Spironolactone: A Helpful Tool in the Treatment of Female Hair Loss and Hormonal Acne
By Kyle T. Amber, MD
Spironolactone is a medication taken by mouth that is traditionally used to treat patients with severe congestive heart failure. In early studies, it was found that while the medication was not a particularly impressive diuretic, it did lead to a reduction in adult acne and female pattern hair loss. While it is not FDA-approved for the treatment of acne or hair-loss, it is a commonly used treatment for both conditions .
Spironolactone works by inhibiting the enzyme 5 alpha-reductase, the enzyme that activates testosterone. Several observational studies have shown significant improvement in female patients taking the medication [2, 3]. It can be safely and effectively combined with oral contraceptive pills or topical retinoids[4, 5]. For women with thinning hair (androgenetic alopecia, female pattern hair-loss) spironolactone can also increase hair growth [6, 7]. Like other solutions for increasing hair-growth, it only lasts while taking the medication.
While spironolactone is overall a well-tolerated medication, there are several side effects that should be noted. Spironolactone can result in severe birth defects if taken while during pregnancy, thus oftentimes a concomitant oral contraceptive is recommended. High potassium has been a concern, though a recent large study demonstrated that in young healthy women, there is no clinical significance to having slightly elevated potassium with spironolactone . Other side effects include irregular menstrual cycles, headache and low blood pressure. For male-pattern hair loss, it is not a good treatment, as it can result in gynecomastia (the development of breasts in men).
Overall, spironolactone is a very helpful and generally well-tolerated medication for improving hormonal acne (around the mouth, chin-strap lines, flares near menses) as well as for female-pattern hair loss. I’ve had many patients with quite stubborn acne that benefited from it.
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