According to the American Osteopathic College of Dermatology (AOCD), pattern hair loss or androgenic alopecia is the most common type of hair loss in women. In recent times, spironolactone hair loss therapy among women with pattern baldness has become quite popular. Basically, it’s blood pressure and acne medication, but it’s also used to treat female alopecia.
Thinning from pattern baldness can occur diffusely; commonly, hair loss occurs in the front and top of the scalp. It is rare for a woman to go bald completely as a result of female pattern hair loss. Still, the visibility of the scalp through the hair makes many women feel self-conscious.
Unfortunately, this condition is hereditary and affects about two-thirds of women after menopause, which indicates the involvement of hormones. Its prevalence also increases with age.
The pressure to constantly look good is so much more on women than men. Their crowning glory – hair – needs to be impeccable: thick, shiny, and strong. Therefore, permanent hair loss in women can significantly impact their self-esteem. So, is spironolactone hair loss therapy effective in treating this alopecia? Let’s find out.
How Effective Is Spironolactone for Hair Loss?
Spironolactone, also known as Aldactone, is a hair loss treatment for women with androgenic alopecia only. This type of hair loss occurs due to the overproduction of male sex hormones – androgens – in females, which results in hair follicle miniaturization.
Now, there are androgen receptors in the hair follicles. Their sensitivity to dihydrotestosterone (DHT) is what causes pattern baldness. But spironolactone, an anti-androgenic, takes care of this problem by binding to the androgen receptors in the hair follicles instead of letting DHT do that.
Not just that, but it also slows down the production of androgens. That’s how it stops the loss of hair in women. It won’t promote hair regrowth, but it will stop the existing hair from falling. Moreover, it can improve the thickness and density of the hair.
In one clinical study published in the Journal of the American Academy of Dermatology, 66 patients with female pattern baldness reported a decrease in the severity of hair loss after taking spironolactone for more than two years.
On taking 0.25 mg of minoxidil and 25 mg spironolactone daily for 12 months, another clinical study, published in the International Journal of Dermatology in 2018, showed the effectiveness of the combination of spironolactone and minoxidil for female hair loss. So, research shows the benefits of its dosage on the density and thickness of hairs.
Spironolactone for hair loss is only prescribed off-label since it does not have FDA- approval. Currently, the only hair loss treatments with FDA approval are minoxidil and finasteride.
Doctors usually prescribe spironolactone to treat high blood pressure, kidney disease, low potassium levels, heart failure, liver disease, and hyperaldosteronism. It is also used to treat acne and hirsutism.
Side Effects of Spironolactone For Hair Loss
Although it can promote hair growth in the treatment of female pattern baldness, it can cause some health problems. When on this spironolactone hair loss therapy, you can experience the following symptoms:
- lightheadedness/dizziness due to low blood pressure
- sexual dysfunction
- irregularities in the menstrual cycle
- upset stomach
It can also cause hyperkalemia (high potassium levels). If you notice any of these signs or symptoms, immediately get in touch with your doctor for medical treatment:
- difficulty breathing
- rapid heartbeat
- muscle fatigue and weakness
- chest pain
- abdominal pain
Why Doesn’t Spironolactone Treat Pattern Baldness in Men?
You might be wondering why spironolactone hair loss therapy isn’t prescribed to men. Truth is:
The way this drug works, it suits women far more than men. Spironolactone has an anti-androgen effect. Its doses slow down the production of androgens and also decrease the levels of testosterone in the blood. This has a “feminizing” effect on males.
The adverse effects of spironolactone include gynecomastia (enlargement of breast tissue in males), breast tenderness, erectile dysfunction, and loss of libido. On long-term daily administration of the doses, the hormonal changes can even make gynecomastia permanent.
Also, spironolactone redistributes body fat, causing weight gain and reducing the growth of hair (facial hair in males). Other health side effects of taking spironolactone include muscle atrophy, headaches, fogginess and frequent urination. That is why spironolactone is not suitable for men.
