Spironolactone for Hair Loss: Benefits, Dosage, and Risks

When you start losing hair and head toward Spiral City, Google quickly becomes your trusted advisor. The quest for answers can be overwhelming, leading you to look up hair loss treatments and scour social media, wondering if that hair-growth tincture is legit or just another money-making scheme.

But hey, that’s where we come in. You may have heard of spironolactone for hair loss, and we’re here to give you the full scoop on how it can help.

Welcome to Spironolactone for Hair Growth 101, where you’ll learn about the benefits and dosage recommendations, plus any side effects you could experience. Here we go — class is in session!

Spironolactone is an antiandrogen drug commonly prescribed as a once-daily pill. In layperson’s terms, an antiandrogen is a type of medication that blocks the effects of androgens (male hormones).

It’s also a diuretic, meaning it helps flush excess fluid out of your body. And it’s sometimes prescribed for acne and hirsutism (a condition where extra hair grows around the chin and mouth). Hello, three-for-one treatment if you’re dealing with breakouts, facial hair, and thinning.

Spironolactone was originally created as a medication used primarily for managing and treating hypertension (high blood pressure) and heart failure.

So, how did a drug meant for the heart start being used for hair loss? It’s thought to be a happy accident when heart patients began noticing its antiandrogenic effects.

If you’re wondering, Does spironolactone cause hair loss? The quick answer is a big no. In fact, it can do the opposite.

Here’s how:

• It lowers DHT. Spironolactone helps hair growth by decreasing the effects of DHT (dihydrotestosterone). And while DHT is a key factor in male pattern baldness (aka androgenetic alopecia), how it impacts female pattern hair loss (FPHL) isn’t totally understood.

• It blocks sex hormones. Spironolactone also inhibits androgens at different physiological levels, so it’s used in women with androgenic alopecia, hirsutism, and excess sebum production — that’s the three-in-one punch we mentioned earlier.

Speaking of excess sebum production, in a spironolactone study with 110 patients, 73 percent of women saw an improvement in acne lesions on their faces. And over 75 percent saw improvements in body acne.

Though 51 women in the trial experienced side effects, only six found them bothersome enough to stop taking spironolactone.

These side effects can especially be common in women with polycystic ovary syndrome (also known as PCOS).

If you’re dealing with hormone-related acne, excess hair growth, or hair loss, you can learn more about the different spironolactone uses in our guide.

In sum, there are many benefits of spironolactone beyond addressing female pattern hair loss. The medication can be used as:

• An acne treatment

• High blood pressure medicine

• A gender-affirming medication therapy

But we’re here to talk about hair loss. Learn about spironolactone for hair growth below.

Nearly half of all women will experience hair loss at some point in their lives. It’s not exactly a fun club to belong to, but it may help to know how common it is.

That said, there are many types of hair loss, ranging from stress-related telogen effluvium to traction alopecia and androgenetic hair loss.

Female pattern hair loss is the most common cause of hair loss in women, and it typically becomes more prevalent with age.

Hair loss can be caused by many factors, including genetics and hormones. Female pattern hair loss and men’s androgenetic alopecia are generally thought to be caused by excessive production of DHT or alteration of androgen receptors (a changing sensitivity to hormones). But the link isn’t yet clearly established.

In its off-label use, spironolactone helps treat female pattern hair loss at the hormonal level. It protects hair from androgens that can weaken hair follicles and contribute to excess hair shedding.

Since spironolactone’s mechanism of action is specifically for hormone-related hair loss, it won’t work for those experiencing hair loss due to non-hormonal causes, like stress or traction alopecia.

We’ve discussed hormonal hair loss and other root causes of excess shedding more in-depth in our guide to female hair loss.

Spironolactone is safe for most women, but there are still some things to be aware of.

Antiandrogen drugs (including spironolactone) are potentially teratogenic, meaning they may cause fetal abnormalities. In fact, the U.S. Food and Drug Administration (FDA) recommends avoiding this medication during pregnancy. Beyond that, women are often advised to have a birth control plan in place while using spironolactone.

In other words, if having children soon is on your vision board or you’re already pregnant, you’ll need to consider another route to hair regrowth. You can try other hair loss treatments for women, like topical minoxidil.

How much spironolactone to take for hair loss really depends on your specific condition. Your healthcare provider will go over your needs and try to pinpoint the cause to figure out what’s right for you.

How Much Spironolactone Is Prescribed for Hair Loss?

But generally speaking, the usual daily dose of spironolactone for hair loss is 100 to 200 milligrams (mg) daily.

One study retrospectively analyzed women with female pattern hair loss who were prescribed spironolactone. The average spironolactone dose was 100 milligrams daily (ranging from 25 to 200 milligrams daily) for at least six months.

The study’s findings showed that patients maintained how much hair they had when starting the medication or saw hair growth improvements. But the best results were seen after a year or more of daily spironolactone use.

In another study, spironolactone showed better efficacy when combined with other therapies, such as oral or topical minoxidil, than when used alone. So if you really want to see results, you might consider pairing oral spironolactone with another hair loss treatment like minoxidil.

