- 1 What is Spironolactone?
- 2 What Conditions Can Spironolactone Treat?
- 3 Spironolactone & Female Pattern Hair Loss
- 4 Spironolactone For Male Pattern Hair Loss?
- 5 Male Baldness & DHT
- 6 Side Effects of Spironolactone
- 7 How to Obtain Topical Spironolactone
- 8 How to Apply Spironolactone to the Scalp
- 9 How Much Does it Cost?
- 10 How Long Till I See Results?
- 11 Conclusion
In this article, you’ll learn whether you can, and should use Spironolactone for hair loss.
Spironolactone is one of the medications doctors most often prescribe for female pattern hair loss. In men, on the other hand, its use is very rare. The route of administration is also very different.
This article will describe all these differences and explain the reasons behind them.
You will also learn about its mechanism of action and side effects. Finally, we will cover how long results take and what is the best way to use Spironolactone today.
What is Spironolactone?
Spironolactone is a medication that has been used for almost 60 years (1), It is available in countless brands, but the most widely known brand name is Aldactone. It is sold in almost all countries around the world.
Originally, spironolactone was marketed as an analog of the female hormone progesterone. Over time, doctors have come to prescribe it for various conditions.
What Conditions Can Spironolactone Treat?
Here are some of the most common indications of spironolactone.
For women who suffer from treatment-resistant acne, spironolactone can be an effective treatment (2). Women can use it for both short- and long-term treatments.
In early puberty, the onset of puberty occurs at an unusually early age. Its medical name is precocious puberty.
In familial male-limited precocious puberty, onset can begin as early as age 2 (3). For the short-term treatment of early-onset puberty, the combination use of spironolactone and testolactone was found to be effective (4).
Edema is a fluid buildup in the body. It is linked to a number of serious medical conditions, including heart failure and renal failure. Spironolactone has been used effectively, in small doses, to treat edema (5).
Excessive Hair Growth
The medical term for excessive hair growth is hirsutism. It is a common symptom in women who suffer from Polycystic Ovarian Syndrome (PCOS). This condition is caused by an excess amount of androgens in the body. and spironolactone has been proven to effectively reduce the level of androgens present and reverse hirsutism (6).
A study was performed on 1663 patients suffering from heart failure (7). 822 of these patients received a daily dose (25 mg) of spironolactone, while 841 patients received a placebo.
Overall, the patients on spironolactone had 35% fewer hospitalizations. They also had a 30% decrease in risk of death.
High Blood Pressure
In patients with uncontrolled hypertension, spironolactone can be an effective treatment.
DHT, the androgen hormone which is also responsible for excessive hair growth in women as mentioned above, is also responsible for pattern baldness which can occur in both men and women.
Spironolactone has been shown to reduce the levels of DHT in the body and has been found to be an effective treatment for those suffering from hair loss.
Spironolactone & Female Pattern Hair Loss
Understanding Female Pattern Hair Loss
Pattern hair loss affects roughly two out of three women at some point. Unlike male pattern hair loss, women never go completely bald. The psychological effects, however, can be equally devastating.
Unlike what is the case men, female pattern hair loss (FPHL) seems to comprise various subsets. In other words, though we group all women under the same group FPHL, the underlying causes are probably very different from woman to woman.
Some of these are linked to excess androgens, others to hypothyroidism, and the remainder to various other causes.
When Will Spironolactone Work?
Since spironolactone is an antiandrogen, it will only be effective for women whose hair loss is due to androgen excess.
For example, a 2015 study looked at 64 women with FPHL who were treated with oral spironolactone (8). Here were the results:
- 15%: worse thinning
- 55%: no response/unchanged
- 20: mild improvement
- 10: increased thickness
In Combination With Minoxidil
A very interesting study was performed on a 53-year-old woman with female-pattern baldness (9).
The woman initially received a 200 mg oral dose of spironolactone daily. She had visible hair regrowth at the 12-month mark, though. This eventually plateaued by the 24-month mark.
At this point in the study, the treating doctor prescribed a twice-daily dose of minoxidil 5% solution. The woman’s hair growth then resumed.
(See how 5% performed against 10% minoxidil here.)
What does this mean for sufferers of androgenetic alopecia?
Firstly, this study shows that spironolactone treatment can effectively stop and partially reverse hair loss.
Secondly, combination treatment with minoxidil can give superior regrowth.
