From the Guidelines
Spironolactone can be effective for treating unwanted male-pattern hair growth in females with normal testosterone levels, and the recommended starting dose is typically 50-100 mg daily. The medication works by blocking androgen receptors and slightly reducing androgen production, which helps prevent hair follicle stimulation even when testosterone levels are normal 1. This is because hirsutism can occur from normal hormone levels if hair follicles are particularly sensitive to androgens.
Key Considerations
- Treatment duration is usually long-term, as hair growth will return if medication is stopped
- Results typically begin after 3-6 months of consistent use, with maximum benefit seen after 6-12 months
- Common side effects include increased urination, menstrual irregularities, breast tenderness, and potential hyperkalemia
- Regular monitoring of potassium levels is recommended, especially in the first few months, particularly in older patients or those with medical co-morbidities such as hypertension, diabetes mellitus, or chronic kidney disease 1
Important Warnings
- Spironolactone should be avoided during pregnancy due to potential feminization of male fetuses, so effective contraception is necessary for women of childbearing age 1
- Combining spironolactone with topical treatments like eflornithine cream or cosmetic hair removal methods can enhance results
- Potassium monitoring should be considered in patients taking medications affecting renal, adrenal, and hepatic function, including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, nonsteroidal anti-inflammatory drugs, digoxin, among others 1
From the Research
Spironolactone for Male Hair Growth in a Female with Normal Testosterone Level
- The use of spironolactone for treating female pattern hair loss (FPHL) has been studied in several research papers 2, 3, 4, 5, 6.
- Spironolactone is a synthetic steroid that has been used for 30 years as a potassium-sparing diuretic and has been shown to arrest hair loss progression with a long-term safety profile 2.
- A significant percentage of women with FPHL have achieved partial hair regrowth while using spironolactone 2.
- The efficacy and safety of oral spironolactone in the treatment of FPHL have been evaluated in a systematic review and meta-analysis, which suggests that spironolactone is an effective and safe treatment option for hair loss 4.
- Combination therapy with spironolactone and minoxidil has been shown to be effective in treating FPHL, with some studies demonstrating an additive effect of combination therapy 3, 6.
- Reviews suggest that anti-hormonal therapy, including spironolactone, can be helpful in treating female pattern alopecia in women with normal hormone levels 5.
- However, it is essential to note that spironolactone is not used in male androgenetic alopecia due to the risk of feminization 2.
- The role and place of anti-androgenic agents, including spironolactone, in female androgenetic alopecia remain to be fully defined, and further research is needed to fully understand the heterogeneity of treatment response and adverse events 4, 5.