How Long Does It Take Spironolactone To Work for Hair Loss?
When on spironolactone hair loss therapy, patients need to be, well, patient! Usually, it takes about 6 months before you start noticing any results. For the best outcome, you’ll have to wait for a year. Some people have to wait for a year to see any results at all.
Taking spironolactone can very well treat female hair loss on a low dose. It may just be a while, though. Don’t get disappointed if you don’t immediately notice any results. Make sure to consult your doctor during the treatment.
How Much Spironolactone For Hair Loss Do You Have To Take?
On average, a dose of 50-100 mg is given. However, it can be as high as 200 mg, but many people experience adverse side effects at such a high dose of spironolactone for hair loss.
It is possible that during the treatment, your doctor changes the dosage of the medication or prescribes you minoxidil with it.
It’s also possible that the drug stops working for you after some time. For some women, it doesn’t work at all to treat pattern hair loss.
But if you’re on this treatment for your alopecia, give it some time to work.
For How Long Do You Have To Take Spironolactone?
To maintain the results of the spironolactone hair loss treatment, you have to continue taking the medication long-term. You won’t necessarily have to take the same dose. However, you will need a “maintenance dose” once the hair loss stops. After that, you may notice that your hair is getting thicker, and the density is increasing.
Will Hair Fall Resume After Stopping Spironolactone?
Once you stop taking the prescribed Aldactone, the normal progression of pattern hair loss will resume. That’s because the androgen receptor is free to bind to testosterone and DHT.
Therefore, you have to continue taking spironolactone to see noticeable growth. Otherwise, your hair will start shedding after you stop taking the medication.
Who Can Use Spironolactone for Hair Loss?
Spironolactone only works for pattern baldness. If you are suffering from a different type of hair loss, spironolactone will not help you. That’s why it’s important to get a medical diagnosis before taking any treatment. Women with PCOS hair loss can also take spironolactone.
It is usually prescribed for female hair loss and not for males because of its “feminizing” effects. However, it comes down to the form in which you’re taking medicine.
Males are not recommended oral spironolactone because of its effects on the body. But, its topical cream can work. One study with male participants showed that it only had local effects on the skin. Another also had similar results where spironolactone cream did not result in hormonal imbalance.
Women who are pregnant or breastfeeding should not take Aldactone as it can cause birth defects, especially in a male fetus. Doctors even recommend taking a birth control pill when on spironolactone.
What Are Some Alternatives To Aldactone?
Spironolactone can cause many health problems that can interfere with your daily life, even when they’re temporary. Moreover, you have to keep taking Aldactone daily in the beginning to see the results of the drug. Some people find out after some time has passed that Aldactone isn’t even working for them.
If that’s the case, you can look into other treatment options for your head. A hair transplant is, to date, the only permanent solution to hair loss. It will take hairs from your scalp and, within a few months, you’ll have your hair forever. You don’t need to take any medicines to maintain the results of the surgery, either.
Moreover, you can get PRP injections before and after a hair transplant because they can boost the results of the surgery and speed up the recovery. Since these injections are “natural” (taken from your blood), you don’t have to worry about any side effects.
Summing It Up
There’s still not enough research on spironolactone hair loss therapy for female pattern baldness, although it is prescribed off-label.
Moreover, it doesn’t have FDA approval as a hair loss treatment. It is also not a cure for pattern hair loss by any means. At most, it will stop the hair loss from occurring by binding to the androgen receptor. This is what will allow hair growth to take place.
It will also decrease the production of androgens. And during that time, it can increase hair thickness and density.
It works best for females, not males, because of the health side effects of its oral dosage. Usually, it takes 6 months to show any results. And, sometimes, it doesn’t show any results following the treatment.
Make sure that you get medical advice about different treatment options. Also, get a medical diagnosis from your doctor. A hair transplant works best for male or female pattern baldness.
Reviewed and Approved by Dr. Hassan Soueid.