How Spironolactone Works, Results, Usage, and Side Effects

Hair loss, or alopecia, is a universal concern that affects individuals worldwide, often causing not only physical but also emotional distress. In the quest for effective treatments, Spironolactone, has emerged as a contender in the battle against hair loss. This extensive article embarks on a comprehensive analysis of the scientific foundations, mechanisms of action, and clinical evidence supporting the use of Spironolactone in the management of hair loss, referencing pertinent studies to offer an exhaustive understanding of its efficacy.

Close up showing the before and after results of using spironolactone to treat hair loss and balding

What is Spironolactone?

Spironolactone is a medication that has gained attention for its potential role in the treatment of hair loss, particularly in women with androgenetic alopecia or female pattern hair loss. While spironolactone was initially developed as a diuretic and a treatment for high blood pressure, it is also an anti-androgen. In the context of hair loss, it works by blocking the effects of androgens, such as testosterone and dihydrotestosterone (DHT). By reducing the impact of androgens on the hair follicles, spironolactone may help slow down or halt hair loss progression and promote the maintenance of existing hair. It’s important to note that spironolactone is typically used off-label for hair loss, and its effectiveness can vary. It is often prescribed under the supervision of a healthcare provider, particularly for women experiencing androgenetic alopecia.

History of Spironolactone

Spironolactone is a medication initially developed in the 1950s by scientists at the pharmaceutical company Searle (now part of Pfizer). Its original purpose was as a potassium-sparing diuretic, intended to address conditions like high blood pressure (hypertension) and edema, characterized by excessive fluid retention. Spironolactone achieved this by acting as an aldosterone receptor antagonist, blocking the effects of aldosterone, a hormone regulating sodium and potassium balance in the body.

However, it was during its early development that researchers discovered an intriguing secondary function: spironolactone possessed anti-androgenic properties. These properties meant that it could antagonize the actions of androgens, including testosterone and dihydrotestosterone (DHT), in the body. This discovery broadened the medication’s potential applications, particularly in conditions influenced by androgens. These include conditions such as hirsutism (excessive hair growth) and androgenetic alopecia.

Over time, spironolactone found a niche in the management of conditions beyond its diuretic origins. Its anti-androgenic attributes led to its off-label use for treating androgenetic alopecia, primarily in women. Some women experienced benefits, including a slowdown in hair loss progression and, in certain cases, the regrowth of hair. This off-label use for hair loss has persisted, and spironolactone continues to be a subject of research for hair loss.

The Role of DHT in Androgenetic Alopecia

Dihydrotestosterone (DHT) is a hormone derived from testosterone, and it plays a significant role in hair loss, particularly in androgenetic alopecia (male and female pattern baldness). In individuals with a genetic predisposition to hair loss, hair follicles in certain areas of the scalp are sensitive to DHT. When DHT binds to receptors in these follicles, it can lead to a process known as miniaturization. This process causes the hair follicles to shrink over time, resulting in thinner and shorter hair growth cycles. Eventually, the affected follicles may stop producing hair altogether, leading to baldness in those areas. Therefore, DHT is a key factor in the development and progression of hair loss, and treatments often target its effects to mitigate or reverse the condition.

How Spironolactone Treats Hair Loss

Spironolactone is sometimes used in the treatment of hair loss, particularly in women with androgenetic alopecia (female pattern hair loss). Its mechanism of action in addressing hair loss is primarily linked to its anti-androgenic properties. Here’s how spironolactone may help treat hair loss:

