You may have heard of Spironolactone in the context of blood pressure or hormonal acne treatment but what few people know is it may also help with hair loss. In general hair loss can be difficult to treat because it depends on the cause and each individual person’s health and lifestyle. To add to the complexity, certain treatments are only effective in hair loss in men but not women (and vice versa!). Spironolactone is gaining popularity for its effectiveness in combating certain types of hormone related hair loss, particularly in women. In this article, we explore how Spironolactone works for treating hair loss, whether it is effective in both women and men, what growth results to expect and side effects.
Quick Guide to Hair Loss
There are many different causes of hair loss including genetics, hormonal imbalances, stress, diet, lifestyle deficiencies and underlying medical conditions. The most common type of hair loss is androgenetic alopecia which is mainly due to hormonal imbalance. In women, it appears as diffuse thinning on the crown and usually caused by conditions that increase androgen levels and often has a genetic component. The most common examples include polycystic ovary syndrome, post pregnancy or menopause. Men, on the other hand, typically experience a receding hairline and vertex balding due to androgenetic alopecia. This is usually due to elevated levels of dihydrotestosterone (DHT), a powerful androgen that is a derivative of testosterone. DHT attacks hair follicles, causing miniaturisation and eventual hair loss. Of course stress, poor diet and certain hair care practices can further exacerbate hair loss.
What is Spironolactone &How Can it Treat Hair Loss?
Spironolactone is a potassium-sparing diuretic primarily used to treat conditions such as heart failure, high blood pressure and fluid retention. However, Spironolactone’s anti-androgen properties have made it a popular off-label treatment for hair loss. It works by blocking androgen receptors and reducing the production of androgens. This is important as androgens are the group of sex hormones in men and women that give ‘male’ characteristics. By limiting the effects of androgens, including DHT, Spironolactone helps to prevent hair follicle miniaturisation. This in turn promotes hair regrowth and reduces shedding.
Studies indicate that Spironolactone is particularly effective in women suffering from androgenetic alopecia and other hormonally-driven hair loss conditions. This is both in oral as well as topical form and even at lower doses. Research also shows that Spironolactone can reduce hair shedding and promote regrowth in some men. However, the risk of side effects such as gynecomastia (breast enlargement), decreased libido and feminisation often limits its use. As such, it is generally only for use in men who do not respond well to traditional treatments like Finasteride.
Oral or Topical Spironolactone for Hair Growth?
Both oral and topical Spironolactone can promote hair growth in men and women at dosages typically between 25-100mg per day (or even lower). The choice between oral and topical Spironolactone for hair growth depends on each person’s individual needs, preferences and tolerance for potential side effects. Oral Spironolactone, taken in pill form, works systemically (throughout the whole body) to reduce androgen levels. This makes it highly effective at combating hormonally-driven hair loss as well acne. This form is particularly beneficial for those with conditions like polycystic ovary syndrome, where systemic hormonal imbalance is the primary factor. However, the systemic nature of oral Spironolactone also means a higher risk of side effects. These include dizziness, breast tenderness, menstrual irregularities and in men, feminizing effects such as gynaecomastia and decreased libido.
On the other hand, you apply topical Spironolactone directly to the scalp, targeting hair follicles locally. This localised treatment reduces the risk of systemic side effects which makes it a safer option for those concerned about the broader impact of the medication. Furthermore, studies suggest that topical Spironolactone may be as effective as oral in reducing hair shedding and promoting growth but with fewer serious side effects. However, we need more research in severe cases of androgenetic alopecia and also in men as most studies were on women.
What Results to Expect from Spironolactone Treatment
It is important to understand that during the initial stages of treatment, users may not notice significant changes for months. This is because it takes time for the medication to adjust androgen levels. Here are the main phases of hair regrowth with Spironolactone:
- Early Signs (3-6 Months): In the first few months, you might begin to see subtle signs of improvement. One of the first signs is usually a reduction in hair shedding, indicating that the medication is beginning to take effect. Thin areas on the scalp may start to show slight increases in hair density. Additionally, the existing hair might begin to feel thicker and healthier as the treatment progresses.
- Noticeable Growth (6-12 Months): Around the six-month mark, more significant changes typically become apparent. During this phase, many users report a noticeable increase in hair density and better scalp coverage. Areas that were thinning or showing signs of baldness may begin to experience visible regrowth. The overall appearance of the hair improves, becoming fuller and stronger.
