Objective: To systematically investigate the clinical efficacy, safety, and impact on patients' quality of life of 0.5mm scalp microneedling combined with 630 nm LED phototherapy for androgenetic alopecia (AGA), providing evidence-based medical evidence for clinical treatment. Methods: A total of 90 patients with AGA who visited the Xuhui Hospital affiliated with Fudan University from January 2023 to September 2024 were selected as the research subjects. They were randomly divided into the control group and the research group, with 45 patients in each group. The control group received treatment with 630nm LED phototherapy, while the research group received treatment with 0.5mm scalp microneedling combined with 630nm LED phototherapy. The efficacy of both groups was assessed using a multi-dimensional evaluation approach, including hair microscopy, fungal fluorescence microscopy, Severity of Alopecia Tool (SALT) scoring, and patient self-assessment questionnaires. In addition, they were followed up to observed long-term outcomes after 6 months. Results: The hair density in the research group after treatment was 118.64±8.21 hairs/cm2, hair shaft diameter was 78.32±4.73 μm, which was higher than that in the control group (P < 0.05). The number of hair follicle units per single hair was 40.23±3.82, and the fungal microscopy positivity rate was 24.44%, which was lower than that in the control group (P < 0.05). The SALT score was 18.10±1.63 at 12 weeks treatment and 19.81±1.95 at the 6-month follow-up, both significantly higher than the control group (P < 0.05). The proportion of patients reporting significant improvement on the Hair Loss Self-Assessment Scale reached 60% at 12 weeks treatment and 68.89% at the 6-month follow-up, both significantly higher than the control group (P < 0.05). Conclusion: Combined scalp microneedling and 630nm LED phototherapy demonstrates rapid, durable improvement in AGA through multi-target synergy, with excellent safety and patient satisfaction, positioning it as a promising first-line clinical option.