About Spironolactone

Spironolactone is an aldosterone receptor antagonist, traditionally used as a ‘diuretic’, which helps to reduce the excess water in the body. It is FDA-approved for the treatment of fluid retention and is also used to treat patients with heart failure and high blood pressure. Apart from this, spironolactone also possesses a significant anti-androgen effect, which is why it is effective in treating hormonal hair loss.

How Does Spironolactone Work?

Androgens are the sex hormones that are primarily responsible for making the hair follicles smaller and eventually making them fall out. Spironolactone blocks androgen production, as well as the binding of dihydrotestosterone (DHT) to the androgen receptors in the target tissue (e.g.hair follicle). This anti-androgen property of spironolactone has also been used in the treatment of hormonal acne and hirsutism. Spironolactone is not FDA-approved for any type of hair loss but has shown pretty impressive success in pilot studies. Approximately 90% of women using it for over a year reported an arrest in hair loss. Spironolactone works well when combined with other therapies such as topical minoxidil. A randomized control trial was conducted recently, in which 40 women used a combination of topical minoxidil 5% once daily and 80-100 mg of oral spironolactone for a duration of 24 weeks. The hair density and hair shaft diameter improved significantly.

Is Spironolactone Right for Me?

Spironolactone is especially suitable for females with two or more conditions due to increased sensitivity to androgens like acne, very oily skin, or increased facial hair. Studies on men using oral spironolactone are limited, due to the sexual side effects and feminization. Topical spironolactone is an emerging treatment option that aims to improve hair density minus the side effects. Spironolactone is a good option for younger women who are not candidates for dutasteride or finasteride because of future plans for child bearing.

How Effective is Spironolactone?

In a study, spironolactone given to 40 women for a duration of one year, showed hair growth in around 44% of the women. The result was comparable to another conventional anti-androgen medication called cyproterone acetate. Interestingly, even though it is well established that androgens play an essential role in androgenetic hair loss, none of the women in the study showed raised levels of androgens in the blood. However, they still benefited from anti-androgen therapy. That indicates that the results of spironolactone are probably not dependent on any particular parameter in blood. In another study, 100 women received a combination of minoxidil 0.25 mg and spironolactone 25 mg and were followed prospectively for 12 months. The hair shedding and visual loss of hair on the scalp decreased significantly in the women who continued the therapy for 12 months. Two women discontinued the treatment due to allergic reactions. A retrospective analysis of 79 women consuming a mean daily dose of spironolactone 100 mg was done recently. It concluded that women with higher severity of androgenetic alopecia responded better, compared to women with milder androgenetic alopecia. The improvement in hair loss was better in those who took spironolactone for 6 months or longer. Treatment was discontinued by 3.8% of women due to adverse effects.