From the Guidelines
Spironolactone can be an effective treatment for hair loss in women with androgenetic alopecia or polycystic ovary syndrome (PCOS), as it blocks the effects of male hormones on hair follicles. The most recent and highest quality study, 1, published in 2019, provides evidence on the use of spironolactone for acne, which is relevant to its use in treating hair loss related to hormonal imbalances. For women with androgenetic alopecia or PCOS, typical dosing ranges from 50-200 mg daily, with many physicians starting at 50-100 mg daily and gradually increasing if needed, as seen in 1 and 1. Results typically take 6-12 months to become noticeable, and continued use is necessary to maintain benefits. Side effects may include increased urination, menstrual irregularities, breast tenderness, and potential birth defects if taken during pregnancy, making reliable contraception essential for women of childbearing age, as noted in 1 and 1. Spironolactone works by blocking androgen receptors and decreasing testosterone production, addressing the underlying hormonal imbalance that contributes to hair thinning in these conditions. Regular monitoring of blood pressure and potassium levels is recommended during treatment, although potassium monitoring in young, healthy women is not required unless they have risk factors for hyperkalemia, as stated in 1. Some key points to consider when prescribing spironolactone include:
- Starting with a lower dose and gradually increasing as needed
- Monitoring for side effects such as menstrual irregularities and breast tenderness
- Ensuring reliable contraception for women of childbearing age
- Regular monitoring of blood pressure and potassium levels, especially in patients with risk factors for hyperkalemia
- Discussing the potential risks and benefits of spironolactone, including the black box warning, with patients, particularly those with a family history of breast or ovarian cancer, as mentioned in 1.
From the Research
Spironolactone and Hair Loss in Women
- Spironolactone has been used to treat hair loss in women with androgenetic alopecia or polycystic ovary syndrome (PCOS) due to its antiandrogenic properties 2.
- The medication works by reducing adrenal androgen production and exerting competitive blockade on androgen receptors in target tissues, which can help arrest hair loss progression and achieve partial hair regrowth 2.
Efficacy of Spironolactone in Female Pattern Hair Loss
- A systematic review and meta-analysis found that oral spironolactone improved hair loss in 56.60% of women, with a higher rate of improvement when combined with other therapies 3.
- Another study compared the combination of topical minoxidil and oral spironolactone with the combination of topical minoxidil and oral finasteride in women with androgenic alopecia, and found that the spironolactone group had a better treatment response and higher patient satisfaction 4.
Safety and Side Effects of Spironolactone
- The overall adverse events rate of spironolactone was 3.69%, with common side effects including scalp pruritus, menstrual disorders, and facial hypertrichosis 3.
- Topical spironolactone has been shown to have significantly fewer side effects compared to oral administration, making it a safer option for both male and female patients 5.