hoi.org/10.23812/19-385-L-51
12 Alster, T.S., Li, M.K.Y. (2020). Microneedling of Scars: A Large Prospective Study with Long-Term Follow-Up. Plastic and Reconstructive Surgery. 145(2). 358-364. Available at: https://doi.org/10.1097/PRS.0000000000006462
13 Wang, Y., Zhang, N., Gao, W., Hu, Y., Cao, S., Li, Z., Huang, Z., Zhang, J., Xu, W., Cheng, R., Chen, C. (2017). International Journal of Clinical and Experimental Medicine. 10(2). 2874-2881.

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