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Reviewed by Kristin Hall, FNP
Written by Our Editorial Team
When you start losing hair, Google quickly becomes your trusted advisor as you head toward Spiral City. This can be overwhelming, from looking up hair loss treatments to scouring social media and wondering if that girl from high school is selling legit hair-growth spray or if it’s just another money-making scheme.
But hey, that’s where we come in. You may have heard of spironolactone for hair loss, and we’re here to give you the full scoop.
Welcome to Spironolactone 101, where you’ll learn about the benefits and dosage recommendations, plus any side effects you could experience. Here we go — class is in session!
What is spironolactone in layman’s terms? Spironolactone is an antiandrogen drug (a type of medication that blocks the effects of androgen hormones) commonly prescribed as a once-daily pill.
It’s also a diuretic, meaning it helps move fluid from your body. The medication is sometimes prescribed for acne and hirsutism (Hello, three-for-one treatment if you’re dealing with breakouts, facial hair and thinning).
Spironolactone was originally created as a medication used primarily in the management and treatment of hypertension and heart failure.
How did a drug meant for the heart start being used for hair loss? It’s believed to be a happy accident when heart patients began noticing its antiandrogenic effects.
So if you’re wondering, Does spironolactone cause hair loss?, that’s a big no.
Spironolactone helps hair growth by decreasing the effects of DHT (dihydrotestosterone). And while DHT (DHT) is a key factor in male pattern baldness, it’s not totally understood how it impacts female pattern hair loss.
The ability of spironolactone to inhibit androgens at different physiological levels has led to its use in women with androgenic alopecia, hirsutism and excess sebum production (that’s the three-in-one punch we mentioned earlier).
In one study with 110 patients, 73 percent of women saw an improvement in acne lesions on their faces, and over 75 percent saw improvements in body acne. While 51 women experienced side effects, only six found them bothersome enough to stop taking spironolactone.
These symptoms can especially be common in women with polycystic ovary syndrome (also known as PCOS). If you’re dealing with any of these issues, learn more about the different spironolactone uses and benefits.
There are several types of hair loss, ranging from stress-related telogen effluvium to traction alopecia and androgenetic hair loss. Nearly half of all women will experience hair loss at some point in their lives.
Not the funnest club to be a part of, that’s for sure. Female pattern hair loss (FPHL) is the most common cause of hair loss in women, and it typically becomes more prevalent with age.
Hair loss can be caused by a multitude of factors, like genetics and hormones. Female pattern hair loss and androgenetic alopecia are generally thought to be caused by excessive production of DHT or alteration of androgen receptors, but the link is not yet clearly established.
In its off-label use, spironolactone helps treat premenopausal female hair loss at the hormonal level. It helps protect hair from the androgens that can weaken follicles and contribute to excess hair shedding. Spironolactone is now the most prescribed antiandrogen treatment of female pattern hair loss in the United States.
We discuss hormonal hair loss and other root causes more in-depth in our guide on female hair loss.
Since spironolactone’s mechanism of action is specifically for hormone-related hair loss, it won’t work for those experiencing hair loss due to non-hormonal causes, such as stress or traction alopecia.
Spironolactone has been shown to be safe for most women, but there’s still caution to exercise.
Antiandrogen drugs (including spironolactone) are potentially teratogenic, meaning they may cause fetal abnormalities. In fact, spironolactone comes with a Category C pregnancy rating from the Food and Drug Administration (FDA), meaning animal studies resulted in a fetal risk.
If having children in the near future is on the vision board or you’re already pregnant, you’ll need to consider another route to hair regrowth.
Just like a Goldilocks and three bears sitch, having just the right proportion of spironolactone may take a little trial and error.
How much spironolactone to take for hair loss really depends on your specific conditions, so it’s best for your healthcare provider to determine what’s right for you.
The usual daily dose is 100 to 200 milligrams. While there isn’t a ton of research supporting efficacy yet, a recent open intervention study concluded that 200 milligrams per day of spironolactone was equally effective in either restoring hair growth or preventing further progression of hair loss.
