Updated: Jul 9
Men losing their hair is a phenomenon that has been ultimately accepted by society. If you walk down the street and see a bald guy, do you think twice about it? Probably not. But for women things are much different.
Society has, unfortunately, set a standard of beauty that revolves around a good head of healthy hair, and, whether we like to admit it or not, seeing a woman who is losing her hair provokes a different reaction in a lot of people versus when they see a man with hair loss.
What is even more unfortunate is that women do not have the treatment options to combat hair loss that men have. Even though androgenic alopecia (pattern hair loss) affects 30 million women in the U.S. alone, the only FDA approved treatment for women’s hair loss is 2% minoxidil (which is not super effective when used alone). Men have access to be prescribed FDA approved finasteride, which is the most effective treatment currently on the market, but women do not, despite studies showing it is effective for them (1,2).
Though this is not without reason. According to medical experts, finasteride can cause fetus complications/birth defects in premenopausal women and women who are pregnant, along with several other negative side effects. This makes it very hard for women to get a prescription, and most doctors either wont prescribe it at all, or will only prescribe it to post-menopausal women.
This may sound very demoralizing for women who are dealing with hair loss, but there may be a viable alternative called spironolactone. The purpose of this article is to explain what spironolactone is, and how it can be used as an alternative to finasteride for the treatment of female pattern hair loss.
Wait: before you continue, it is important that you talk to your doctor to determine the root cause of your hair loss, spironolactone is for the treatment of androgenic alopecia only and should not be used otherwise.
What is spironolactone?
Commonly sold under the brand name “Aldactone”, spironolactone is an FDA approved diuretic, meaning it helps the body get rid of extra fluid. It is most commonly used to treat fluid build up from the kidneys, liver, and heart problems, and is also used to treat high blood pressure, low blood potassium, and several other less-severe conditions. These are its on-label uses.
Spironolactone also has several off-label uses. Most commonly are for gender transitions from male to female, acne treatment, and hair loss treatment. Though it is only recently that doctors have been prescribing it as an off-label hair loss treatment for women, here’s why:
How spironolactone can help hair loss
Before you understand how spironolactone works, you first must understand how hair loss works.
Everyone’s body, both male and female, produces androgens. Androgens are responsible for a number of things including the onset of puberty, regulation of reproductive organs, kidneys, liver, and muscles, and much more. They are very important, but they are also responsible for hair loss. Specifically, the androgen testosterone (that’s right, both men and women produce testosterone) is converted into dihydrotestosterone (DHT) through several metabolic processes and DHT is what is primarily responsible for hair loss.
Spironolactone has anti-androgenic properties. This means that it actively works to slow down the bodies production of androgens such as testosterone. When there is less testosterone present, there will subsequently be less DHT present, and hair loss will slow or stop. There have been many studies (1,2,3) that have shown spironolactone to be quite effective at stopping hair loss. One study even showed that 73% of the women observed had a noticible improvement in their hair loss.
Typically, your doctor will prescribe 100-200mg for hair loss, but may start you at 25mg to work up to that dosage. Just like any other hair loss treatment, you will need to wait at least 6 months before determining whether spironolactone is working or not, though waiting a year is much better. Everyone’s hair cycle has different time lengths and may respond differently to DHT damage, which is why you need to wait long enough for your hair cycles to normalize.
Though spironolactone has shown to be effective, it is important to note that it works differently than finasteride and should be treated as an alternative not a substitute. This is because finasteride blocks the enzyme (5-alpha reductase) that converts testosterone into DHT (essentially it blocks the mechanism behind the conversion) whereas spironolactone eliminates testosterone at the source.
Side effects of spironolactone
To every yin there must be a yang. Just like finasteride, spironolactone can have negative effects on an unborn male (specifically) fetus. It can affect the development of male genitals mainly due to the potential lack of androgens reaching the fetus. Your doctor will most likely prescribe contraceptives alongside your spironolactone prescription, and will not prescribe it to you if you are pregnant. It is also recommended that you stop taking spironolactone at least one month before you plan on trying to get pregnant.
Though this sounds similar to the finasteride situation, it isn’t. If you are post-menopausal or do not plan on getting pregnant it is much easier to get a prescription for spironolactone. There are other side effects you need to be aware of such as:
-drowsiness (doctors often recommend you take it at night)
-enlarged breast tissue in men and breast tenderness in women
In large part, those side effects are relatively uncommon, and even more uncommon is:
-unusual bleeding or bruising
-flu like symptoms
But, if you experience those or any other serious side effects, you should talk to your doctor right away.
Take action: How to use spironolactone for female pattern hair loss
Step one: talk to your doctor, voice your concerns about hair loss, and inquire about spironolactone. Your doctor should check to make sure the cause of your hair loss is androgenic alopecia.
Step two: once you get your prescription, go to your local Target, Walmart, etc. and pick up 2% minoxidil (5% is for men and may cause unwanted hair growth in women). More on how minoxidil works here.
Step three: use both treatments consistently for at least 6 months, ideally a year. After this time has elapsed, make judgments as to whether or not your treatments are working and if you should continue using them. This study showed how spironolactone and minoxidil were more effective when used together.
They key is to remain consistent and patient with your treatments. Spironolactone and minoxidil are the two most effective treatments available for womens pattern hair loss and should yield good results if used correctly.
Even though 30 million women in the U.S. alone suffer from androgenic alopecia, there is still only one treatment that is FDA approved to help their hair loss.
Using spironolactone off-label may be a good alternative to finasteride to stop the damage that can be done by DHT to your hair follicles. There is a healthy amount of research supporting its efficacy and as long as you are aware of the potential side effects, there are a lot of potential benefits that can come from taking it. Unfortunately, spironolactone, or any other treatments for that matter, do not seem to be on the horizon for FDA approval for hair loss, meaning you will have to continue to use it off-label. Oh, and always remember consistency and patience are extremely important for anyhair loss treatment you use.