Background <p>Androgenetic alopecia (AGA) affects both sexes equally and lasts long. AGA is the most common kind of hair loss in men. Gradual, pattern-based hair thinning on the scalp is a hallmark of the disease. The front, back, center, and sides of a man’s head are the most common areas where hair thinning and loss occur.</p> Aim <p>To evaluate the efficacy of microneedling-administered topical cetirizine in treating androgenetic alopecia in men.</p> Methods <p>A total of 80 AGA male patients were randomly assigned to this single-blind, parallel placebo-controlled study conducted at Beni-Suef University Hospital’s Dermatology Outpatient Clinic. Researchers allocated 40 patients to undergo topical cetirizine microneedling (MN) and 40 patients to saline MN for 8 weeks.</p> Results <p>In the 8th week, the cetirizine group demonstrated a greater prevalence of vellus hair (70.0%) than the saline group (30.0%), with a statistically significant difference (<i>p</i>-value = 0.001). The majority of patients administered cetirizine by MN exhibited enhanced hair density (80.0%) in contrast to 25.0% in the saline group, with a statistically significant difference between the two groups (<i>p</i>-value = 0.001). No notable adverse effects linked to the administration of cetirizine by MN were reported.</p> Conclusion <p>The microneedling of 1% topical cetirizine proved efficient in promoting hair growth without problems in the treatment of male androgenetic alopecia.</p>