Another study retrospectively analyzed adult women with female pattern hair loss who were prescribed spironolactone. The average spironolactone dose was 100 milligrams daily (ranging from 25 to 200 milligrams daily) for a minimum of six months. Findings showed that patients maintained or improved results but had the best recorded results after one year of use or more.
If you’re really looking to see results, you may want to consider pairing oral spironolactone with another hair loss treatment like minoxidil.
In one study, spironolactone showed better efficacy in combination with other therapies, such as oral or topical minoxidil, compared to using it alone.
We know, we know — everyone wants to see results overnight, but you’re going to have to practice a little patience to see spironolactone hair growth success.
Based on the available data, the efficacy of spironolactone for hair growth at a 12-month treatment was significantly better than that of six months.
According to research, you can expect to see improvement after 12 months of oral use at 80 to 200 milligrams daily. So based on your dosage, you may see progress a little faster or slower, but still try to give it a year to see the maximum potential of how spironolactone can help your hair loss.
There hasn’t been much research specifically on the treatment of hair loss and usage of spironolactone. But studies have shown common side effects from long-term use of spironolactone for acne treatment, including:
Because of these potential side effects, it’s recommended that women have regular blood pressure and electrolyte monitoring. This is especially crucial in the first few months of treatment for those with any renal abnormalities.
In one eight-year study on 91 patients who used spironolactone for an average of 28.5 months, 60 percent experienced some mild side effects, like lightheadedness and upset stomach. But only 15 percent discontinued medications, with no serious adverse events reported.
The most common side effects were diuretic effects (29 percent), menstrual irregularities (22 percent) and breast tenderness (17 percent).
The takeaway here? The authors concluded that long-term use of spironolactone in the treatment of acne appears to be safe.
Be aware, though, this is not a medication recommended for dudes. Male patients who take oral spironolactone often experience gynecomastia, loss of libido and general feminization that results in the termination of treatment.
For these reasons, men are generally not prescribed oral spironolactone. That said, topical spironolactone may be something to discuss with your healthcare provider or dermatologist.
Spironolactone could be a helpful treatment to add to your arsenal in the quest for fuller, thicker hair. But as mentioned above, pairing it with another hair loss treatment will probably yield the best results. Think of it like a Batman and Robin duo for your hair.
Here are a few other hair loss treatments to consider:
Minoxidil foam. Research has shown that the combination of minoxidil (commonly sold under the brand name Rogaine®) and spironolactone can be helpful in treating thinning hair. One study testing the usage of 5% minoxidil with 80 to 100 milligrams of spironolactone showed a significant increase in hair shaft diameter.
Oral minoxidil. This once-a-day pill might be prescribed off-label to those who prefer pills to topicals. If you’ve tried topical minoxidil in the past and it didn’t seem to work, you may have better luck with the oral form. Also, minoxidil requires the presence of an enzyme called follicular sulfotransferase, but not everyone has high enough levels of this enzyme in their hair follicles, so an oral form may be more helpful.
Topical finasteride and minoxidil spray. This topical treatment combines 6% minoxidil and 0.3% finasteride in a prescription-strength spray. It’s currently only FDA-approved for men but has demonstrated considerable results for women as a hair loss treatment. In one study, finasteride suppressed scalp DHT levels by 43 percent in 28 days, and up to 65 percent at 42 days with 5 milligrams of daily finasteride in patients with androgenetic alopecia.
Additionally, a double-blind, randomized trial compared the efficacies of twice-daily finasteride 1% topical gel to a once-daily finasteride 1-milligram oral tablet for six months. The results were similar for both medications, which is great news since women can’t use oral finasteride.
No matter what treatment (or treatments) you decide to go with, you have options to treat hair loss. If you’re ready to take the next step, consult a healthcare provider today to get the best hair loss treatment for you.
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