From the Guidelines
Spironolactone can be used to treat androgenetic alopecia in women with low testosterone levels, as it works by blocking androgen receptors and inhibiting 5-alpha reductase, regardless of baseline testosterone levels. The typical dosage ranges from 50-200 mg daily, with most women starting at 50-100 mg daily and gradually increasing if needed 1. This is because female pattern hair loss can occur even with normal or low testosterone due to increased sensitivity of hair follicles to androgens.
Key Considerations
- Treatment typically requires 6-12 months to see noticeable improvement, and continued use is necessary to maintain results.
- Side effects may include increased urination, menstrual irregularities, breast tenderness, and potential birth defects if used during pregnancy, so effective contraception is essential for women of childbearing age 1.
- Regular monitoring of blood pressure and electrolytes is recommended, especially during the first few months of treatment.
- Combining spironolactone with topical minoxidil 5% solution or foam applied twice daily often provides enhanced results for female pattern hair loss.
Important Safety Information
- Spironolactone should not be used in pregnancy, as it crosses the placenta and exposure in utero in animal studies may cause feminization of a male fetus 1.
- Potassium monitoring should be considered in older patients, patients with medical co-morbidities, and patients taking medications affecting renal, adrenal, and hepatic function 1.
- Avoiding a diet high in potassium should be considered, especially in patients with risk factors for hyperkalemia 1.
Clinical Decision Making
- The decision to use spironolactone for androgenetic alopecia in women with low testosterone levels should be made on a case-by-case basis, taking into account the individual patient's medical history, risk factors, and potential benefits and risks of treatment 1.
- Patients should be counseled on the potential risks and benefits of spironolactone, including the risk of birth defects and the importance of effective contraception 1.
From the Research
Treatment of Androgenetic Alopecia in Women with Low Testosterone Levels
- The use of spironolactone in treating androgenetic alopecia in women with low testosterone levels, specifically hypotestosteronism, has been studied in several research papers 2, 3, 4.
- A study published in the Journal of cosmetic dermatology found that the combination of topical minoxidil and oral spironolactone was more effective than the combination of topical minoxidil and oral finasteride in women with androgenic alopecia 2.
- Another study published in the Dermatology online journal suggested that anti-hormonal therapy, including spironolactone, can be helpful in treating female pattern alopecia in some women with normal hormone levels, but larger controlled studies are needed 3.
- A systematic review published in Clinical, cosmetic and investigational dermatology found that both oral and topical spironolactone have been shown to be effective for alopecia recovery, but topical use has significantly fewer side effects and is suitable for any gender 4.
Efficacy and Safety of Spironolactone
- The efficacy and safety of oral and topical spironolactone in androgenetic alopecia treatment have been evaluated in a systematic review, which found that spironolactone is an effective and safe treatment for androgenic alopecia 4.
- The review also found that topical spironolactone is safer than oral administration and is suitable for both male and female patients 4.
- Another study published in the Journal of the American Academy of Dermatology found that minoxidil, finasteride, and low-level laser light therapy are effective for promoting hair growth in men with androgenetic alopecia, and that minoxidil is effective in women with androgenetic alopecia 5.
Treatment Options for Androgenetic Alopecia
- The current treatment alternatives for androgenetic alopecia, including their efficacy, safety profile, and quality of evidence, have been discussed in a review article published in Drugs 6.
- The article found that finasteride and minoxidil for male androgenetic alopecia and minoxidil for female androgenetic alopecia are the therapeutic options with the highest level of evidence 6.
- The role of antiandrogens for female patients, the importance of adjuvant therapies, as well as new drugs and procedures, have also been addressed in the article 6.