Background: Monofilament thread therapy (PLLA) and minoxidil have been used as alternative treatments for female androgenetic alopecia. Aim: The aim was to determine the efficacy and safety of thread therapy combined with minoxidil in female androgenetic alopecia. Patient and methods: Twenty-seven women were enrolled in this randomized half-split study based on a left-head to the right-head pattern. Thread therapy (PLLA) treatment was unilaterally performed (once); minoxidil was bilaterally applied for 6 months. Global photographs and dermoscopy assessments were performed in the baseline and every 2 months till the end of treatment. Global photographs underwent blinded review by three independent dermatologists. Results: Mean hair density increased from 114 ± 27 to 143 ± 25/cm2 (P < .001) in the combined group and from 113 ± 24 to 123 ± 19/cm2 in the minoxidil group (P < .001). The mean change from baseline between the two groups was also compared (P = .003). Global photographs showed improvement in 93% (25/27) patients in the combined group and 52% (14/27) patients in the minoxidil group. Conclusion: Poly-l-lactic acid microthread therapy combined with minoxidil may improve hair density, hair thickness, and hair appearance better than minoxidil alone.