Here’s How Spironolactone Can Treat Hair Loss & Help With Growth

You may have heard of spironolactone in the context of blood pressure or hormonal acne treatment. But what few people know is that it may also help with hair loss. In general, hair loss can be difficult to treat because it depends on the cause and on your health and lifestyle. To add to the complexity, certain treatments are only effective for hair loss in men but not women (and vice versa). Spironolactone is gaining popularity for its effectiveness against certain types of hormone-related hair loss, particularly in women. In this article, we explore how spironolactone works, whether it is effective in both women and men, and what results to expect.

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 is androgenetic alopecia, better known as male and female pattern hair loss. Despite involving hormones, it is not usually caused by having too many androgens. Instead, the hair follicles are genetically more sensitive to normal levels of androgens, particularly dihydrotestosterone (DHT). DHT is a powerful androgen derived from testosterone. In genetically prone follicles, DHT attacks the hair, gradually shrinking it in a process called miniaturisation. Over time, this leads to finer, weaker hairs and eventual hair loss.

In men, this typically appears as a receding hairline and thinning at the crown. In women, it usually shows up as diffuse thinning across the crown. Some women do have raised androgen levels from conditions like polycystic ovary syndrome, but many women with thinning hair have completely normal hormone levels. Hair loss after pregnancy or around menopause is also common. Of course, stress, poor diet and certain hair care practices can worsen hair loss too.

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, its 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 prevent hair follicle miniaturisation. This in turn promotes hair regrowth and reduces shedding.

Studies indicate that spironolactone is particularly effective in women with androgenetic alopecia and other hormonally-driven hair loss conditions. This is true in both oral and topical form, and even at lower doses. Research also shows that it can reduce hair shedding and promote regrowth in some men. However, the risk of side effects such as gynaecomastia (breast enlargement), decreased libido and feminisation often limits its use. As such, it is generally reserved for 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. The choice between them depends on each person’s individual needs, preferences and tolerance for potential side effects. You take oral spironolactone as a daily tablet and works systemically (throughout the whole body) to reduce androgen levels. Your prescriber will tailor the dose to your response and overall health. Most women respond well to lower doses. This makes it highly effective at treating hormonally-driven hair loss and acne. It 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, feminising effects such as gynaecomastia and decreased libido.

On the other hand, you apply topical spironolactone directly to the scalp as a solution or serum, targeting hair follicles locally. This localised treatment reduces the risk of systemic side effects, which can make it a safer option in particular for men. Furthermore, studies suggest that topical spironolactone may be as effective as oral in reducing 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, you 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 to 6 months): in the first few months, you might begin to see subtle signs of improvement. One of the first is usually a reduction in hair shedding, which indicates that the medication is taking effect. Thin areas on the scalp may start to show slight increases in density, and the existing hair might begin to feel thicker and healthier.
• Noticeable growth (6 to 12 months): around the six-month mark, more significant changes typically become apparent. During this phase, many people report a noticeable increase in hair density and better scalp coverage. Areas that were thinning may begin to show visible regrowth, and the overall appearance of the hair becomes fuller and stronger.
• Peak results (12 months and beyond): long-term use, usually beyond a year, yields the most substantial results. By this time, the medication has effectively maintained lower androgen levels, leading to considerable regrowth and stabilisation of hair loss. 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. Whilst some people experience dramatic improvements, others notice more gradual changes. Factors such as age, the extent of hair loss and overall health can all influence how well the treatment works. So sticking to the prescribed protocol and regularly consulting 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 the potential side effects and risks. Understanding these can help you make an informed decision and manage any issues that arise during treatment. General side effects of spironolactone include the following:

• 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 and 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 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. This can cause dizziness or lightheadedness, especially upon standing.
• Gastrointestinal issues: some people may experience nausea, vomiting or stomach cramps. Taking the medication with food can help reduce these effects.
• Headaches: these can occur, particularly when starting treatment or adjusting the dose. They usually subside as the body adjusts to the medication.
• Rash and skin reactions: though rare, some people may develop rashes or other skin reactions. If this occurs, it’s essential to consult a healthcare provider.

In addition to the above, there are also some potentially severe side effects. These include the following:

• Severe hyperkalaemia: although rare, this 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, people 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. As such, it is not for use in women who are pregnant or trying to become pregnant. However, premenopausal women of childbearing age can use it, but they must use effective contraception whilst taking it.

It’s worth noting that most of these side effects are more likely with oral than topical spironolactone, though caution is still required. It is vital to inform your healthcare provider about all other medications you are taking. This is because spironolactone can interact with various drugs and potentially increase the risk of side effects. To reduce the risks of these systemic effects with oral medication, your doctor may recommend the following:

• Frequent blood tests 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 to help manage dizziness. Standing up slowly from sitting or lying positions can also help.

Who is Spironolactone Hair Loss Treatment Best For?

Spironolactone is particularly effective for hormonally-driven hair loss, but it is not for everyone. Only a medical provider can assess whether it is safe and appropriate for you. In general, here are the people most likely to benefit:

• Premenopausal women with hormone-driven hair loss: women experiencing female pattern hair loss due to androgenetic alopecia or polycystic ovary syndrome are prime candidates. Spironolactone counteracts the hormone imbalances that drive it, helping to stabilise hair loss and promote regrowth.
• 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 said, due to its risks and side effects, there are many groups for whom it should not be used. These include pregnant women, men where other options are available, and people with kidney problems or other medical conditions. 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.

How Does Spironolactone Compare to Other Hair Loss Treatments?

Whilst spironolactone is a potent treatment, there are several other well-established non-surgical options. These often serve as first-line treatments by themselves and include the following:

• 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 use. 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 than spironolactone. However, due to its impact on DHT, it is not typically recommended for women of childbearing potential. It is also used in postmenopausal 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 at reducing DHT. 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 follicle health and stimulate regrowth. Microneedling can also improve the delivery of topical hair loss medications to the scalp. PRP involves injecting a concentration of the patient’s own platelets into the scalp to release growth factors, whilst LLLT uses light energy to stimulate follicles and improve density. These can all be used alongside spironolactone to boost overall effectiveness, especially in stubborn hair loss.

Where to Get Spironolactone Hair Growth Treatments

First of all, spironolactone is a prescription-only medicine, regardless of the dose or form it comes in. It is not licensed 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 (such as a doctor), either in person or through an online clinic. They can diagnose the cause of your hair thinning and suggest suitable treatments. This may be spironolactone (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 it to a specialist compounding pharmacy. The pharmacy will then formulate your treatment and deliver it to you. In the UK, you can get topical spironolactone for hair loss online through a growing number of regulated clinics.

Spironolactone can help promote hair growth, particularly in premenopausal women with hormonally-driven hair loss. It can also help treat hair loss in some men and postmenopausal women, though the risk-benefit balance is different. So it’s 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 whatever is safe, effective and easy for you to use consistently. Remember that successful treatment takes months of consistent use and patience. Like most hair loss treatments, this is generally a long-term commitment if you want to maintain your results.

At City Skin Clinic, we understand that hair loss is a deeply personal journey. This is why our doctors create personalised hair loss treatments for women and men through our online clinic. We use actives like minoxidil, spironolactone, finasteride and dutasteride where appropriate, in bespoke compounded treatments designed around you. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin and hair starts here.

This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.