Read our spironolactone dosage guide to get a better idea of what your healthcare provider might recommend when prescribing the medication off-label for hair loss.

We know, we know — everyone wants results overnight, but you’ll have to practice a little patience to see spironolactone hair growth success.

Based on the available data, taking spironolactone for hair growth for 12 months seems to offer significantly better results than a six-month treatment plan.

According to research, you can expect to see improvement after a year of oral use at 80 to 200 milligrams daily. Based on your dosage, you may see progress slightly faster or slower than this — some may notice improvements closer to the six-month mark.

Still, try to give it a year — that’s when you’ll see the maximum potential of how spironolactone can help your hair loss.

There hasn’t been much research specifically on the treatment of hair loss and usage of spironolactone. But studies have shown common side effects from long-term use of spironolactone for acne treatment.

Spironolactone side effects may include:

• Irregular menstruation

• Frequent urination

• Dizziness

• Headaches

• Nausea or vomiting

• Breast tenderness

• Breast enlargement

Because of these potential side effects, it’s recommended that women regularly get their blood pressure and electrolyte levels checked. This is especially crucial in the first few months of treatment for those with any renal abnormalities (one or two small or missing kidneys).

However, there are some exceptions to monitoring your potassium levels (which is an electrolyte) — for example, if you’re a relatively healthy young woman taking spironolactone, as multiple studies suggest.

You can read more about the relationship between potassium and spironolactone, including what foods should be avoided when taking it, in our blog.

How Common Are Spironolactone Side Effects?

In an eight-year study of 91 patients who used spironolactone for an average of 28.5 months, 60 percent experienced mild side effects, like lightheadedness and upset stomach. But only 15 percent discontinued the medication, and no serious adverse events were reported.

The most common side effects were diuretic effects (29 percent), menstrual irregularities (22 percent), and breast tenderness (17 percent).

Is Spironolactone Safe?

The authors of the study mentioned above concluded that long-term use of spironolactone in treating acne appears to be safe.

Additionally, a recent systematic review and meta-analysis determined that spironolactone is a safe and effective treatment for hair loss.

Who Shouldn’t Take Spironolactone for Hair Loss?

Be aware, though, that this isn’t a medication recommended for men. Male patients who take oral spironolactone often experience gynecomastia (increased breast tissue), loss of libido (lowered sex drive), and general feminization that results in the termination of treatment.

For these reasons, men generally aren’t prescribed oral spironolactone. That said, topical spironolactone may be something to discuss with your healthcare provider or dermatologist.

If you’re living with a severe autoimmune disease or a chronic illness, your medical provider will advise you on whether you should take spironolactone for hair loss.

Also, if you’re pregnant, breastfeeding, or trying to conceive, ask your healthcare provider before taking this medication — or any prescription drug or supplement for hair loss.

Though spironolactone is the most used antiandrogen treatment for female pattern hair loss in the U.S., other hair loss treatment options are available.

If you’re curious about alternatives, here are a few to consider.

Topical Minoxidil

Research has shown that the combination of minoxidil (commonly sold under the brand name Rogaine®) and spironolactone can help treat thinning hair.

One study testing the usage of 5% minoxidil with 80 to 100 milligrams of spironolactone showed a significant increase in hair shaft diameter. This topical hair loss medication also has pretty good results when used on its own.

Oral Minoxidil

This once-a-day pill might be prescribed off-label to those who prefer tablets to topicals. If you’ve tried topical minoxidil in the past and it didn’t seem to work, you may have better luck with the oral form.

Minoxidil requires the presence of an enzyme called follicular sulfotransferase, and the oral form needs less enzymatic activity to be effective.

Topical Finasteride and Minoxidil Spray Combo

This topical treatment combines 6% minoxidil and 0.3% finasteride in a prescription-strength spray. It’s currently only FDA-approved for men but has demonstrated considerable results for women as a hair loss treatment.

In one study, 5 milligrams of daily finasteride suppressed scalp DHT levels by 43 percent at 28 days and up to 65 percent at 42 days in patients with androgenetic alopecia.

A double-blind, randomized trial compared twice-daily finasteride 1% topical gel to once-daily finasteride 1-milligram oral tablet for six months. The results were similar for both medications.

When combined, minoxidil and finasteride have shown to work even better together than using either alone.

Spironolactone could be a helpful treatment to add to your arsenal in the quest for fuller, thicker hair.

Here’s what to keep in mind as you consider spironolactone for hair loss:

• Spironolactone is an antiandrogen drug, meaning it blocks certain sex hormones. It’s commonly prescribed as a once-daily pill.

• This medication helps with hair growth by decreasing the effects of the hormone DHT.

• Spironolactone can also treat acne and high blood pressure.

• Though it can start working after six months, it takes about a year to start seeing the full potential of spironolactone.

• Pairing spironolactone with another hair loss treatment will probably yield the best results. Think of it like a Batman and Robin duo for your hair.

No matter what’s causing your thinning or excess shedding, you have options to treat hair loss. Ready to take the next step? Consult a healthcare provider to get the best hair loss treatment for you.

Did we mention you can get started today with a super easy, no-pressure online quiz? That’s the best part.