Spironolactone and Hair Loss
Spironolactone typically does not cause hair loss but rather is used to treat female pattern hair loss; however, there is documented evidence of scalp hair loss as a rare side effect in some patients. 1, 2
Mechanism and Primary Use for Hair Conditions
Spironolactone is primarily used to treat hair loss in women through its anti-androgenic properties:
It works through multiple anti-androgenic mechanisms:
- Decreases testosterone production
- Competitively inhibits testosterone and dihydrotestosterone binding to androgen receptors
- Inhibits 5α-reductase
- Increases steroid hormone-binding globulin 1
Typical dosage for hair loss treatment ranges from 50-200 mg daily 1
Evidence of Hair Loss as a Side Effect
While spironolactone is generally used to treat female pattern hair loss, there is documented evidence of hair loss as a side effect:
In a 1988 study of 26 premenopausal women with hirsutism treated with spironolactone, one woman discontinued treatment specifically due to scalp hair loss 2
This side effect appears to be rare and is not listed among the common side effects documented in clinical guidelines 1
Common Side Effects of Spironolactone
The more frequently reported side effects include:
| Side Effect | Frequency |
|---|---|
| Menstrual irregularities | 15-30% |
| Diuresis | 29% |
| Breast tenderness | 3-5% |
| Dizziness | 3-4% |
| Nausea | 2-4% |
| Polyuria | 1-2% |
| [1] |
Clinical Considerations
If a patient experiences hair loss while taking spironolactone:
- Evaluate for other causes of hair loss that may be coincidental
- Consider dosage adjustment - lower doses (50 mg twice daily) are associated with fewer side effects than higher doses 2, 3
- Consider discontinuation if hair loss persists and is clearly associated with medication initiation
- Evaluate for potential drug interactions that might exacerbate hair loss
Dosing Recommendations
- For treating female pattern hair loss: Start with 50 mg daily and titrate up as needed 1, 4
- For minimizing side effects: Consider cyclical administration (days 4-21 of menstrual cycle) 2
- Low-dose therapy (50 mg daily) has been shown to be effective with minimal side effects 3
Special Considerations
- Spironolactone is not recommended for use in men with hair loss due to risk of feminization 4, 5
- It should not be used during pregnancy (pregnancy category C) 1
- Combination therapy with low-dose minoxidil may be more effective for female pattern hair loss 6