According to a study conducted by JAAD, female pattern hair loss (abbreviated to FPHL) affects approximately 40 percent of women by age 50. Harvard Medical School defines androgenetic alopecia as “gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head.” IAT Certified Trichologist and licensed cosmetologist Sophia Emmanuel says depending on their race, women will likely also experience a receding hairline, but will not go completely bald if they are treated for this condition.
Initially developed as a diuretic for high blood pressure (and more recently tackling acne), the oral medication, spironolactone, has been shown to help with hair regrowth. Hair loss, at its root, can have many potential origins, including genetics, medical conditions, and physical/emotional stress.
Meet the Expert
Below, board-certified dermatologists Flora Kim, MD, FAAD of Flora Kim Dermatology; Purvisha Patel, MD, MOHS, and Annie Gonzalez, MD, of Riverchase Dermatology, explain exactly what you need to know about taking spironolactone for hair loss purposes.
Type of ingredient: Potassium-sparing diuretic
Main Benefits: Originally created for high blood pressure, derms have recently started prescribing spironolactone for acne to block DHT (dihydrotestosterone), which is one of the main causes of androgenetic alopecia as well.
Who Should Use It: Because the mechanism of action is specifically for hormone-related hair loss, spironolactone won't work on those experiencing hair loss due to non-hormonal causes, such as stress or chemotherapy.
How Often Can You Use It: To address female pattern hair loss, derms traditionally recommend 100-200 mg daily, for a minimum of six months to determine if this is the proper treatment option.
Works Well With: Everyday vitamins and many prescriptions, though always check with a physician first.
Don’t Use With: Anything that can further increase your potassium levels. Kim cites that drugs contraindicated with spironolactone include amiloride, drospirenone, eplerenone, triamterene, cyclosporine, lofexidine, bosutinib, and pomalidomide, to name a few medications.
Benefits of Spironolactone
First of all, just what is spironolactone? “Structurally, its backbone is a basic steroidal nucleus with four rings. The primary metabolite of spironolactone is canrenone, which is an active metabolite that is also an antagonist of aldosterone, and thus promotes diuresis,” Gonzalez explains.
You might be wondering what on earth all of that means—and what it means for hair loss. To start, we must address that which causes hormonal hair loss in people (specifically those with ovaries), which is a difficult question to answer. In simple terms, estrogen increases the amount of time that hair spends in the growing phase, so when estrogen declines, hair loses these protective effects.
- Blocks the effects of certain hormones: According to Gonzalez, by definition, spironolactone is a potassium-sparing diuretic that blocks the effects of the hormones aldosterone and testosterone and has some estrogen-like effects.
- Protects against hair loss: “Estrogen is synthesized in the ovary and other peripheral tissues and then travels to its receptors, some of which are located in scalp hair follicles,” explains Kim. “At the scalp follicle, estradiol has been reported to induce aromatase activity. Estrogen has been hypothesized to have a protective role against hair loss based on of the observation that patients with lower estrogen levels during menopause, postpartum, or treatment with aromatase inhibitors or selective estrogen receptor modulators are more likely to develop hair loss.”
- Reduces the effects of DHT: DHT is a hormone created when certain enzymes convert testosterone in women's ovaries. So, in theory, if DHT is one of the main reasons for androgenetic alopecia, then spironolactone makes sense to try. Essentially, spironolactone helps reduce the effects of DHT by competitively blocking the attachment to its receptor, helping prevent miniaturization of the hair follicles.
- Treats high blood pressure: Spironolactone is traditionally used to treat high blood pressure and heart failure.
- Treats a host of other health issues: Lowering high blood pressure comes with a host of other benefits, as it helps prevent strokes, heart attacks, and kidney problems.
- Treats acne: Similar to how it works to minimize hair loss, spironolactone has also been found to help people battling acne.
Hair Type Considerations
Though many thinning hair types can benefit, aging women and those who genetically predisposed to hair loss will be most likely to see results. “As we age, we lose estrogen over time,” explains Patel. “When there is a genetic predisposition, female pattern hair loss can occur. Testosterone in the body and in the hair follicles goes unopposed, and this can lead to miniaturization of the hair follicles and hair loss. Spironolactone helps oppose the testosterone in the hair follicles and decreases hair loss.”
Gonzalez adds, “If your body produces an increased amount of testosterone or other androgens, spironolactone can help to reduce hair thinning by blocking the effects of testosterone in the body. The principle behind this is that there would be less testosterone-induced stimulation on the hair follicles, and therefore more hair retention.”
How To Use Spironolactone
Currently, spironolactone is administered by prescription and is taken orally and/or compounded into topical formulations for hair loss with fewer side effects.
- Take as a daily prescription: Derms traditionally recommend 100-200mg daily, a minimum of six months to determine if this is the proper treatment option. Patel emphasizes that this treatment method is by no means an overnight fix. “[Patients complain] that it is not working, but this is mostly due to expectation. It stops hair from further falling out and regrowth may take time,” she details. “The dose can also be adjusted by your board-certified dermatologist.”
Side Effects of Spironolactone
Remember, spironolactone is a diuretic, so it is imperative that you make the extra effort to drink plenty of water. Patel notes that “it could make your electrolytes out of whack, leading to high potassium levels. This is why your doctor checks this level during treatment.”
While taking spironolactone, Patel also recommends that patients lower their potassium intake (by way of supplements or banana consumption) in addition to avoiding the following: cholestyramine, digoxin, lithium, trimethoprim; heart or blood pressure medicine (especially another diuretic); medicine to prevent blood clots; or NSAIDs (nonsteroidal anti-inflammatory drugs) which includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, and meloxicam.
According to Kim, other potential side effects include “dizziness with postural hypotension, breast tenderness, decreased libido, spotting, and electrolyte imbalance. This androgen receptor blocker is categorized as pregnancy category D.”
Gonzalez emphasizes that due to its estrogen-like effects, this medication is only given to those who are not pregnant. “The most common side effects are diuresis, menstrual irregularities, gastrointestinal upset, and breast tenderness. To add, women of childbearing potential must be on a reliable form of birth control with spironolactone to avoid exposure during pregnancy.”
Before exploring this option, speak with your primary health doctor or dermatologist to determine if this is the right treatment method for your current lifestyle.
Other options, like minoxidil (at least 5 percent or higher per Kim), flutamide, dutasteride, finasteride, birth control (those that are combined and contain both estrogen and progestin) may be a better solution.
Ultimately, hormonal balance is exactly that—a balance. “Tipping one way or another with hormone levels does not help everyone,” cautions Patel.
Is spironolactone safe for everyone?
It's always best to seek expert advice first, particularly when it comes to prescription medications. If you notice any unusual hair changes, we strongly encourage you speak to your primary care doctor or dermatologist to determine the correct treatment plan for you.
Does spironolactone have negative side effects?
Drowsiness, dizziness, lightheadedness, upset stomach, and nausea can all occur as a result of taking spironolactone. Always seek expert advice before taking a prescription.
Are there additional benefits of taking spironolactone?
Spironolactone has also been shown to benefit those who suffer from acne.
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Glynis A. A double-blind, placebo-controlled study evaluating the efficacy of an oral supplement in women with self-perceived thinning hair. J Clin Aesthet Dermatol. 2012;5(11):28-34.
Grymowicz M, Rudnicka E, Podfigurna A, et al. Hormonal effects on hair follicles. Int J Mol Sci. 2020;21(15):5342.