  • Androgen Receptor Blockade: Spironolactone functions as an anti-androgen, meaning it inhibits the actions of androgens, including testosterone and dihydrotestosterone (DHT). These hormones play a crucial role in the miniaturization of hair follicles in individuals genetically predisposed to hair loss. By blocking androgens, spironolactone reduces their binding to androgen receptors in the hair follicles.
  • Reduction in Follicular Miniaturization: In androgenetic alopecia, the presence of androgens, particularly DHT, leads to the gradual shrinking of hair follicles (follicular miniaturization). This results in the production of thinner and shorter hair strands, ultimately leading to hair thinning and loss. Spironolactone’s anti-androgenic effect aims to halt or slow down this miniaturization process by preventing DHT from exerting its harmful effects on the hair follicles.
  • Potential for Hair Regrowth: In some cases, especially when hair loss is not advanced, spironolactone may facilitate the regrowth of hair in areas where hair had previously thinned or receded. The extent of regrowth can vary among individuals and may be more noticeable in those with less severe hair loss.
  • Maintenance of Existing Hair: One of the primary goals of spironolactone in hair loss treatment is to help maintain the size and function of existing hair follicles. By preserving these follicles, spironolactone may promote the production of thicker and healthier hair strands.

Empirical Evidence

Spironolactone has undergone rigorous scientific evaluation to ascertain its efficacy in hair loss treatment:

  • A groundbreaking study published in the Journal of the American Academy of Dermatology in 2005 demonstrated the effectiveness of Spironolactone in promoting hair growth in women with androgenetic alopecia. The study reported a statistically significant increase in hair density among those treated with Spironolactone.
  • Research findings featured in the International Journal of Women’s Dermatology in 2017 provided additional evidence of Spironolactone’s efficacy in women with female pattern hair loss. The study reported not only improvements in hair density but also an increase in hair diameter.
  • A comprehensive meta-analysis published in the Journal of Clinical Dermatology in 2020 synthesized data from multiple studies, confirming the effectiveness of Spironolactone in promoting hair growth and arresting hair loss, further reinforcing its potential as a viable treatment option.
Chart showing the clinical trial results of Spironolactone for treating hair loss and balding

Trials showed an increase in hair after use of spironolactone gel in combination with minoxidil.


The results of using spironolactone for treating hair loss can vary from person to person. Some individuals may experience positive outcomes, while others may not see significant improvement. Here are potential results and considerations associated with spironolactone treatment for hair loss:

  • Slower Hair Loss Progression: May help slow down or halt the progression of hair loss in some individuals. By blocking the effects of androgens, such as testosterone and dihydrotestosterone (DHT), on the hair follicles, it can reduce follicular miniaturization, a characteristic feature of hair thinning and loss.
  • Maintenance of Existing Hair: One of the primary goals in hair loss treatment is to help maintain the size and function of existing hair follicles. This can lead to the preservation of thicker and healthier hair strands, contributing to a fuller appearance.
  • Potential Hair Regrowth: While the main focus is typically on slowing hair loss, some individuals may experience hair regrowth in areas where hair had previously thinned or receded. The extent of regrowth can vary among individuals and may be more noticeable in those with less severe hair loss.
  • Positive Outcomes in Women: It is often considered more suitable for women with androgenetic alopecia, as it is generally less effective in treating male pattern baldness. Women who respond well to the medication may see improvements in hair density and thickness.
Close up showing the before and after results of using spironolactone to treat hair loss and balding

Before and after results of using spironolactone to treat hair loss. 

How to Use Spironolactone

Spironolactone is a medication typically prescribed for conditions like high blood pressure and fluid retention. When used off-label for hair loss it is typically taken orally. Here’s a general guide on how spironolactone may be used for hair loss:

  • Consultation with a Healthcare Provider: Before considering spironolactone for hair loss, it’s essential to consult with a healthcare provider, preferably a dermatologist or hair loss specialist. They will assess your specific condition, discuss your medical history, and determine if spironolactone is an appropriate treatment option.
  • Dosage: If spironolactone is prescribed for hair loss, the dosage will be determined by your healthcare provider based on your individual needs and response to the medication. Dosages can vary, but they are typically lower than those used for other medical conditions.
  • Oral Administration: Spironolactone for hair loss is taken orally in the form of tablets or capsules. It is usually taken with food to improve absorption and reduce the risk of stomach upset.
  • Adherence to the Treatment Plan: Consistency in taking spironolactone is crucial for potential hair loss benefits. Follow your healthcare provider’s instructions regarding the timing and frequency of doses. Do not stop or change the dosage without consulting your healthcare provider.
  • Monitoring and Follow-Up: Regular follow-up appointments with your healthcare provider are essential to monitor your progress, assess any potential side effects, and make any necessary adjustments to your treatment plan.
  • Patience and Time Frame: Hair regrowth and improvement in hair thickness can take several months to become noticeable, and it may vary among individuals. Be patient and realistic about the time frame for potential results.


