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Dermatologists are Prescribing This Acne Medication to Treat Hair Loss
Initially developed as a diuretic for high blood pressure (and more recently tackling acne), the oral medication, spironolactone, has been shown to help with hair regrowth. Hair loss, at its root, can have many potential origins, including genetics, medical conditions, and physical/emotional stress.
Meet the Expert
- Flora Kim, MD, FAAD, is a board-certified dermatologist at Flora Kim Dermatology.
- Purvisha Patel, MD, MOHS, is a cosmetic surgeon and creator of Visha Skincare.
- Annie Gonzalez, MD, is a dermatologist at Riverchase Dermatology.
Below, board-certified dermatologists Flora Kim, MD, FAAD of Flora Kim Dermatology; Purvisha Patel, MD, MOHS, and Annie Gonzalez, MD, of Riverchase Dermatology, explain exactly what you need to know about taking spironolactone for hair loss purposes.
Spironolactone
Type of ingredient: Potassium-sparing diuretic
Main Benefits: Originally created for high blood pressure, derms have recently started prescribing spironolactone for acne to block DHT (dihydrotestosterone), which is one of the main causes of androgenetic alopecia as well.
Who Should Use It: Because the mechanism of action is specifically for hormone- related hair loss, spironolactone won't work on those experiencing hair loss due to non-hormonal causes, such as stress or chemotherapy.
How Often Can You Use It: To address female pattern hair loss, derms traditionally recommend 100-200 mg daily, for a minimum of six months to determine if this is the proper treatment option.
Works Well With: Everyday vitamins and many prescriptions, though always check with a physician first.Don’t Use With: Anything that can further increase your potassium levels. Kim cites that drugs contraindicated with spironolactone include amiloride, drospirenone, eplerenone, triamterene, cyclosporine, lofexidine, bosutinib, and pomalidomide, to name a few medications.
Hair Type Considerations
Though many thinning hair types can benefit, aging women and those who genetically predisposed to hair loss will be most likely to see results. “As we age, we lose estrogen over time,†explains Patel. “When there is a genetic predisposition, female pattern hair loss can occur. Testosterone in the body and in the hair follicles goes unopposed, and this can lead to miniaturization of the hair follicles and hair loss. Spironolactone helps oppose the testosterone in the hair follicles and decreases hair loss.â€
Gonzalez adds, “If your body produces an increased amount of testosterone or other androgens, spironolactone can help to reduce hair thinning by blocking the effects of testosterone in the body. The principle behind this is that there would be less testosterone-induced stimulation on the hair follicles, and therefore more hair retention.â€
Side Effects of Spironolactone
Remember, spironolactone is a diuretic, so it is imperative that you make the extra effort to drink plenty of water. Patel notes that “it could make your electrolytes out of whack, leading to high potassium levels. This is why your doctor checks this level during treatment.â€
While taking spironolactone, Patel also recommends that patients lower their potassium intake (by way of supplements or banana consumption) in addition to avoiding the following: cholestyramine, digoxin, lithium, trimethoprim; heart or blood pressure medicine (especially another diuretic); medicine to prevent blood clots; or NSAIDs (nonsteroidal anti-inflammatory drugs) which includes aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), celecoxib, diclofenac, indomethacin, and meloxicam.
According to Kim, other potential side effects include “dizziness with postural hypotension, breast tenderness, decreased libido, spotting, and electrolyte imbalance. This androgen receptor blocker is categorized as pregnancy category D.â€
Gonzalez emphasizes that due to its estrogen-like effects, this medication is only given to those who are not pregnant. “The most common side effects are diuresis, menstrual irregularities, gastrointestinal upset, and breast tenderness. To add, women of childbearing potential must be on a reliable form of birth control with spironolactone to avoid exposure during pregnancy.â€
Final Thoughts
Before exploring this option, speak with your primary health doctor or dermatologist to determine if this is the right treatment method for your current lifestyle.
Other options, like minoxidil (at least 5 percent or higher per Kim), flutamide, dutasteride, finasteride, birth control (those that are combined and contain both estrogen and progestin) may be a better solution.
Ultimately, hormonal balance is exactly that—a balance. “Tipping one way or another with hormone levels does not help everyone,†cautions Patel.
It's always best to seek expert advice first, particularly when it comes to prescription medications. If you notice any unusual hair changes, we strongly encourage you speak to your primary care doctor or dermatologist to determine the correct treatment plan for you.
Drowsiness, dizziness, lightheadedness, upset stomach, and nausea can all occur as a result of taking spironolactone. Always seek expert advice before taking a prescription.
Spironolactone has also been shown to benefit those who suffer from acne.
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Levy LL, Emer JJ. Female pattern alopecia: current perspectives. Int J Womens Health. 2013;5: 541-556.
Glynis A. A double-blind, placebo-controlled study evaluating the efficacy of an oral supplement in women with self-perceived thinning hair. J Clin Aesthet Dermatol. 2012;5(11): 28-34.
Grymowicz M, Rudnicka E, Podfigurna A, et al. Hormonal effects on hair follicles. Int J Mol Sci. 2020;21(15): 5342.