- Peak Results (12 Months and Beyond): Long-term use of Spironolactone, usually extending beyond a year, yields the most substantial results. By this time, the medication has effectively maintained lower androgen levels, leading to considerable hair regrowth and stabilisation of hair loss. Users often report that their hair is significantly thicker and healthier, with ongoing improvements in density and coverage. Continued use helps maintain these results and can potentially enhance the gains achieved.
It’s essential to understand that individual responses to Spironolactone can vary. While some individuals may experience dramatic improvements, others might notice more gradual changes. Factors such as age, the extent of hair loss, and overall health can influence the treatment’s effectiveness. Sticking to the prescribed treatment protocol and regularly consulting with your healthcare provider will maximise your chances of success.
Side Effects & Risks of Spironolactone Hair Growth Treatment
Whilst Spironolactone can be effective in treating hair loss, it’s important to be aware of potential side effects and risks associated with its use. Understanding these can help you make an informed decision and manage any issues that may arise during treatment. General side effects of Spironolactone include:
- Breast Tenderness and Enlargement: Spironolactone has anti-androgen properties, which can lead to hormonal changes. Women may experience breast tenderness or enlargement. Men, though less commonly prescribed this medication, may also notice gynaecomastia (breast enlargement).
- Menstrual Irregularities: Women may experience changes in their menstrual cycles, including irregular periods or breakthrough bleeding. This is due to Spironolactone’s impact on hormone levels.
- Feminisation & Sexual Dysfunction: These are less common as men are less likely to be put on this treatment.
- Hyperkalaemia (High Potassium Levels): Spironolactone is a potassium-sparing diuretic, meaning it can cause potassium levels to rise. Elevated potassium levels can be dangerous, leading to symptoms like muscle weakness, fatigue, and in severe cases, cardiac arrhythmias.
- Dizziness and Lightheadedness: As a diuretic, Spironolactone can lead to dehydration or lowered blood pressure, causing dizziness or lightheadedness, especially upon standing.
- Gastrointestinal Issues: Some users may experience nausea, vomiting, or stomach cramps. Taking the medication with food can help mitigate these effects.
- Headaches: Headaches can occur, particularly when starting treatment or adjusting the dose. These usually subside as the body adjusts to the medication.
- Rash and Skin Reactions: Though rare, some individuals may develop rashes or other skin reactions. If this occurs, it’s essential to consult a healthcare provider.
In addition to the above general side effects, there are also some potentially severe ones. These include:
- Severe Hyperkalaemia: Although rare, severe hyperkalaemia can be life-threatening. Symptoms include muscle paralysis, severe fatigue and arrhythmias.
- Kidney Function Impairment: Spironolactone can affect kidney function, particularly in those with pre-existing kidney issues. Monitoring kidney function with regular blood tests is essential to avoid complications.
- Allergic Reactions: In rare cases, individuals may experience severe allergic reactions, including anaphylaxis. Symptoms include swelling, difficulty breathing, and severe rashes. You will need to seek immediate medical attention if these occur.
- Teratogenicity: The anti-androgen effects can interfere with the normal development of a male foetus. Therefore, it is not for use in women who are pregnant or trying to become pregnant. However, premenopausal women of childbearing can use it but they should use an effective contraception while taking it.
It’s worth noting that most of these side effects are more likely to occur with oral vs topical Spironolactone however, caution is still required. It is vital to inform your healthcare provider about all other medications you are taking, as Spironolactone can interact with various drugs, potentially increasing the risk of side effects. To reduce the risks of these systmeic effects with oral medications, your doctor may recommend:
- Frequent blood tests are recommended to monitor potassium levels and kidney function, particularly at the start of treatment or when adjusting the dose.
- Limiting potassium-rich foods (such as bananas, oranges, and spinach) to help manage potassium levels.
- Ensuring adequate hydration and monitoring blood pressure can help manage dizziness and lightheadedness. Standing up slowly from sitting or lying positions can also mitigate these symptoms.
Who is Spironolactone Hair Loss Treatment Best For?