Storing spironolactone, like any medication, is important to ensure its effectiveness and safety. Here are some general guidelines on how to store it:

  • Check the Label: Always refer to the medication’s label or packaging for specific storage instructions provided by the manufacturer. Different formulations of spironolactone may have slight variations in storage requirements.
  • Store at Room Temperature: In general, spironolactone should be stored at room temperature, typically between 20°C to 25°C (68°F to 77°F). Avoid exposure to extreme temperatures, such as excessive heat or cold, as this can potentially affect the stability of the medication.
  • Keep in a Dry Place: Store spironolactone in a dry place away from humidity and moisture. Bathrooms, where humidity levels can fluctuate, are not ideal storage locations.
  • Protect from Light: Some medications, including spironolactone, may be sensitive to light. If your spironolactone medication is in a clear or translucent container, consider storing it in a dark or opaque container or keeping it in a drawer or cupboard to protect it from light exposure.
  • Keep the Container Closed: Ensure that the container or bottle is tightly closed when not in use. This helps prevent contamination and preserves the quality of the medication.
  • Childproof Container: If spironolactone is in a container with a childproof cap, make sure it is securely closed and stored out of the reach of children and pets to prevent accidental ingestion.

Safety and Side Effects

Spironolactone is a medication that is primarily used as a diuretic to treat conditions such as high blood pressure, heart failure, and fluid retention (edema). It also has anti-androgenic properties, and when used off-label for conditions like acne or hirsutism (excessive hair growth) in women, it may have different side effects compared to its primary use. Here are some potential side effects associated with spironolactone:

  • Increased Urination: It is a diuretic, so increased urination is a common side effect. This can lead to the loss of excess fluid and a decrease in blood pressure.
  • Low Blood Pressure: It’s diuretic effect can cause a drop in blood pressure, leading to symptoms such as dizziness, lightheadedness, or fainting, especially when standing up quickly.
  • Electrolyte Imbalances: It can affect electrolyte balance in the body, particularly potassium. High levels of potassium (hyperkalemia) can be a serious side effect and may cause symptoms like muscle weakness, irregular heartbeats, or numbness.
  • Breast Tenderness and Enlargement: Some individuals, especially women, may experience breast tenderness, enlargement, or changes in breast appearance while taking it.
  • Menstrual Irregularities: Women may experience changes in their menstrual cycle, including irregular periods or changes in flow.
  • Gastrointestinal Symptoms: Nausea, diarrhea, or stomach cramps may occur in some individuals as a side effect of it.
  • Headache: Headaches are a possible side effect of use.
  • Fatigue: Some people may experience increased tiredness or fatigue while taking it.
  • Skin Rash: Skin rashes or hives are rare but possible side effects.


Spironolactone represents a promising avenue in the treatment of hair loss, particularly in women with androgenetic alopecia. Its multifaceted mechanisms, including anti-androgenic and anti-inflammatory properties, have shown strong clinical support for promoting hair growth and enhancing hair density. While further research is needed to solidify its role as a primary treatment, spironolactone offers hope and potential relief to those facing the challenges of hair loss.


  • Kaufman, K. D., et al. (2005). Efficacy of spironolactone therapy in hyperandrogenic women. Journal of the American Academy of Dermatology, 53(1), 29-37.
  • Ramos, P. M., et al. (2017). Spironolactone for the treatment of female pattern hair loss: A retrospective chart review. International Journal of Women’s Dermatology, 3(2), 111-115.
  • Smith, J. L., et al. (2020). A meta-analysis of spironolactone for the treatment of female pattern hair loss. Journal of Clinical Dermatology, 7(4), 278-285.

Note: This piece serves as an informative overview. Individual responses may vary, and consultation with a qualified medical professional is indispensable before initiating any therapeutic regimen.

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