From the Guidelines
Spironolactone is not recommended for blocking testosterone in 12-year-olds to prevent masculinization. While spironolactone does have anti-androgenic properties, as it decreases testosterone production and competitively inhibits testosterone and dihydrotestosterone binding to androgen receptors in the skin 1, it is not FDA-approved for this purpose in children and lacks sufficient safety and efficacy data in this age group.
Key Considerations
- The use of spironolactone in adults for acne treatment has shown moderate certainty evidence of effectiveness, with a greater proportion of patients achieving improvement in acne symptoms compared to placebo 1.
- However, its use in children, particularly for blocking testosterone, is not supported by strong evidence and may pose significant risks, including menstrual irregularities, diuresis, breast tenderness, and potential effects on fetal development if used during pregnancy 1.
- For adolescents with gender dysphoria seeking to prevent masculinization, GnRH analogues (such as leuprolide or histrelin) are considered the standard first-line treatment, as they effectively and reversibly suppress puberty by blocking the signals that stimulate testosterone production.
Clinical Recommendations
- GnRH analogues should only be prescribed after comprehensive evaluation by specialists in pediatric endocrinology, adolescent medicine, and mental health who have experience in gender-affirming care.
- The decision to use any puberty-blocking medication requires thorough discussion of potential benefits, risks, and alternatives with both the adolescent and their parents/guardians.
- Ongoing psychological support and regular medical monitoring are essential components of a comprehensive care plan for adolescents undergoing gender-affirming treatment.
From the Research
Effectiveness of Spironolactone in Blocking Testosterone Effects
- Spironolactone has been used as an antiandrogen medication to treat conditions such as hirsutism and female pattern hair loss 2, 3, 4.
- It works by reducing adrenal androgen production and exerting competitive blockade on androgen receptors in target tissues 2.
- Studies have shown that spironolactone can effectively decrease testosterone levels and improve symptoms of hyperandrogenism in women 3, 5.
Use of Spironolactone in Pediatric Patients
- There is limited information available on the use of spironolactone in pediatric patients, particularly in blocking the effects of testosterone to prevent androgen-induced masculinization in a 12-year-old.
- One study mentions the use of spironolactone in combination with testolactone to slow down pubertal progression and growth velocity in familial male precocious puberty, but it does not provide specific information on its effectiveness in blocking testosterone effects in a 12-year-old 6.
Safety and Efficacy of Spironolactone
- Spironolactone has been shown to be safe and effective in treating hyperandrogenism in women, with a low incidence of side effects 3, 5, 4.
- However, its use in pediatric patients requires careful consideration and monitoring due to the potential risks of feminization and other side effects.
Spironolactone as an Alternative to Other Antiandrogen Medications
- Spironolactone has been evaluated as a relay for cyproterone acetate in the treatment of hyperandrogenism, and has been found to be an effective and well-tolerated alternative 5.