Objective To analyze the efficacy of microneedling combined with Compound Siyadan Shengfa tincture in the treatment of androgenetic alopecia. Methods A total of 80 patients with androgenetic alopecia admitted to the First Affiliated Hospital of Shihezi University from January 2024 to January 2025 were selected, and they were divided into the control group and the study group by the random number table method, with 40 patients in each group. The control group was treated with conventional western medicine, and the study group was treated with microneedling combined with Compound Siyadan Shengfa tincture. The dermoscopy examination results, subjective symptom scores, adverse reaction rate and psychological status were compared between the two groups. Results The total hair count, hair density, terminal hair count, total hair follicle count in the study group at 6 months after treatment were higher than those in the control group (P <0.05). The scores of greasy hair, dandruff, scalp pruritus and seborrheic dermatitis in the study group at 6 months after treatment were lower than those in the control group (P <0.05). The incidence of adverse reactions in the study group (5.00%) was lower than that in the control group (20.00%) (P <0.05). The CES-D score of the study group at 6 months after treatment was lower than that of the control group (P <0.05). Conclusion Microneedling combined with Compound Siyadan Shengfa tincture has excellent efficacy in the treatment of androgenetic alopecia, which can further optimize hair status, alleviate alopecia symptoms, help to reduce the risk of adverse reactions and improve patients' psychological status, and is worthy of clinical application.