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Does Spironolactone Cause Weight Gain?

Katelyn Hagerty

Reviewed by Katelyn Hagerty, FNP

Written by Geoffrey C. Whittaker

Published 02/17/2022

Updated 09/08/2023

While it may sound like an extinct creature from the Cretaceous period, spironolactone did not roam the earth battling the T. rex for turf. Sorry to disappoint. 

Spironolactone is actually a heart medication. But because of the way it works (specifically in regulating the hormone aldosterone), it can also be used off-label for acne and hair loss.

Spironolactone is an oral potassium-sparing diuretic for heart conditions. It reduces the sodium your body stockpiles during fluid retention and increases your potassium levels, both of which are beneficial for long-term heart health.

Healthcare professionals may prescribe spironolactone to treat many conditions, including: 

  • Hypertension (high blood pressure)

  • Heart failure 

  • Edema

Spironolactone also has off-label uses that aren’t officially approved by the FDA (U.S. Food and Drug Administration). Off-label and secondary uses are often employed by healthcare professionals when traditional treatments don’t work — or when the side effects of an initial treatment aren’t manageable.

Off-label uses for spironolactone include the treatment of various medical conditions:

  • Polycystic ovary syndrome (PCOS)

  • Hirsutism (facial hair in women)

  • Hair loss in women

  • Acne vulgaris

  • Bloating and weight gain due to PMS

For women, it’s considered an effective hormonal acne treatment. Most women see a decrease in oiliness and breakouts in two to three weeks. 

For women with hair loss, some research suggests spironolactone can boost hair growth by affecting the androgen hormones associated with female patterned hair loss.

Now that we understand the basics of spironolactone and what it’s used to treat, let’s hop into the topic at hand: spironolactone and weight gain.

Spironolactone, like every prescription medication, does have certain side effects associated with its use. However, weight gain doesn’t appear to be one of them.

While weight gain is listed as a possible side effect of spironolactone on some credible medical websites, it’s not listed as a side effect on the drug’s FDA package insert — which is pretty much the be-all and end-all of relevant prescribing information.

Also, clinical studies don’t suggest spironolactone causes weight gain. 

In fact, spironolactone is a diuretic — also known as a water pill — meaning it causes your body to get rid of salt and water through urination.

Diuretics are often used to reduce blood pressure. But the secondary effect is that your weight (specifically water weight in the form of fluid retention) can go down. And it doesn’t affect body fat levels.

When your body loses water, it typically loses weight. So it would seem improbable to gain weight because you’re taking spironolactone, as the medication is actually associated with potential weight loss.

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As mentioned, weight loss might be a potential side effect of spironolactone use. But let’s be clear: Spironolactone is not a weight loss drug.

Let us say that again: Spironolactone is not a weight loss drug.

There are zero medical studies (not even ones with questionable rigor) showing that this medication can be used for weight loss.

So where did the rumors come from? Well, it has to do with one side effect of the medication.

Since spironolactone is a diuretic, it technically can (and does) decrease water retention. That, in turn, could result in temporary, slight weight loss. 

Notice, please, that we didn’t use the word “healthy” to describe the weight loss you’ll experience.

Many people struggle with weight, body dysmorphia and other appearance-related issues — and we certainly don’t want to make light of that. That said, this medication isn’t going to be the “surprising new way” to achieve any lasting changes.

Weight loss is a minuscule, common side effect of spironolactone, and it’s not long-term. If you’re trying to lose weight, go a different, more sustainable route.

There are other common side effects of spironolactone besides the potential for diuretic weight loss. And most aren’t nearly as appealing. 

The long list of things to watch out for when taking this medication includes:

  • Breast tenderness or enlargement

  • Constipation

  • Loss of appetite

  • Nausea

  • Drowsiness

  • Irregular heartbeat

  • Menstrual irregularities

Are there ways to alleviate the side effects of spironolactone? Potentially.

Something many women use every day — hormonal birth control — can help reduce certain side effects. Taking birth control pills along with spironolactone may help alleviate some adverse effects, like irregular periods, breast enlargement and breast pain. 

Additionally, it’s useful to take birth control with spironolactone because if you become pregnant while on the medication, it may cause serious birth defects. If you’re using spironolactone and become pregnant, talk to a healthcare provider immediately.

If you experience an allergic reaction or any other adverse effects, it’s important to inform your healthcare provider right away.

We should also note that spironolactone is only prescribed to women as an acne medication because it can cause breast growth in men.

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If you’ve run out of other options to help get your acne or hair loss under control, it’s definitely worth getting medical advice from a healthcare provider.

But if you’re here looking for a weight loss supplement, keep browsing.

Spironolactone probably won’t increase your weight, but it’s also not a weight loss drug. What you need to remember is this:

  • Spironolactone has many possible adverse effects — although it is widely considered safe to use.

  • One possible effect is weight loss, which may be minimal, unsustainable and temporary.

  • Some women who’ve used the drug to treat acne anecdotally claim to have gained body weight while on spironolactone.

  • Whether it can cause weight gain is still up for debate. Clinical studies suggest it doesn’t, and the drug’s FDA pamphlet doesn’t list weight gain as a side effect.

  • If you’ve tried different acne medications without success, you may want to discuss spironolactone with your healthcare provider.

Want to learn more about hair loss in women? Our guides on female pattern baldness and how to tell if it’s shedding or hair loss have lots of useful info.

We can also help you stop hair loss with our hair loss treatments, including our oral minoxidil and minoxidil drops.

Hers prescription acne treatment might also be an effective addition to your anti-acne skincare routine.

Want to make changes under the guidance of a healthcare professional? Reach out today.

7 Sources

Hims & Hers has strict sourcing guidelines to ensure our content is accurate and current. We rely on peer-reviewed studies, academic research institutions, and medical associations. We strive to use primary sources and refrain from using tertiary references.

  1. Patibandla S, Heaton J, Kyaw H. (2023). Spironolactone. Treasure Island (FL): StatPearls Publishing.
  2. Stubborn acne? hormonal therapy may help. American Academy of Dermatology. (n.d.-d).
  3. Patibandla S, Heaton J, Kyaw H. Spironolactone. (2023). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  4. Wang, C., Du, Y., Bi, L., Lin, X., Zhao, M., & Fan, W. (2023). The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clinical, cosmetic and investigational dermatology, 16, 603–612.
  5. HIGHLIGHTS OF PRESCRIBING INFORMATION: ALDACTONE® (spironolactone) tablets for oral use. (n.d.-c).
  6. Long T, et al. (2022). Effects of Low-Dose Spironolactone Combined with Metformin or Either Drug Alone on Insulin Resistance in Patients with Polycystic Ovary Syndrome: A Pilot Study. Int J Endocrinol.
  7. Kaur G, et al. (2004). Premenstrual dysphoric disorder: A review for the treating practitioner. Cleveland Clinic Journal of Medicine.

This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.

Katelyn Hagerty, FNP

Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.

She received her undergraduate degree in nursing from the University of Delaware and her master's degree from Thomas Jefferson University. You can find Katelyn on Doximity for more information.

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