Byrdie posted "Dermatologists Are Prescribing This Acne Medication to Treat Hair Loss" and features Visha Skincare founder, Dr. Purvisha Patel's expert insights on the effects of spironolactone on hair loss.
According to a study conducted by JAAD, female pattern hair loss (abbreviated to FPHL)—which can range from thinning to bald spots, or even develop into alopecia—affects approximately 40% of women by age 50. Unlike men who typically see hair loss beginning at the temples and forming an “M” shape, Harvard Medical School defines androgenetic alopecia as “gradual thinning at the part line, followed by increasing diffuse hair loss radiating from the top of the head.” While it can happen, women rarely experience receding and/or go completely bald if diagnosed with this condition.
Initially developed as a diuretic for high blood pressure (and more recently tackling acne), the oral medication, spironolactone, has been shown to help with hair regrowth. Hair loss, at its root, can have many potential origins including genetics, medical conditions and physical/emotional stress.
Below, board-certified dermatologists Flora Kim, MD, FAAD of Flora Kim Dermatology in Highland Park, Texas; Purvisha Patel, MD, MOHS, and cosmetic surgeon of Advanced Dermatology and Skin Cancer Associates in Memphis, Tennessee and Olive Branch, Mississippi; and Annie Gonzalez, MD, of Riverchase Dermatology in Miami, explain exactly what you need to know about taking spironolactone for hair loss purposes.
Editor's Note: If you notice any unusual hair changes, we strongly encourage you speak to your primary care doctor or dermatologist to determine the correct treatment plan for you.
What Is Spironolactone?According to Gonzalez, by definition, spironolactone is a potassium-sparing diuretic that blocks the effects of the hormones aldosterone and testosterone and has some estrogen-like effects. “Structurally, its backbone is a basic steroidal nucleus with four rings. The primary metabolite of spironolactone is canrenone, which is an active metabolite that is also an antagonist of aldosterone, and thus promotes diuresis,” she explains. You might be wondering what on earth all of that means—and what it means for hair loss. To start, we must address that which causes hormonal hair loss in people (specifically those with ovaries), which is a difficult question to answer. In simple terms, estrogen increases the amount of time that hair spends in the growing phase, so when estrogen declines, hair loses these protective effects. “Estrogen is synthesized in the ovary and other peripheral tissues and then travels to its receptors, some of which are located in scalp hair follicles,” explains Kim. “At the scalp follicle, estradiol has been reported to induce aromatase activity. Estrogen has been hypothesized to have a protective role against hair loss on the basis of the observation that patients with lower estrogen levels during menopause, postpartum, or treatment with aromatase inhibitors or selective estrogen receptor modulators are more likely to develop hair loss.” So, in theory, if DHT is one of the main reasons for androgenetic alopecia, then spironolactone makes sense to try. Essentially, spironolactone helps reduce the effects of DHT by competitively blocking the attachment to its receptor, helping prevent miniaturization of the hair follicles.
Who Can Use It?“As we age, we lose estrogen over time,” explains Patel. “When there is a genetic predisposition, female pattern hair loss can occur. Testosterone in the body and in the hair follicles goes unopposed, and this can lead to miniaturization of the hair follicles and hair loss. Spironolactone helps oppose the testosterone in the hair follicles and decreases hair loss.” Gonzalez adds, “If your body produces an increased amount of testosterone or other androgens, spironolactone can totally help to reduce hair thinning by blocking the effects of testosterone in the body. The principle behind this is that there would be less testosterone-induced stimulation on the hair follicles, and therefore more hair retention.”
How Should It Be Used?Currently, spironolactone is administered by prescription and is taken orally and/or compounded into topical formulations for hair loss with less side effects. Derms traditionally recommend 100-200mg daily, a minimum of six months to determine if this is the proper treatment option. Patel emphasizes that this treatment method is by no means an overnight fix. “[Patients complain] that it is not working, but this is mostly due to expectation. It stops hair from further falling out and regrowth may take time,” she details. “The dose can also be adjusted by your board certified dermatologist.”
What About the Side Effects?Remember, spironolactone is a diuretic, so it is imperative that you make the extra effort to drink plenty of water. Patel notes that “it could make your electrolytes out of whack leading to high potassium levels. This is why your doctor checks this level during treatment.” While taking spironolactone, Patel also recommends that patients lower their potassium intake (by way of supplements or banana consumption) in addition to avoiding cholestyramine, digoxin, lithium, trimethoprim; heart or blood pressure medicine (especially another diuretic); medicine to prevent a blood clots; or NSAIDs (nonsteroidal anti-inflammatory drugs) which includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, and meloxicam. According to Kim, other potential side effects include “dizziness with postural hypotension, breast tenderness, decreased libido, spotting, and electrolyte imbalance. This androgen receptor blocker is categorized as pregnancy category D.” Gonzalez emphasizes that due to its estrogen-like effects, this medication is only given to those who are not pregnant. “The most common side effects are diuresis, menstrual irregularities, gastrointestinal upset, and breast tenderness. To add, women of childbearing potential must be on a reliable form of birth control with spironolactone to avoid exposure during pregnancy.”
Before exploring this option, speak with your primary health doctor or dermatologist to determine if this is the right treatment method for your current lifestyle. Other options, like minoxidil (at least 5% or or higher per Kim), flutamide, dutasteride, finasteride, birth control (those that are combined and contain both estrogen and progestin) may be a better solution. Ultimately, hormonal balance is exactly that—a balance. “Tipping one way or another with hormone levels does not help everyone,” cautions Patel.