Spironolactone for female pattern hair loss

Why is Spironolactone used for hair loss in women?

Finasteride is not approved for women and must not be used by women who can become pregnant, so the main anti-androgen option available to men is not a standard treatment for women. Spironolactone blocks androgen receptors and reduces androgen production as a secondary effect, making it a common off-label choice for female pattern hair loss, most often when there are signs of androgen excess, though also used without them.

How strong is the evidence supporting Spironolactone for hair loss?

The evidence base for Spironolactone is thinner than for Finasteride or Minoxidil, drawn mostly from observational series and small studies rather than large randomised trials, and dosing varies between prescribers. It is widely used and plausible in mechanism, but less well evidenced than the treatments licensed for men.

What safety monitoring does Spironolactone require in women?

Spironolactone is contraindicated in pregnancy because of the risk of feminising a male fetus, so reliable contraception is required. Because it is potassium-sparing, potassium levels may need monitoring, and it can lower blood pressure, sometimes causing dizziness. Menstrual changes and breast tenderness are commonly reported, and it interacts with ACE inhibitors, ARBs and potassium supplements.

• Pregnancy. Contraindicated because of the risk of feminising a male fetus. Reliable contraception is required.
• Potassium. It is potassium-sparing, so levels may need monitoring, particularly with other drugs affecting potassium.
• Blood pressure. It can lower blood pressure, sometimes causing dizziness.
• Menstrual changes and breast tenderness are commonly reported.
• Interactions with ACE inhibitors, ARBs and potassium supplements.

Where does Spironolactone fit in treating female pattern hair loss?

Spironolactone is usually used alongside topical Minoxidil rather than in place of it, and only after the cause of the hair loss has been established, since female hair loss has a far wider range of possible causes than male pattern hair loss and needs proper diagnostic work-up first.

Our guide to hair loss in women covers the diagnostic work-up that should come first.

Sources

1. Wang C, Du Y, Bi L, Lin X, Zhao M, Fan W. The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clinical, Cosmetic and Investigational Dermatology, 2023;16:603-612. pubmed.ncbi.nlm.nih.gov/36923692
2. Aleissa M. The Efficacy and Safety of Oral Spironolactone in the Treatment of Female Pattern Hair Loss: A Systematic Review and Meta-Analysis. Cureus, 2023;15(8):e43559. pubmed.ncbi.nlm.nih.gov/37719557
3. Searle TN, Al-Niaimi F, Ali FR. Spironolactone in dermatology: uses in acne and beyond. Clinical and Experimental Dermatology, 2020;45(8):986-993. pubmed.ncbi.nlm.nih.gov/32844462
4. Hecker A, Hasan SH, Neumann F. Disturbances in sexual differentiation of rat foetuses following spironolactone treatment. Acta Endocrinologica, 1980;95(4):540-545. pubmed.ncbi.nlm.nih.gov/7456979
5. Hughes BR, Cunliffe WJ. Tolerance of spironolactone. British Journal of Dermatology, 1988;118(5):687-691. pubmed.ncbi.nlm.nih.gov/2969259
6. Plovanich M, Weng QY, Mostaghimi A. Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne. JAMA Dermatology, 2015;151(9):941-944. pubmed.ncbi.nlm.nih.gov/25796182

This article summarises published research. It is general educational information, not medical advice, and it is not a recommendation to start, stop or change any medication. Prescription drugs carry contraindications and interactions; discuss them with a doctor who knows your medical history.