Here you will find details about the use of spironolactone for the treatment of female pattern hair loss.
What is female pattern hair loss?
It’s the most common cause of hair loss in women and it also can happen in man. It’s referred to as pattern hair loss or androgenetic alopecia.
This is basically a sensitivity of the hair follicle to the male hormones testosterone and dihydrotestosterone. Basically the hairs start miniaturizing as a result of exposure to testosterone levels in the body.
Female pattern hair loss affects about 40 percent of women by the age of 50. The only FDA-approved treatment for female pattern hair loss is topical minoxidil or Rogaine. It’s something that you have to apply to the scalp. It can be irritating and cause dryness and irritation.
But dermatologists use a medication called spironolactone off-label for the treatment of female pattern hair loss.
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What is Spironolactone?
It’s actually a blood pressure medication, but it also has some other effects that make it helpful for treating hair loss in
women. Specifically it has anti-androgen effect.
Spironolactone competes with testosterone and dihydrotestosterone for the androgen receptor. Spironolactone also lowers the cofactor required for testosterone synthesis and it helps lower the amount of testosterone in the body.
For women this is helpful for treating not only hair loss, but there are a variety of other skin conditions that we use it for in women.
You might ask why this medication can not be used to treat pattern hair loss in men. Unfortunately, if you use in men, it has negative side effects of gynecomastia or breast development and profound impact on the libido.
So it’s not used in men but it is used to treat pattern hair loss in women.
Spironolactone is actually pretty effective for female pattern hair loss. It doesn’t work for everybody but it can be effective. About 75% of women taking spironolactone in large studies reported either an improvement in their hair loss or at the very least their hair loss did not continue to worsen.
Overall it seems to be effective in about 40 percent of women and it can prevent further hair loss as well as a result in thickening of the hair.
For the treatment of female pattern hair loss the dosage for spironolactone is a 100 to 200 milligrams per day, given in divided doses. For example 50 milligrams in the morning and 50 milligrams in the evening.
It takes a long time to see results. At least 6 months but at a year you will really start to see results.
Experience shows that people who stay on it over a year see the best results.
Spironolactone can be used along with other hair loss treatments to get even better results.
In studies, women who had been using minoxidil for a long time and had reached a plateau with it, when they added on spironolactone, they saw additional improvement in hair density.
It can be used with minoxidil and it also can be used with low-level laser therapy. I am a huge fan of this low level laser therapy device.
For hair loss, spironolactone stops hair loss progression and it has a favorable long-term safety profile.
How Long Do You Have to Take It?
People who take it at least a year, see the best results. It does need to be continued long term in order to continue to maintain those results.
In many people the dosage can be dropped after results are achieved, as kind of a maintenance dose. But it does need to be continued. This is only a resting the hair loss process. When it’s stopped, that will resume, because those androgen receptors are now free to see the testosterone and dihydrotestosterone in the body and so the hair loss will ensue when the medication is stopped.
But when it comes to stopping the medication, it’s not as though you stop the medication and in the next few weeks all of your hair falls out. It’s really you stop the medication and now you’re going to have normal progression of pattern hair loss as hair follicles are gonna start seeing the testosterone or dihydrotestosterone.
But it’s not gonna be an all at once thing.
But it’s not a cure!
It merely arrests the process and in arresting the process, you can get improvement in thickness and density.
Safety & Side Effects
It is a safe medication to take long term. The long term safety profile is very favorable.
What are the side effects of taking spironolactone?
They are dose dependent. You are at a slightly higher dose with treating hair loss as opposed to when spironolactone is used to treat acne.
The side effects are still pretty favorable.
You can experience low blood pressure. If you get up in the middle of the night, make sure you get up slowly because if you go from lying down to standing up very quickly, you may find that you experience some dizziness.
You also can experience headaches and because this is a blood pressure medication, it works as a diuretic, so it can make you go to the bathroom more frequently.
This medication can raise your potassium levels, although in people who have normal renal function and otherwise are healthy this is not an issue.
It can make you feel a little fatigued.
These side effects typically stabilize after a few months and a long term these things are less of an issue.
The other side effects that can happen are menstrual irregularities. You can also have breast tenderness and slightly decrease in libido.
But these side effects also will stabilize and usually resolve after a few months.
When you get the medication though, you will see a black box warning.
The black box warning says this medication has mutagenic properties.
What you have to understand about that black box warning is that the FDA is required to put that there. That’s from animal studies where they put a mega dose of the medication into animals and tumors and other things have formed. Those doses are much, much higher than what is used to treat people. There’s no evidence of any curse mutagenic effect in people.
There were two very large retrospective population based studies of women that found no association with spironolactone and increased risk of breast, ovarian, uterine or cervical cancer.
While it’s a very safe medication, it’s not safe in pregnancy. It’s not considered safe in breastfeeding either.
A lot of people will ask do you need to be on a birth control pill to take this. We actually don’t have any studies that show adding birth control pills to spironolactone yields any better results in terms of pattern hair loss.
In the case of acne, it does offer additional advantage for the acne control. But when it comes to hair loss, we don’t have any studies that suggest that adding birth control really gets you any better in terms of your hair loss.
Instead, adding things like minoxidil and low-level laser therapy will get you even better results with a hair loss along
with the spironolactone.
Spironolactone is effective for pattern hair loss, but like any hair loss treatment, it’s not going to work for everybody and it seems to work best when combined with other treatments.
Spironolactone is only going to be effective for hair loss that is pattern hair loss.There are many other types of hair loss out there. So before even entertaining the idea of spironolactone, it’s critical that you have an accurate diagnosis of your hair loss.
It’s not gonna work for many other different types of hair loss out there. So it’s critical that you see a dermatologist and get an accurate diagnosis.
Getting an accurate diagnosis of your hair loss is so important. We know that having the correct diagnosis and treating that diagnosis early is pivotal to stopping the hair loss and giving you the best results long term.
That’s everything I can tell you about spironolactone for female hair loss.