Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 7/28/2021
Female pattern hair loss — or female androgenic alopecia — is the most common cause of hair loss in women.
As women, our hair can be a big part of our identity and femininity, which is why losing it can be devastating.
The good news is that female pattern hair loss is treatable with medications like spironolactone.
In this article, we’ll explore what spironolactone is, how it works and who can take spironolactone as well as side effects of the medication.
Spironolactone is what’s called an aldosterone receptor agonist. Essentially, it’s a slick way of saying spironolactone subdues what aldosterone does in the body.
It’s considered to have an antiandrogenic effect because it clings to steroid receptors.
Spironolactone is approved by the FDA to treat fluid retention resulting from kidney and liver disease.
It can also be used to treat high blood pressure, heart failure and hyperaldosteronism.
It’s also used to treat hair loss.
Healthcare providers now also prescribe spironolactone off-label to treat female pattern hair loss, or female androgenic alopecia.
In fact, there’s some research out there to indicate that spironolactone is actually the most commonly used off-label anti-androgen used in the treatment of female pattern hair loss.
As we already covered, spironolactone is a medication that has antiandrogenic effects. Spironolactone both decreases testosterone levels in the blood and lessens its effect in the body.
After taking spironolactone, it’s absorbed and metabolized rapidly by the liver, and is then transformed into potassium canrenoate and canrenone, which are the active antagonists of aldosterone.
It also slows down testosterone production in your adrenal gland.
Although there isn’t a ton of high-quality research on the use of spironolactone for female pattern hair loss, several studies have demonstrated promising results.
In a small study involving just four patients, a 200mg dose of spironolactone administered daily reduced hair loss by up to 62.9 percent.
It also increased the total number of hairs in the anagen phase of the hair growth cycle.
Another study documented the combined benefits of 200mg spironolactone and minoxidil 5% twice daily.
This study suggested that the addition of spironolactone to topical minoxidil therapy is a solid option for women who have reached a plateau in treatment efficacy with topical therapy alone.
When used for female pattern hair loss, spironolactone’s dosage is typically 100mg, taken daily. Hers offers a standard 100mg dose. Some other healthcare providers may try patients on lower doses to start or prescribe as high as 200mg.
According to some research lower doses of spironolactone (typically 50mg to 75mg daily) may stop hair loss. If you're curious about lower doses, we also have an article on spironolactone 25 mg.
But higher doses — like the recommended 100mg — may wind up being more beneficial long term.
Taking spironolactone in conjunction with birth control pills may also be beneficial. The birth control helps with irregularities in your period while also improving acne and female pattern hair loss. Win-win-win.
Many women can benefit from spironolactone—especially those whose hair loss begins prior to menopause.
Spironolactone may be most effectively used by women experiencing female pattern hair loss because of excessive androgen production.
Spironolactone may also, strangely enough, be most effective in women suffering from polycystic ovarian syndrome, also known as PCOS.
The medication is not without risk, however, especially for pregnant or breastfeeding women.
The FDA currently gives spironolactone pregnancy category D rating, which means it may be harmful to a fetus.
Spironolactone should only be used while breastfeeding or pregnant if it can be proven that the benefits to the mother actually outweigh the risk to her fetus.
Side effects of spironolactone depend on the dosage you take. Aldosterone has several effects on the renal system, including hyperkalemia (high potassium levels), hypotension, fatigue, weight loss, headache, dry skin and needing to pee more frequently.
The antiandrogenic effects of spironolactone can also predispose you to menstrual irregularities and breast tenderness.
TL;DR and you found yourself scrolling to the bottom of this article, here’s what you need to know.
Female pattern hair loss can be absolutely devastating, but there are treatments out there that’ll help you see things through.
Spironolactone is an off-label medication used for hair loss treatment—especially FPHL caused by excess androgen production.
If you’re going through the painful experience of female pattern hair loss and you’ve decided it’s time to do something about it, it’s worth having a conversation about.
Start a conversation with your healthcare provider to see if this is the best treatment option for you.