Spironolactone is particularly effective in addressing hormonally-driven hair loss but it is not for everyone! Only a medical provider will be able to assess whether it is safe and appropriate for you. In general, here are the more likely people to benefit:
- Premenopausal women with hormone driven hair loss: Women experiencing female pattern hair loss due to androgenetic alopecia or polycystic ovarian syndrome are prime candidates. Spironolactone effectively counteracts the hormone imbalances stabilise and promote hair regrowth in women.
- Individuals who have not responded to other treatments: Spironolactone may help women and men (with caution) who have tried other hair loss treatments such as Minoxidil or even Finasteride.
- Postmenopausal women with hair loss: Although Spironolactone is primarily prescribed for premenopausal women, it can also be effective for postmenopausal women experiencing androgenetic alopecia.
That being said, due to its risks and side effects there are many groups of people where it should not be used. These include pregnant women, men where other options are available, people with kidney problems as well as a host of other medical condition or medications. This is why it is vital to have a detailed assessment by a medical practitioner to decide whether it is safe and effective for you.
Spironolactone vs. Other Non-Surgical Hair Loss Treatments
Whilst Spironolactone is a potent treatment, there are several other well-established non-surgical treatments. These often serve as first-line options by themselves. They may also be used combination with Spironolactone to enhance results.
Minoxidil is a non-hormonal treatment that stimulates hair follicles by increasing blood flow to the scalp and prolonging the anagen (growth) phase. It is suitable for both men and women of all ages. Minoxidil is available over-the-counter in lower strength topical forms (such as Regaine®) and by prescription for higher strengths or oral form. Using Minoxidil with Spironolactone can target hair loss through multiple pathways.
Finasteride specifically inhibits the conversion of testosterone to DHT. It is primarily used in men as it is less likely to cause severe feminising side effects compared to Spironolactone. However, due to its impact on DHT, it is not typically recommended for women of childbearing potential. It is also used in post menopausal women with hormonal hair loss.
Dutasteride is similar to Finasteride but inhibits both type I and type II 5-alpha-reductase enzymes, making it even more potent in reducing DHT levels. It is often considered a second-line treatment for those who do not respond to Finasteride and is generally limited to men or postmenopausal women.
Microneedling, Platelet-Rich Plasma (PRP) Therapy and Low-Level Laser Therapy (LLLT) are physical treatments that enhance hair follicle health and stimulate regrowth. Use of microneedling can enhance the delivery of topical hair loss medications to the scalp and boost hair regrowth. PRP involves injecting a concentration of the patient’s own platelets into the scalp. This releases growth factors to promote hair growth. LLLT uses light energy to stimulate hair follicles and improve hair density. These treatments can be used with Spironolactone to boost overall effectiveness especially in individuals with stubborn hair loss.
Where to Get Spironolactone Hair Growth Treatments
So first of all, Spironolactone is a prescription only medicine regardless of the dose or form it comes in. It is not licensed for use for hair loss but is used off label by clinicians where they feel it is safe and appropriate. You would need a careful assessment with a medical provider (e.g. a doctor) either in a physical or online hair loss clinic to diagnose the cause of your hair thinning and suggest suitable treatments. This may be Spironolactone (either as a tablet or topical solution) alone or in combination with other hair loss treatments. They will either give you a prescription to take to a pharmacy or send your prescription to a specialist compounding pharmacy depending on their setup. The latter will formulate your treatment and deliver it to you.
Spironolactone can help promote hair growth particularly in premenopausal women with hormonally-driven hair loss. It can also help in treating hair thinning in men and post menopausal women but the risk benefit analysis is different. Its really important to have a medical assessment with a healthcare provider to understand the most appropriate treatments for you as well as the possible risks.Ultimately the best treatment will be what is safe, effective and easy for you to use consistently. Remember that successful treatment takes months of diligent use and patience. Like most hair loss treatments, this is generally a long-term commitment if you want to maintain your results.
We believe that hair regrowth should always be a personal journey. This is why we launched personalised hair loss and regrowth treatments through our virtual clinic. Our doctors create bespoke hair loss treatments using actives like Minoxidil, Spironolactone, Finasteride, Dutasteride and Tretinoin. We also treat skin concerns like acne, hyperpigmentation, melasma and signs of skin ageing with custom skincare treatments. Book your virtual consultation and start your journey to great hair today.
