Spironolactone for Women with Female Pattern Hair Loss

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I'm often asked if Spironolactone is an option for women with genetic hair loss (also known as female pattern hair loss). My first comment would be 'maybe' and that anyone considering the possibility of using spironolactone should receive a full and comprehensive evaluation by a physician experienced with the diagnosis of hair loss, and of course the use of spironolactone. Often this is a dermatologist. 
Spironolactone can help 30-40 % of women improve their hair and another 30 % stop hair loss. It must never be used by any female who may become pregnant, is planning a pregnancy, or is currently pregnant. One must be aware of the 'potential' side effects of the medication before staring. This includes
  • It can cause harm to a developing baby, but does not affect fertility in women once off the medication. 
  • Irregular periods, 
  • Dizziness and rare alterations in blood pressure
  • Mood changes, depression, decreased libido
  • Hair shedding in the first few months
  • beast tenderness, breast enlargement
  • frequent urination 
  • rarely elevated potassium levels in the blood


Despite the widespread use of spironolactone and anti androgens in my practice, I'm reminded that spironolactone has been studied in only a limited number of small studies. The largest and best referenced is a study by Professor Rodney Sinclair and colleagues which as published in the 2005 British Journal of Dermatology. Among 40 women using spironolactone Dr Sinclair reported that 40 % achieved and improvement, 40 % stabilized and only a small proportion got worse.



REFERENCE
Sinclair R, et al. Br J Dermatol. 2005. Treatment of female pattern hair loss with oral anti androgens. Br J Dermatol. 2005 Mar;152(3):466-73.
Article by
Vancouver Dermatologist