The vast majority of hair loss – both in men and women – is caused by hormones. Spironolactone (spiro) is a medication that is able to counteract the effects of these hormones, making it a potentially effective hair loss treatment. But does it actually work? In this article, we’ll take a look at the evidence supporting topical spironolactone for hair loss.
What is spironolactone?
Spironolactone (brand name Aldactone) is a medication primarily used to treat high blood pressure and heart failure.
It also has anti-androgenic properties, meaning spironolactone is sometimes prescribed to treat hormone-related conditions in women, such as acne. It’s also used by transgender women to lower levels of the male hormone testosterone.
The anti-androgenic properties of spironolactone also make it a potentially effective treatment for certain kinds of hair loss, in particular androgenetic alopecia.
Androgenetic alopecia, more commonly known as male pattern hair loss, is strongly tied to hormones. Contrary to popular belief, though, it’s not testosterone that makes men go bald. Instead, the main culprit is dihydrotestosterone (DHT), a related hormone.
Taken orally, spironolactone lowers testosterone levels. And while this will have the knock-on effect of reducing DHT and stopping hair loss, it’s definitely not advised!
Instead, spironolactone for hair loss is applied topically to the scalp – usually in the form of a cream. This way, it only acts locally, and you avoid the nasty side effects associated with low testosterone.
As mentioned, oral spironolactone is commonly prescribed to transgender women to counteract the effects of testosterone.
It has a very powerful effect on hormones – hence why it’s only prescribed to women. In men, likely side effects include:
- Sexual dysfunction
- Testicular atrophy
- General feminization
Other side effects – which effect both females and males – are related to its diuretic properties. Spironolactone can cause high levels of potassium in the blood, low levels of sodium, dehydration, and hypotension.
Topically applied spironolactone is far less likely to cause these negative side effects as it is unlikely to get absorbed into the bloodstream in significantly large amounts.
Spironolactone for hair loss: how does it work?
Men who suffer from androgenetic alopecia have hair follicles that are particularly sensitive to DHT.
DHT binds to hormone receptors in the hair follicles, causing them to shrink. Eventually, the follicles get so small that they stop producing visible hair.
Broadly, there are two ways to stop this from happening: reduce DHT levels, or stop DHT binding to the hormone receptor.
Finasteride – an FDA approved hair loss treatment – works using the first method.
It lowers DHT levels by around 70%. For many men, this is enough to completely stop hair loss – or at least slow it down very dramatically. For some, though, such a drastic reduction in DHT can cause negative side effects.
Many natural hair loss treatments also work by lowering DHT levels as well.
Unlike these methods, though, spironolactone works at the receptor level. It blocks DHT from attaching to the hormone receptor, preventing this hormone from causing damage to the hair follicle.
Acne – a related condition
As you may already know, acne is strongly related to DHT too.
In fact, a hair loss treatment currently in development – CB0301 – is being trialled for both acne and hair loss. Like spironolactone, it also works by blocking the action of DHT on hormone receptors.
Anyway, back to spironolactone.
Spironolactone is sometimes prescribed to women as a treatment for acne. However, the anti-androgenic effects previously mentioned mean oral spironolactone is not suitable for men with acne.
But a recent study found that spironolactone may have similar effects when applied topically:
“Topical spironolactone may be effective for the treatment of acne patients with increased sebum secretion. […] The 5% spironolactone topical gel resulted in a decrease in the [total acne lesions] in acne vulgaris, while it had no significant efficacy in the [acne severity index].”
This suggests that topical spironolactone may be a viable treatment for androgenetic alopecia as well as acne.
So, does topical spironolactone for hair loss work?
Unfortunately, there hasn’t been much research.
There is limited research (e.g. this study, this study, and this study) that oral spironolactone may be beneficial for women with androgenetic alopecia. But, as mentioned, this is not a viable option for men.
In the absence of clinical trials, the only other form of evidence available is anecdotal reports.
And if you look online at the various reports from users of topical spironolactone for hair loss, the response is pretty lukewarm. Some users report modest improvements, others claim it makes no difference at all. As for results photos – they’re very rare indeed.
That’s not to say that it doesn’t work. However, it seems safe to say that topical spironolactone is not a miracle hair loss cure by itself.
Perhaps as an addition to established treatments – such as minoxidil and finasteride – topical spironolactone cream may provide an added benefit. After all, it has been demonstrated to improve acne symptoms – albeit only mildly.