Does Spironolactone Cause Weight Gain?

If you have hair loss or frequent breakouts, you might have heard about spironolactone — a medication often used to treat female pattern hair loss and hormonal acne. But are there any drawbacks to using this treatment? Does spironolactone cause weight gain?

In short, no — spironolactone doesn’t cause weight gain. At least, there’s no clinical evidence to suggest it does. In fact, it might help you lose some “water weight” because it’s a diuretic (aka water pill, a substance that makes you pee more).

Here’s what to know about spironolactone and weight gain.

Spironolactone is  a medication approved by the U.S. Food and Drug Administration (FDA) to treat conditions like high blood pressure (hypertension), heart failure, and edema (swelling from fluid retention). You might’ve seen it sold under the brand name Aldactone®. Its effectiveness in these conditions stems from its ability to block aldosterone, a hormone that regulates the balance of salt and water in the body. 

Ever since it was discovered that spironolactone also has anti-androgen effects, it’s been used to treat a number of conditions where androgens are thought to play a role. Androgens, though primarily male sex hormones, are present in both men and women in differing amounts. Conditions which are often treated with spironolactone include acne and female pattern hair loss (androgenic alopecia). Its use for these conditions is off-label, meaning it’s prescribed for purposes other than those for which the drug received its FDA approval.  

Healthcare providers may prescribe spironolactone to treat various medical conditions, in some cases using it off-label. These conditions include:

• Hypertension

• Primary hyperaldosteronism (high levels of aldosterone)

• Heart failure 

• Edema (fluid retention)

• Polycystic ovary syndrome (PCOS)

• Hirsutism (excessive hair growth in women)

• Female pattern hair loss Acne 

• Bloating/fluid retention due to PMS 

For women with female pattern hair loss (also known as androgenic alopecia) , some research suggests spironolactone can slow down hair loss and promote regrowth. It works by blocking androgens, hormones that can shrink hair follicles and cause thinning, thereby helping to preserve hair and encourage regrowth. .

For some women with acne, particularly hormonal acne, spironolactone is an effective treatment. It's usually prescribed when other treatments have failed and works by blocking the effects of androgens on the skin. This leads to lower sebum (oil) production, which in turn can reduce the occurrence of clogged pores, inflammation and acne breakouts.

As with all medications, spironolactone can have side effects. The good news? Weight gain doesn’t seem to be one of them.

And if so, why does spironolactone cause weight gain? Although 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 — the official source of prescribing information. Also, clinical studies don’t suggest spironolactone causes weight gain as a common or significant side effect.

However, some people anecdotally report gaining weight after starting spironolactone treatment. One possible explanation is that spironolactone is sometimes used to treat hormone imbalances, which may indirectly affect metabolism and appetite, potentially leading to weight changes. Additionally, individuals taking spironolactone often have underlying conditions that contribute to weight gain, which may explain the perceived association. So, while there is no evidence that spironolactone directly causes weight gain, the situation is complex with multiple factors potentially influencing weight.   In fact, spironolactone is a diuretic, meaning it helps your body get rid of excess salt and water through urination. This can lead to a reduction in water weight particularly in those with significant fluid retention. However, it doesn’t affect body fat levels.

When your body loses water, it typically loses weight. So it would seem unlikely that spironolactone would cause weight gain, as, as the medication is actually associated with potential weight loss due to its diuretic effect.

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

There are zero clinical studies (not even ones with questionable rigor) showing that this medication can be used or is effective  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. 

Weight loss with spironolactone is generally a minor and temporary i, side effect, ,often seen in people taking the medication to reduce fluid retention. However, the weight loss is due to fluid loss and is not long-term. If you’re trying to lose weight, consider lifestyle changes, weight loss medication, or both.

There are other common side effects of spironolactone besides the potential for diuretic-related weight loss.

Spironolactone is an oral potassium-sparing diuretic. This means it helps the body eliminate excess sodium and fluid while maintaining your potassium levels. This is beneficial for long-term heart health, particularly in managing conditions like high blood pressure and heart failure.

But there are some potential side effects of spironolactone, including: 

• Breast tenderness or enlargement (called gynecomastia in men)

• Constipation

• Loss of appetite

• Nausea and stomach cramps

• Drowsiness 

• Dizziness

• Menstrual irregularities

• Low blood pressure

• Electrolyte imbalances (which can lead to irregular heartbeat)

• Headaches

Are there ways to alleviate some of the side effects of spironolactone? Potentially. We’ll go over these below.

Something many women use every day — hormonal birth control — can help reduce certain side effects of this medication. Some types of birth control pills may help alleviate some adverse effects associated with spironolactone use, like irregular periods, breast enlargement, and breast pain. Consulting with a healthcare provider is essential to  finding the right combination to help manage these side effects effectively. Notably, the two are often prescribed together for hormonal acne, not only to reduce  spironolactone side effects, but also because each targets different aspects of acne. Additionally, using birth control with spironolactone is important because becoming pregnant while on the medication, can increase the risk of congenital abnormalities (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 crucial to let your healthcare provider know right away.

Another important disclaimer: For hair loss and acne treatment, spironolactone is typically only prescribed to women as it can cause gynecomastia (breast growth) in men.

Lastly, you’ll want to avoid taking spironolactone with certain medications and supplements, especially potassium supplements, as this can lead to potassium levels that are too high (hyperkalemia). This can result in  serious complications, including kidney damage, and heart problems. It is also recommended  to limit foods high in potassium while taking spironolactone. Consult with your healthcare provider to learn more about specific medications and foods to avoid when using spironolactone.

Does spironolactone cause weight gain? No — it’s not a known direct side effect.

If you’re dealing with acne or hair loss, it’s worth getting medical advice from a healthcare provider. They can help you figure out whether spironolactone is an appropriate treatment option for you..

Spironolactone comes with side effects, but weight gain isn’t typically one of them. And while you might lose some water weight on spironolactone, it’s definitely not a weight loss supplement.

Here’s what to remember about spironolactone and weight gain:

• Spironolactone (Aldactone) is used to treat a variety of medical conditions. Although we focused on female pattern hair loss and hormonal acne in this article, spironolactone is also used to treat heart failure, high blood pressure, and some types of fluid retention.

• This medication is considered safe when used as prescribed. But there are some potentially serious side effects and drug interactions you need to be aware of. Avoid using spironolactone if you think you’re pregnant or if you are trying to get pregnant.

• Spironolactone does not typically cause weight gain. At least, clinical studies have not shown it to be a common or significant side effect.. It might actually cause slight, temporary weight loss, especially in those taking it for fluid retention, as it helps the body get rid of excess fluid.

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

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

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

Want to explore treatment options with a licensed healthcare professional? Reach out today.