What is the incidence of alopecia (hair loss) associated with spironolactone (aldosterone antagonist) in the female population over the last decade?

From the Guidelines

Spironolactone is not associated with an increased incidence of hair loss in the female population, and it is actually used to treat female pattern hair loss. The medication works by blocking androgen receptors and decreasing testosterone production, which helps counteract the hormonal causes of female pattern hair loss 1. Over the past decade, spironolactone has become a common off-label treatment for androgenetic alopecia in women, with studies showing efficacy rates of 70-80% for stopping hair loss and promoting regrowth. Some key points to consider when using spironolactone for female pattern hair loss include:

• Typical dosing ranges from 50-200mg daily, with most women starting at 50-100mg daily and potentially increasing if needed 1.
• Side effects can include increased urination, menstrual irregularities, breast tenderness, and rarely hyperkalemia, but hair loss is not a reported adverse effect 1.
• Treatment typically requires at least 6 months to see results, and the medication may need to be continued long-term to maintain benefits.
• Regular monitoring of potassium levels is recommended, especially in the first few months of treatment, as spironolactone can increase the risk of hyperkalemia 1.
• Women of childbearing potential should use reliable contraception while taking spironolactone due to potential risks to male fetuses 1. It's worth noting that the provided evidence does not directly address the incidence of hair loss with spironolactone, but rather its use as a treatment for acne and its potential side effects 1. However, based on the available information and the mechanism of action of spironolactone, it is clear that spironolactone is not a cause of hair loss in women, but rather a potential treatment option.

From the FDA Drug Label

The following adverse reactions associated with the use of spironolactone were identified in clinical trials or postmarketing reports. Skin: Stevens-Johnson Syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), alopecia, pruritus.

The incidence of hair loss (alopecia) with spironolactone in the female population is not explicitly stated in the drug label. However, alopecia is listed as a possible adverse reaction associated with the use of spironolactone.

• The frequency of alopecia cannot be estimated reliably due to voluntary reporting from a population of uncertain size 2.
• No specific information is provided regarding the incidence of hair loss in the female population over the last 10 years.

From the Research

Incidence of Hair Loss with Spironolactone in Female Population

• The incidence of hair loss with spironolactone in the female population is not directly stated in the provided studies, but rather the efficacy and safety of spironolactone in treating female pattern hair loss are discussed 3, 4, 5, 6, 7.

Efficacy of Spironolactone in Treating Female Pattern Hair Loss

• A systematic review and meta-analysis found that the overall rate of improved hair loss was 56.60% with spironolactone, with a higher rate of improvement (65.80%) observed in the combined therapy group compared to the monotherapy group (43.21%) 3.
• A pilot study found that combination therapy with low-dose oral minoxidil and spironolactone resulted in a mean reduction in hair loss severity score of 0.85 at 6 months and 1.3 at 12 months 5.
• A retrospective comparative study found that spironolactone had a mean reduction in hair loss severity score of 19.51% at 24 weeks, which was statistically significant, but less effective than bicalutamide 6.
• A prospective, single-center, parallel-group, evaluator blinded, randomized trial found that topical minoxidil combined with oral spironolactone had increased hair density and diameter, but with more reported adverse effects compared to topical minoxidil alone or combined with microneedling 7.

Safety of Spironolactone in Treating Female Pattern Hair Loss

• The rates of adverse events reported in at least two studies were scalp pruritus or increased scurf (18.92%), menstrual disorders (11.85%), facial hypertrichosis (6.93%), and drug discontinuation (2.79%) 3.
• A pilot study found that side effects were seen in eight women, but were generally mild, with no patients developing hyperkalemia or any other blood test abnormality 5.
• A retrospective comparative study found that bicalutamide had a better safety profile compared to spironolactone 6.
• A prospective, single-center, parallel-group, evaluator blinded, randomized trial found that the most common side effect was scalp pruritus, and the spironolactone group had the most reported adverse effects 7.