Spironolactone (Aldactone) is NOT used to treat hypersexuality; rather, decreased libido and sexual dysfunction are well-documented side effects of this medication.
Mechanism and Primary Indications
Spironolactone is an aldosterone receptor antagonist and potassium-sparing diuretic with anti-androgenic properties 1. The drug is FDA-approved for treating congestive heart failure, primary hyperaldosteronism, and hypertension—not for managing hypersexuality 1, 2.
Anti-Androgenic Effects Leading to Sexual Dysfunction
The medication's anti-androgenic activity actually causes the opposite effect of what the question implies:
Decreased libido is a common side effect, occurring in more than 10% of patients treated with spironolactone 1.
In men, spironolactone causes gynecomastia, impotence, and decreased sexual function due to its anti-androgenic properties 1, 3.
In women, the drug can cause menstrual irregularities, decreased arousal, and sexual dysfunction 1.
A 2019 study documented that spironolactone may cause hormonally associated vestibulodynia and female sexual arousal disorder, with patients experiencing dyspareunia and decreased arousal that resolved after discontinuing the medication 4.
Clinical Context of Sexual Side Effects
The sexual side effects are dose-dependent and well-established:
In a study of 699 men with hypertension, gynaecomastia occurred in 6.9% at 50 mg/day and increased to 52.2% at doses of 150 mg or more per day 3.
The anti-androgenic effects include decreased testosterone production and competitive inhibition of testosterone and dihydrotestosterone binding to androgen receptors 1.
These effects have historically limited the use of spironolactone in clinical practice, particularly in men 3.
Common Pitfalls
Do not confuse spironolactone's anti-androgenic properties with an indication for treating hypersexuality. While the drug does reduce androgen activity and can decrease libido as a side effect, this is an adverse effect rather than a therapeutic indication 1, 2. The medication is used off-label in dermatology for conditions like acne and hirsutism in women precisely because of these anti-androgenic effects, but sexual dysfunction remains an unwanted consequence 1, 5.