spironolactone-jpgSpironolactone For Female Hair Loss

Spironolactone (brand name Aldactone®) is an oral diuretic with anti-androgen effects. All women have both estrogens (female hormones) and androgens (male hormones). As their estrogen production wanes (usually around menopause) it can unmask underlying normal levels of androgens. These androgens are believed responsible for unwanted facial hair and possibly hair thinning. Doctors believe that FPHL is related to a genetically increased sensitivity to normal circulating levels of androgens at the level of the hair follicle.

In women, the use of spironolactone can help block androgen receptors at the level of the hair follicle. It can help reduce unwanted facial hair and also help regrow thinning hair on the scalp. Like minoxidil or finasteride, it must be taken consistently in order to see benefits from the drug. This involves taking it for a minimum of 6 months. In women who respond, regrowth generally peaks at 24 months. We prescribe spironolactone at doses of 25-100 mg daily for acne, but must use higher doses of 150-200 mg daily for use in treating female pattern thinning.

At higher doses, it is important to periodically check electrolytes (potassium and sodium) while taking spironolactone. Spironolactone is a potassium-sparing diuretic, meaning that it can increase the body’s potassium stores. The kidneys can generally adjust for this but we use extra caution in patients with a known history of kidney disease. Patients should not take this drug in addition to any other potassium-sparing diuretic or ACE-inhibitor. Sodium can be lowered, so patients with a known history of hyponatremia (very low sodium levels) should be cautious. The diuretic effects usually manifest as urinating an extra time or two during the day. A less common effect is allergic reaction to spironolactone, manifest as skin itching and hives.