Spironolactone is a medication usually used for fluid retention, but doctors sometimes use it to treat androgenetic alopecia, a type of hair loss in females.
Spironolactone (Aldactone) is a type of medication known as an aldosterone receptor antagonist. It’s FDA-approved for the treatment of fluid retention caused by a variety of conditions, including liver disease and kidney disease. However, it’s also used to treat other conditions, including:
- high blood pressure
- heart failure
- hyperaldosteronism
Some doctors may prescribe it for female pattern hair loss caused by androgenetic alopecia. This is a type of hair loss that’s associated with the overproduction of “male” sex hormones. Doctors typically only prescribe it if other treatments do not work.
Read on to learn more about how spironolactone treats female pattern hair loss, how long it takes to work, and the side effects it can cause.
Spironolactone slows down the production of androgens, or “male” sex hormones, including testosterone.
All people, regardless of sex, produce some amount of androgens. People with ovaries typically produce much less of them. Overproduction can lead to higher levels of:
- dihydrotestosterone (DHT) production
- heightened levels of 5 alpha-reductase
- androgen receptors on the scalp in areas affected by hair loss
This can cause female pattern baldness or androgenetic alopecia.
Spironolactone can help reduce the production of androgens, slow down the progression of hair loss, and encourage hair to regrow.
Keep in mind that it does not treat male pattern baldness. That type of androgenetic alopecia is caused by the actions of another hormone, dihydrotestosterone (DHT).
Spironolactone is usually only prescribed when other treatments, such as minoxidil, don’t work.
A 2023 review of research found that about 43% of people with female pattern hair loss noticed an improvement in their hair loss after taking spironolactone. Up to 66% noticed an improvement if spironolactone was combined with another therapy.
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It’s important to note that spironolactone does not work for female hair loss that’s only due to nonhormonal causes, such as:
- stress
- chemotherapy
- nutritional deficiencies
For hair loss, a doctor typically prescribes a daily dose of 100 to 200 milligrams (mg). However, they might recommend starting with 25 mg a day and slowly increasing your dose to reduce your risk of side effects.
Spironolactone sometimes causes drowsiness, so it’s best to take it at night. You can take it with or without food.
If you haven’t gone through menopause, your doctor might also prescribe birth control pills to take with spironolactone. They might also prescribe minoxidil to take with spironolactone, regardless of your age.
The exact dosage and combination of medications that your doctor suggests can depend on how severe your hair loss is and whether you take other medications for hair loss or other conditions.
Spironolactone takes a while to start working for hair loss, so try not to be discouraged if you don’t see improvement right away.
Most people need to take it for at least 6 months before they start seeing results. Others might not notice any benefits until they’ve taken it for at least a year.
Follow up with a doctor after taking spironolactone for 6 months. Depending on your results, they might increase your dosage or prescribe a different medication to take with or instead of spironolactone.
Spironolactone is commonly prescribed to lower blood pressure, and it may cause low blood pressure in those taking it for hair loss. You should regularly check your blood pressure while taking spironolactone, as this can be dangerous if you don’t have high blood pressure. Learn how to check your blood pressure at home.
Other common side effects of spironolactone include:
- drowsiness
- nausea
- diarrhea
- headache
- dizziness
- irregular periods
- breast tenderness
- weight gain
- low sex drive
- depression
- fatigue
More serious but less common side effects include:
- gastrointestinal bleeding
- high potassium levels
High blood potassium is serious and potentially life threatening. Call your doctor right away if you notice any of the following symptoms while taking spironolactone:
- muscle fatigue
- weakness
- abnormal heart rate
- nausea
- paralysis
Spironolactone is generally safe, but it can lead to health problems if not taken correctly. As with any medication, some people may also be allergic or sensitive to it.
Talk with your doctor before taking any other medications while taking spironolactone. That includes nutritional supplements (especially potassium) and diuretics.
Before taking spironolactone, tell your doctor if you’re pregnant, nursing, planning to become pregnant, or have:
- liver disease
- kidney disease
- high potassium
- Addison’s disease
- electrolyte imbalance
Talk with a doctor right away if you become sick while taking spironolactone, especially if you have severe or persistent nausea, vomiting, or diarrhea. These can all cause dangerously low blood pressure when taking spironolactone.
Make sure you drink plenty of water while taking spironolactone, especially in hot weather or during exercise. Know how to recognize the signs of dehydration, which include:
- extreme thirst
- infrequent urination
- dark-colored urine
- confusion
Get emergency medical treatment if you experience any signs or symptoms of a severe allergic reaction to spironolactone, including:
- trouble breathing
- rapid or weak heartbeat
- seizures
- loss of consciousness
Spironolactone is an effective treatment for hair loss due to androgenetic alopecia in women. However, it can take up to a year to work.
If you’re interested in trying spironolactone for hair loss, talk with your doctor. Make sure to tell them about any medical conditions you have and the kinds of hair loss treatments you’ve tried in the past.