Using Oral or Topical Spironolactone for Hair Loss

Spironolactone bottle centered against several other pill containers

Pattern hair loss, a concern that affects millions of men and women worldwide, is primarily due to a combination of genetic and hormonal factors. To combat this progressive form of hair loss, minoxidil and laser hair therapy have been approved by the US Food and Drug Administration as treatments for women and men. The only other FDA-approved hair loss medication, finasteride, which combats the hormonal component of hair loss, is only meant for use in men.

Women can technically use finasteride off-label as long as they can get a prescription for it and understand the potential side effects. However, instead of finasteride, doctors may offer a different anti-androgenic medication: spironolactone. Both women and men can take this drug orally or apply it topically when using it as a hair loss treatment.

What Is Spironolactone?

Spironolactone is usually used to treat a variety of cardiovascular indications, from high blood pressure to heart failure. This drug, which is commonly known by the brand name Aldactone® – can also treat water retention and swelling caused by kidney, liver, or heart problems. Spironolactone’s androgen-blocking effects were reported as a side effect when using it to treat other health issues. By the 1980s and 1990s, multiple mentions of the drug’s anti-androgenic effects had been published in the scientific literature. (1,2)

Currently, spironolactone has become the most widely used anti-androgenic medication used to treat dermatological indications in the USA. It’s commonly used off-label to treat acne, hirsutism (excessive hair growth), and pattern hair loss in women. It can also be used as an off-label treatment for male pattern hair loss, but it’s prescribed for this purpose much less frequently. (1)   

How Does Spironolactone for Hair Loss Work?

Spironolactone works as a hormone-blocking drug in multiple ways. It blocks androgens directly at hair follicles by binding to the receptors they are targeting, reduces the conversion of testosterone to dihydrotestosterone, and limits the secretion of androgens from the adrenal gland. (1-5)

Like finasteride, spironolactone works as an anti-androgenic drug by blocking dihydrotestosterone (DHT), the primary androgenic hormone involved in the shrinkage of hair follicles and the progression of pattern hair loss. This occurs as spironolactone stops the conversion of testosterone to DHT. However, unlike finasteride, spironolactone binds to the receptors DHT affects, preventing this androgen from triggering inflammation and hair follicle miniaturization. Also, unlike finasteride, it can help reduce testosterone levels, lowering the amount of DHT produced by the body even more. (1-5)

The downside of spironolactone is that when taken orally, it can have systemic effects in some patients. Spironolactone has many other mechanisms of action on the body, such as its ability to affect blood pressure and potassium levels. Given its potential for unwanted systemic side effects, spironolactone is generally safer to use as a hair loss treatment when administered topically. (1-5) 

Using Spironolactone for Hair Loss

When used orally, spironolactone for hair loss can be taken at doses between 25 and 200 milligrams daily. Notably, this dosage range is similar to the dosages spironolactone is administered at when used off-label to treat acne and hirsutism in women. (1,4,5)

The most common spironolactone dosage for hair loss ranges between 80 and 110 milligrams daily. Lower doses are generally less effective or only useful when combined with another hair loss treatment, like oral minoxidil. In comparison, higher doses tend to be more challenging to tolerate due to increased side effects. (1,5)

Topical spironolactone for hair loss, like liquid and foam minoxidil, is used twice daily. Spironolactone can be administered in two forms – as a 1 percent gel or as a 5% solution. Topical spironolactone has far fewer side effects compared to oral spironolactone.

Spironolactone Side Effects (as a Hair Loss Treatment) 

When taken orally, spironolactone’s potential side effects include (4,5):

  • Dizziness
  • Headache
  • Menstrual irregularity (“Spotting”)
  • Rash
  • Nausea
  • Increased urination
  • Breast tenderness
  • Increased potassium levels
  • Facial hypertrichosis (excessive hair growth)
  • Hair shedding
  • Itchy scalp
  • Dandruff
  • Swelling and water retention affecting the arms or legs
  • Palpitations
  • Postural changes triggering low blood pressure

Out of all of these issues, the most common side effects in individuals taking 100 milligrams of spironolactone or more a day were headaches and menstrual changes. In contrast, side effects in individuals using topical spironolactone were limited to mild symptoms of contact dermatitis. (5)

Just like other anti-androgenic medications, spironolactone should not be used by pregnant women or women who are trying to get pregnant. The drug should be used only in conjunction with reliable birth control, as anti-androgenic medications have the potential to affect developing fetuses. (4)

Spironolactone vs. Finasteride for Female Pattern Hair Loss

When exploring alternative female pattern hair loss treatments, finasteride is another option many women consider. Like spironolactone, finasteride is available in oral and topical form, and the topical variation tends to produce fewer side effects in both women and men. Topical finasteride is becoming increasingly popular, but this remains an off-label, prescription-only use of this medication.

In the few studies that have compared spironolactone and finasteride, spironolactone produces better results than finasteride when used to treat female and male pattern hair loss. Notably, spironolactone also seems to be better at improving hair thickness in women. (6)

To date, no studies have compared topical finasteride and topical spironolactone or combined both drugs. However, despite their similar mechanisms of action, it is thought that they could actually act synergistically as they can function as different types of DHT blockers. (1)

Spironolactone and Minoxidil for Pattern Hair Loss

Spironolactone seems to yield even better results when used as a combination treatment. When combined with topical minoxidil, oral spironolactone improved female hair density more than the combination of topical minoxidil and oral finasteride. Notably, this combination treatment was also deemed as  “excellent” in over 50% of men given the same treatment. (6)

One recent, cross-sectional, comparative study explored twice daily dosing of 5% topical spironolactone and 5% topical minoxidil. Both treatments were deemed effective, and the combination of both topical solutions was found to be safe and effective, as well. (7) 

Interestingly, combining topical spironolactone and minoxidil in the same solution may reduce both of these drugs’ effectiveness. But there’s a workaround for this issue – minoxidil just needs to be applied first, then spironolactone can be applied afterward. (1)

Does Spironolactone Cause Hair Loss?

There is no evidence to suggest that spironolactone causes hair loss. Despite the wide range of side effects oral spironolactone can cause, hair loss is not a potential issue. 

However, spironolactone can temporarily increase hair fall when you start using the medication. This hair shedding-related side effect commonly occurs with many hair loss treatments, including FDA-approved minoxidil and finasteride. It’s consequently dubbed “minoxidil shedding”, “finasteride shedding”, or similar, depending on the treatment being used. This shedding-related side effect is limited to the first few months when starting a new hair loss treatment and does not continue beyond that point.

Spironolactone hair growth success has been reported after using both oral and topical versions of the medication. This drug’s anti-androgenic properties make it an effective option when treating the hormonal component of androgenetic alopecia. When used under the guidance of a healthcare professional, it seems that spironolactone can be a great alternative to help reduce hair loss and promote regrowth in men and women with pattern hair loss.

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