The four figures above show that supplementation with spironolactone is effective in preventing further hair loss and promoting hair growth. And, while the results plateaued after two years of use, the combination of spironolactone and minoxidil had further positive results.
Spironolactone For Male Pattern Hair Loss?
Men lose their hair in a very different pattern to women. Unlike women, men can go completely bald, and their baldness progresses along with a well-defined pattern.
The first signs of hair loss are at the temples. This is followed by the mid-frontal hairline and eventually the crown of the head. Eventually, the baldness in the frontal area and crown fuse, rendering the entire top of the head bald.
You can see this natural progression of male pattern baldness in the figure below.
Male Baldness & DHT
Unlike what is the case with women, all cases of male pattern baldness share the same underlying cause and mechanism of action.
The culprit is the male hormone dihydrotestosterone or DHT for short.
You may be wondering, if AGA is more common in men, why are the majority of studies on AGA and spironolactone performed on women? There’s a very good reason for this: oral spironolactone in men can cause feminization.
According to a 2004 study entitled Gynecomastia and Antihypertensive Therapy, oral supplementation of spironolactone in men has a number of unpleasant side effects. These side effects include gynecomastia, impotence, and a decreased libido (10).
The incidence and severity of these effects depend on the dosage. Even a low oral dosage of 25mg/day, however, had a 10% incidence of gynecomastia and/or breast pain in men (11).
Does this mean that men cannot use spironolactone to treat hair loss? Absolutely not! While oral supplementation has been linked to gynecomastia and other feminization effects, topical supplementation was found to be highly effective in the treatment of alopecia, and the side effects were minimal or even non-existent.
Side Effects of Spironolactone
Because the routes of spironolactone administration are very different for men and women, so are the side effects. Let’s look at these in turn.
Oral Spironolactone (Women)
Women who take spironolactone for their hair loss should be on the lookout for the following side effects (12):
- facial hair
Women who respond to therapy can also expect to see a temporary phase of increased hair shedding 3-6 weeks after the start of treatment. This is very similar to minoxidil shedding and is temporary in nature. After a few weeks, the shedding will go away on its own.
Topical Spironolactone (Men)
The topical version of spironolactone produces completely different side effects than the oral one. The most common are (13):
- contact dermatitis
Men who take topical spironolactone do not develop the side effects seen from the oral version. They can, however, expect the temporary hair shedding a few weeks into treatment, just like women.
How to Obtain Topical Spironolactone
Topical spironolactone is not widely available in the United States or most countries around the world. It is also not available over-the-counter.
You will require a doctor’s prescription to start treatment. A compounding pharmacy will then be able to prepare the topical for you.
How to Apply Spironolactone to the Scalp
There’s no right or wrong way to apply spironolactone topically.
Some individuals who are using spironolactone to treat male-pattern baldness apply it only to problem areas, while other individuals will apply it to the entirety of the scalp.
Application is simple: begin with a pea-sized amount of spironolactone on your fingertips. Rub your fingertips together, and then massage the cream into your scalp in a gentle, circular motion. Repeat the above steps until the areas you’d like to target (either problem areas or the entirety of the scalp) have been massaged and the spironolactone applied.
While clinical studies have applied spironolactone on a daily basis, you may also find that every few days or even once per week is sufficient for your needs.
How Much Does it Cost?
Having been on the market for several decades, spironolactone is now a very affordable medication.
Women can expect to pay under $20 a month for their pills.
The cost for the topical will be slightly higher. Prices will vary depending on location and the rates of the compounding pharmacy.
How Long Till I See Results?
Regardless if you take the oral or topical form, you will need at least 3 months to see the first results.
After 6 months, you will have a good idea of how well you are responding to treatment. Together with your doctor, you can then decide if spironolactone is an appropriate long-term treatment for your hair loss.
Though the FDA has not approved spironolactone against female pattern hair loss, this has not stopped doctors from prescribing it off-label to millions of women worldwide.
For many women, it will be a relatively safe, effective, and affordable solution. Women can also combine it with topical minoxidil (which the FDA has approved) to get even better results.
The hormonal effects of spironolactone prohibit its systemic use for men with hair loss. Instead, men can apply it topically.
There is surprisingly little research on topical spironolactone for hair loss. The available evidence suggests that it is relatively safe, with only mild topical side effects.
Combination treatment with minoxidil is also likely to result in superior regrowth.
Regardless if you use spironolactone topically or systemically, always bear in mind that it is a very powerful medication. Make no changes to your treatment unless you discuss them with your doctors first.
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