Spironolactone for Hair Loss: Benefits, Dosage, and Risks

Key Takeaways:

• Spironolactone is used off-label to slow down and prevent female pattern hair loss. It’s available in both topical and oral format.

• Spironolactone works by blocking the hormones that cause certain forms of hair loss. 

• Common side effects of spironolactone include frequent urination, menstrual changes, breast tenderness, and dizziness. 

• Avoid spironolactone during pregnancy. Discuss contraception and any medical conditions/medications with a licensed provider.

• Alternative hair loss treatments are available. If spironolactone isn’t a fit, options include topical or oral minoxidil and — for postmenopausal women — topical and oral finasteride.
  

When you start losing hair, Google quickly becomes your trusted advisor. The quest for answers can be overwhelming, leading you to look up hair loss treatments and scour social media, wondering if that hair-growth tincture is legit or just another money-making scheme.

But hey, that’s where we come in. You may have heard of spironolactone, and we’re here to give you the full scoop on how it can help.

Below, you’ll learn more about using oral and topical spironolactone for hair growth. We’ll explore the benefits, side effects, and dosage recommendations — plus some alternative hair loss treatments.

Spironolactone is an antiandrogen drug. In layperson’s terms, an antiandrogen is a type of medication that blocks the effects of androgens (male hormones).

The medication has a number of uses and benefits:

• Managing blood pressure. It was primarily used for managing and treating hypertension (high blood pressure) and heart failure. 

• Potassium-sparing diuretic. This means it helps flush excess fluid out of your body while maintaining your levels of potassium. 

• Reducing acne and hirsutism. Because it lowers your androgen levels, it’s sometimes prescribed for excess body/facial hair and acne.

If you’re dealing with hormone-related acne, excess facial hair growth, or hair loss, you can learn more about the different spironolactone uses in our guide. 

It’s fair to say spironolactone is pretty versatile — but for today, let's focus on how oral and topical spironolactone can treat hair loss.  

Hair loss can be caused by many factors, including genetics and hormones. 

Female pattern hair loss (androgenetic alopecia) is one common form of hair loss. It is thought to be caused by excessive production of DHT or alteration of androgen receptors (a changing sensitivity to hormones). But the link isn’t yet clearly established.

In its off-label use, spironolactone helps treat female pattern hair loss at the hormonal level. Here’s how:

• It lowers DHT. Spironolactone works by decreasing the effects of DHT (dihydrotestosterone). DHT is a key factor in male pattern baldness, but how it impacts female pattern hair loss isn’t totally understood.

• It blocks sex hormones. Spironolactone also inhibits androgens at different physiological levels, so it’s used in women with androgenic alopecia, hirsutism, and excess sebum production — that’s the three-in-one punch we mentioned earlier. 

Research shows that both oral and topical spironolactone work well for hair loss. A review of seven studies found that the topical treatment has fewer side effects than the oral medication, although both can slow down hair loss effectively. Because the topical formulation is applied directly to the scalp, there’s a lower risk of systemic side effects. 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, like stress or traction alopecia. So, it’s important to figure out the cause of hair loss before trying to treat it. 

We discuss hormonal hair loss and other root causes of excess shedding more in-depth in our guide to female hair loss.

How much spironolactone to take for hair loss really depends on your specific condition. Your healthcare provider will go over your needs and try to pinpoint the cause to figure out what’s right for you.

How Much Spironolactone Is Prescribed for Hair Loss?

Generally speaking, the usual daily dose of spironolactone for hair loss is 100 to 200 milligrams (mg) daily.

One study retrospectively analyzed 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 at least six months.

The study’s findings showed that patients maintained how much hair they had when starting the medication or saw hair regrowth. But the best results were seen after a year or more of daily spironolactone use.

In another study, spironolactone showed better efficacy when combined with other therapies, such as oral or topical minoxidil, than when used alone. So if you really want to see results, you might consider pairing oral spironolactone with another hair loss treatment, like minoxidil.

Read our spironolactone dosage guide to get a better idea of what your healthcare provider might recommend when prescribing the medication off-label for hair loss. 

We know, we know — everyone wants results overnight, but you’ll have to practice a little patience to see spironolactone hair growth success.

Based on the available data, taking spironolactone for hair growth for 12 months seems to offer significantly better results than a six-month treatment plan.

According to research, you can expect to see improvement after a year of oral use at 80 to 200 milligrams daily. Based on your dosage, you may see progress slightly faster or slower than this — some may notice improvements closer to the six-month mark.

Still, try to give it a year — that’s when you’ll 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.

Spironolactone side effects may include:

• Irregular menstruation

• Frequent urination

• Dizziness

• Headaches

• Nausea or vomiting

• Breast tenderness

• Breast enlargement

Because of these potential side effects, it’s recommended that women regularly get their blood pressure and electrolyte levels checked. This is especially crucial in the first few months of treatment for those with any renal abnormalities (kidney problems).

