Best minoxidil enhancer: tretinoin or microneedling?

[LITUATUI]

Hi guys!

I'm really interested to know which is the best minoxidil enhancer, especially for non-responders to topical minoxidil alone.


Both minoxidil and microneedling are proved to increase VEGF (Vascular endothelial growth factor).

However, tretinoin is still debatable. You can go to Google Scholar (open articles with Sci-Hub) and find multiple studies that say that retinoids do increase VEGF and others that say the complete opposite...

Considering that tretinoin works great to treat rosacea, I'm more inclined to believe that the use of tretinoin reduces VEGF and angiogenesis.


We definitely want VEGF and angiogenesis for hair regrowth. With good blood flow on the scalp, less testosterone will be converted to DHT.

Areas of the scalp with sparse hair growth have been shown to be relatively hypoxic, have slow capillary refill, and to have high levels of dihydrotestosterone.

The enzymatic conversion of testosterone to dihydrotestosterone is oxygen dependent. In low-oxygen environments, the conversion of testosterone to dihydrotestosterone is favored; whereas in high-oxygen environments, more testosterone is converted to estradiol.

https://journals.lww.com/plasrecons..._Male_Pattern_Baldness_with_Botulinum.79.aspx



Old study that shows great results (strong regrowth) from minoxidil combined with tretinoin:

https://sci-hub.se/https://www.sciencedirect.com/science/article/abs/pii/S019096228680024X


More recent study that shows great results (strong regrowth) from minoxidil combined with microneedling:

https://europepmc.org/article/med/23960389



There are much more recent studies that show good results with minoxidil combined with microneedling than with tretinoin.


As a non-responder to topical minoxidil alone, recently I started microneedling every week and using tretinoin 3 days a week.


I'm worried that tretinoin could be undermining the microneedling sessions, by reducing VEGF and angiogenesis...



What do you guys think works best?


1) Minoxidil + microneedling
2) Minoxidil + tretinoin
3) Minoxidil + microneedling + tretinoin


Thanks!

 

[longhair1983]

I vote no.3

 

[-Synergy-]

Has to be the third one right? Makes the most sense because obviously tretinoin does great stuff for skin gets minoxidil in the follicles and increases sult.

 

[LITUATUI]

Has to be the third one right? Makes the most sense because obviously tretinoin does great stuff for skin gets minoxidil in the follicles and increases sult.

I hope so since I'm using tretinoin 2-3 times a week.

Curiously, tretinoin seems to make my scalp skin thicker. Previously I was doing microneeding sessions with an adjustable derma-stamp at 1 mm and aiming for pinpoint bleeding, but in last session 1 mm wasn't enough to get pinpoint bleeding, I had to increase the needle's length a bit (to 1,5 mm).

Thicker skin on the scalp would be great, since it could provide a better environment (more support) for the hair follicle.

 

[brandnew88]

Any updates? I have been micro needling with a roller once a week for almost 4 months. Definitely improvement in density. I have been on minoxidil foam and finasteride for a few years.
I just added tretinoin cream (probably way too much) and have been shedding. I have to use a about 3-4 pea size amounts to get it to my scalp as I am a diffuse thinner.

 

[hairgone1234]

Got to be third option. Ive been using microneedling once a week with topical dutasteride after and minoxidil twice daily.

 

[LITUATUI]

I'm still using tretinoin 2/3 times a week on my face and scalp, but I'm not sure if it helps.

Furthermore, insult to dermal papilla by reactive oxygen species and DHT promotes expression of TGF-β1 (H. Shin et al., 2013) (whereas retinoids induced hair loss is by over expression of TGF-β2 (Foitzik, Spexard, Nakamura, Halsner, & Paus, 2005)), cascading into effects described above. Treatment using topical retinol or retinoic acid aids in normalizing the ratios and expression of the TGF-β subtypes, and can accommodate some hair rejuvenation (Bazzano, Terezakis, & Galen, 1986), but there is also a risk of creating retinoid alopecia (Sadgrove & Simmonds, 2021).

Sci-Hub | The “bald” phenotype (androgenetic alopecia) is caused by the high glycaemic, high cholesterol and low mineral “western diet.” Trends in Food Science & Technology | 10.1016/j.tifs.2021.06.056

The only study that showed great visible results in hair regrowth with tretinoin is from 1986 and the sample size was extremely small. The microneedling is backed up by more and better studies.