Hair loss can affect both men and women and takes a toll on one’s self-esteem and quality of life.40% of women experience hair loss by the age of 50 years. There is a myriad of medications that cause hair loss as well. In this article, we will discuss what is true and what is false about spironolactone and what the evidence says about the following aspects;
- What is spironolactone?
- Can spironolactone cause hair loss?
- How does spironolactone work?
- How long does it take to work?
- Myths and truths about spironolactone?
- Is spironolactone safe?
- Who should use spironolactone?
What is spironolactone?
Spironolactone is an oral medication sold under the brand name Aldactone. It is classified as a diuretic drug and is FDA-approved to treat medical conditions such as heart failure, kidney disease, liver disease, and high blood pressure.
However, for the past twenty years, spironolactone has been used off-label alongside other hair loss treatments to treat hair loss caused by androgens in women. Though not approved by the FDA, studies have shown its efficacy as a treatment for female pattern hair loss.
Can spironolactone cause hair loss?
Can spironolactone cause hair loss? No, spironolactone is not known to cause hair loss. It helps to treat androgen-related hair loss in women. It is also known to slow down or stop the progression of androgenetic alopecia in women.
How does spironolactone work?
When used to treat hair loss, spironolactone works in the following way:
Spironolactone suppresses the production of male hormones, also known as androgens. The male hormones responsible for hair thinning are testosterone and dihydrotestosterone (DHT). Dihydrotestosterone is converted from testosterone by a hormone known as 5 alpha-reductase.
The DHT accumulates around the hair follicles on the vertex area and causes the hair follicles to have a shortened anagen phase. Once the levels of DHT are suppressed, hair at the vertex region thickens.
Increased male hormone levels are also responsible for excess facial hair growth in women. The use of spironolactone suppresses the male hormones, and facial hair growth (hirsutism) resolves.
Spironolactone also treats polycystic ovarian syndrome. People with PCOS have high levels of male hormones, which may lead to hair thinning and facial hair growth. Thus spironolactone treats PCOS-related hair loss and facial hair growth.
Suppressing the male hormones also gives estrogen an upper hand to rise and become more dominant. Estrogen is good for hair and keeps the hair in the growing phase (anagen) for longer, preventing premature shedding.
How long does it take to work?
It takes up to six months to see changes in the hair after starting on spironolactone. Some people will see hair thickening after one year of using the medication. To thicken hair, your healthcare providers may also combine spironolactone with other therapies such as oral minoxidil or platelet-rich plasma(PRP). In some cases, the doctor may combine spironolactone with family planning pills to combat the menstrual effects of spironolactone intake.
You might also be started on a low dose of about 25mg of spironolactone and increase the dose with time after assessing your tolerability to the drug.
Myths about spironolactone
Spironolactone causes hair loss.
Spironolactone encourages hair growth by thickening hair in women.
Spironolactone can be used to treat hair loss in men.
Spironolactone is not used to treat a type of hair loss in men. Because its mode of action suppresses male hormones, using it in men could potentially cause feminization.
Spironolactone can treat any hair thinning in women.
There are many causes of hair thinning in women:
2. Childbirth could trigger telogen effluvium
3. Nutritional deficiencies
5. Male hormones
6. Other medications
Spironolactone can only treat androgen-related hair loss in women.
Spironolactone causes hair shedding.
Spironolactone does not cause hair shedding. It encourages growth.
Is spironolactone safe?
Yes, spironolactone is a safe drug to take when taken correctly. It is not an over-the-counter medication but a prescription medication. The doctor needs to assess your general health and hour health history before prescribing the drug.
Some of the possible side effects of Spironolactone include:
- Low sex drive
- Weight gain
- Irregular menstrual cycles
- Breast tenderness
Some of the rare severe side effects include:
- Uncontrolled blood pressure
- Swelling in the mouth, tongue, lips, or throat
- Difficulty in breathing
These effects could indicate an allergic reaction to the medication.
Who should use spironolactone?
Women with androgen-related hair loss or hair thinning and women with PCOS-related hair thinning.
Spironolactone does not cause hair loss. Instead, it helps resolve hair loss caused by the production of androgens in women. Studies show that over 70% of women who use spironolactone see improvement in their hair.
Spironolactone is also used to treat hair loss caused by conditions such as PCOS and resolve facial hair growth caused by androgens or PCOS. Spironolactone can only be used in women as suppressing male hormones in men may cause men to have female characteristics.
Celestine is certified by the International Association of Trichologists (IAT). She has written articles on hair and scalp health to create awareness. Celestine was a key note speaker at the first Virtual World Trichology Society Summit in May 2021 speaking about hair transplant techniques on afro ethnic hair.