However, there are some exceptions to monitoring your potassium levels (which is an electrolyte) — for example, if you’re a relatively healthy young woman taking spironolactone, as multiple studies suggest. You can read more about the relationship between potassium and spironolactone, including what foods should be avoided when taking it, in our blog.

How Common Are Spironolactone Side Effects?

In an eight-year study of 91 patients who used spironolactone for an average of 28.5 months, 60 percent experienced mild side effects, like lightheadedness and upset stomach. But only 15 percent discontinued the medication, and no serious adverse events were reported.

The most common side effects were diuretic effects (29 percent), menstrual irregularities (22 percent), and breast tenderness (17 percent).

Is Spironolactone Safe?

The authors of the study mentioned above concluded that long-term use of spironolactone in treating acne appears to be safe.

Additionally, a recent systematic review and meta-analysis determined that spironolactone is a safe and effective treatment for hair loss.

Who Shouldn’t Take Spironolactone for Hair Loss?

While spironolactone can be helpful for many, it’s not suitable for everyone. 

You shouldn’t take spironolactone if you:

• Are male. Men who take oral spironolactone often experience gynecomastia (increased breast tissue), loss of libido (lowered sex drive), and general feminization. This is because spironolactone has anti-androgenic effects. 

• Are pregnant or trying to conceive. As an antiandrogen drug, spironolactone is not safe during pregnancy. While it may be safe while breastfeeding, you’ll need to speak with your doctor before taking spironolactone. 

• Have a non-hormonal cause of hair loss. If you’re experiencing hair thinning thanks to, say, telogen effluvium, spironolactone won’t work. Rather consider oral minoxidil — more on this later.  

If you’re living with a severe autoimmune disease or a chronic illness, your medical provider will advise you on whether you should take spironolactone for hair loss. 

Though spironolactone is the most used antiandrogen treatment for female pattern hair loss in the U.S., other hair loss treatment options are available.

If you’re curious about alternatives, here are a few to consider.

Topical Minoxidil

An over-the-counter topical treatment, minoxidil (commonly sold under the brand name Rogaine^®) can help treat thinning hair. In addition to boosting hair growth, minoxidil may improve hair density by stimulating the hair follicles. 

What’s more is that it can be combined with spironolactone. One study testing the usage of 5% minoxidil with 80 to 100 milligrams of spironolactone showed a significant increase in hair shaft diameter.  

You could try minoxidil solution or minoxidil foam. 

Oral Minoxidil

This once-a-day pill might be prescribed off-label to those who prefer tablets 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. 

Oral minoxidil may also be combined with spironolactone. 

Topical Finasteride and Minoxidil Combo 

Finasteride also reduces your levels of DHT, the hormone.

While finasteride is only FDA-approved for men, it can also help women with hormonal hair loss. In one study, 5 milligrams of daily finasteride suppressed scalp DHT levels by 43 percent at 28 days and up to 65 percent at 42 days in patients with androgenetic alopecia.

When combined, minoxidil and finasteride have shown to work even better together than using either alone. 

We offer postmenopausal hair loss spray and Hair Blends Postmeno Serum, both of which contain a combo of minoxidil and finasteride. They’re only prescribed for postmenopausal hair loss, where appropriate. 

Dutasteride

Dutasteride might be another option to discuss with your healthcare provider. This prescription-only oral medication is sometimes prescribed off-label for female pattern hair loss when other treatments haven’t been effective. 

Like spironolactone and finasteride, dutasteride reduces your levels of DHT. This can help slow certain types of hair loss over time. 

Because it works hormonally, dutasteride is not safe to use during pregnancy or breastfeeding, and it’s typically reserved for women who are postmenopausal or using reliable contraception.  

Hair-Supportive Supplements

While supplements won’t treat hormonal hair loss, they can help you if your hair loss is caused by nutritional deficiencies. Often, these supplements include nutrients like biotin, folate, vitamin D, and zinc.  

If your hair shedding is linked to nutrient deficiencies, supplements can help fill in the gaps and give your strands a better growth environment. You can also use hair growth supplements alongside minoxidil, spironolactone, and other hair loss treatments — if appropriate.  

Hers offers a biotin and minoxidil gummy, as well as a biotin-based multivitamin gummy for hair growth. 

Spironolactone could be a helpful treatment to add to your arsenal in the quest for fuller, thicker hair.

Here’s what to keep in mind as you consider spironolactone for hair loss:

• It’s an antiandrogen drug, meaning it blocks certain sex hormones. It’s commonly prescribed as a once-daily pill.

• Spironolactone works by decreasing the effects of the hormone DHT. 

• Though it can start working after six months, it takes about a year to start seeing the full potential of spironolactone.

Pairing spironolactone with another hair loss treatment — whether an oral medication or a topical solution — will probably yield the best results. Think of it like a Batman and Robin duo for your hair

No matter what’s causing your excess hair shedding, you have options to treat it. Ready to take the next step? Consult a healthcare provider to get personalized medical advice.