Objective To explore the efficacy of fractional laser combined with nanocrystalline microneedle and minoxidil tincture in the treatment of androgenetic alopecia (AGA). Methods A total of 90 patients with AGA admitted to the Department of Dermatology of our hospital from September 2023 to September 2024 were selected, and they were divided into group A, group B and group C by the random number table method, with 30 patients in each group. Group A was treated with minoxidil tincture, group B with nanocrystalline microneedle combined with minoxidil tincture, and group C with fractional laser combined with nanocrystalline microneedle and minoxidil tincture. The trichoscope indicators, clinical efficacy and adverse reaction rate were compared among the three groups. Results The hair density and hair diameter of group C were higher than those of group B and group A, and the proportion of vellus hair was lower than that of group B and group A (P<0.05). There was no statistically signiffcant difference in hair diameter between group B and group C (P>0.05 ).The hair density and hair diameter of group B were higher than those of group A, and the proportion of vellus hair was lower than that of group A (P<0.05). The total effective rate of group C was higher than that of group B, but the difference was not statistically signiffcant (P>0.05). The total effective rates of group B and group C were higher than that of group A (P<0.05). There was no statistically signiffcant difference in the incidence of adverse reactions among the three groups (P>0.05). Conclusion Fractional laser combined with nanocrystalline microneedle and minoxidil tincture can effectively improve hair-related indicators and enhance clinical efffcacy in the treatment of AGA, which is superior to minoxidil tincture alone and nanocrystalline microneedle combined with minoxidil tincture. All three schemes have good safety and can be selected clinically according to patients' conditions.