How Effective is Spironolactone for Female Hair Loss?

I have VERY thin hair, especially around my crown area. Derm did a blood workup and said I needed to take a iron and Vitamin D supplement because they were very low and also put me on spiro and recommended I do a combination therapy with 5% minoxidil. I am very skeptical on using minoxidil since it is a lifetime commitment, so I decided to just try the spiro. I also have very minaturized hair. I want to know how well spiro works for your patients? And if I really should use minoxidil (5%) THANKS

Doctor Answers 5

Spironolactone can work quite well for female androgenetic alopecia

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Spironolactone has worked very well for my patients with androgenetic alopecia with Ludwig pattern where there is preservation of hairline along anterior scalp but with significant thinning on the crown. I typically start spironolactone 25mg 2x/day though sometimes dose may have to be increased to 100mg 2x/day. Finasteride is also a good alternative but should be prescribed by board-certified dermatologist. Concurrent use of Rogaine 5% foam also is quite helpful. For women and men who seek relatively quicker and consistent clinical results, NeoGraft hair restoration should be considered where there is no linear scarring, sutures with less downtime compared to traditional hair transplant.

Spironolactone and hair loss in women

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Current research suggests spironolactone helps 30% of women "improve" their hair density and helps 30% of women "prevent" further loss.  Spironolactone does not help all women. 

It is important to understand that this medication must be used "long term." Just like minoxidil, spironolactone is a lifetime commitment. If you gain improvement with spironolactone and then stop the medication, you will lose all benefit over 9 months. 

The dose required to treat female pattern hair loss is 200 mg per day. Many women take 100 mg in the morning and 100 mg in the afternoon.  Doses less than 200 mg daily are less effective. Women must never get pregnant while using this medication.  Side effects include mood changes, breast tenderness, decreased libido, menstrual irregularities and dizziness. It can interact with some medications so be sure to tell your physician all medications you take. 



Jeff Donovan, MD, PhD
Vancouver Dermatologist

Medical therapy for female hair loss

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Minoxidil topical solution (Rogaine┬«) is the only medication indicated for promoting hair growth in women with Androgenic Alopecia (aka hereditary hair thinning or female-pattern hair loss), resulting in increase hair counts and total hair weight (i.e. re-enlarge the fine hairs). This is a safe and effective medication when used properly.

Minoxidil is most effective when the following conditions are met:

-Apply every day (even birthdays and holidays)

-Apply to dry scalp, not right after shower

-Apply direction on the scalp, and spread gently

-Minoxidil needs time to absorb, without spray/mousse, etc so wait 30 minutes after applying Minoxidil before styling your hair with other products

-Do not blow dry, let it dry on its own on your scalp

-Minoxidil 5% foam has no propylene glycol so there is less scalp irritation compared to the solution; it is also less oily and absorbed faster

Women with AGA may also consider Spironolactone (Aldactone®) which has less evidence to back its efficacy compared to Minoxidil, but might be a good choice in women with hirsutism (excess body hair).

Finasteride (Propecia┬«) is a medication (5-alpha reductase inhibitor) that decreases levels of Dihydrotestosterone (the hormone that directly causes the hair follicles to shrink and lead to androgenetic alopecia). Although it is by far the most effective treatment of androgenetic alopecia in men, it is NOT FDA-approved for women.  Finasteride therapy for female-pattern hair loss has also been studied and has been shown to result in significant improvement in hair density and hair thickness at higher medication doses. It is therefore sometimes prescribed off-label. Pregnancy must be ruled out before initiating therapy and women should be maintained on strict birth control during treatment because it may pose a risk to the fetus.

You might also like...


{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Hair loss is a chronic condition, and therefore treatments must be continued indefinitely. That is true for spironolactone as well as minoxidil, finasteride, light based treatments, and PRP. There are very few scientific studies that support the use of spironolactone, however, those of us that use it generally find that it can be helpful for many patients. I find the greatest benefit with high doses of 100 mg twice daily. There are risks associated with spironolactone, so its very important that this drug be initiated and monitored by a hair loss physician familiar with its proper use.

Robert Haber, MD
Cleveland Dermatologic Surgeon
5.0 out of 5 stars 8 reviews

Spironolactone and Minoxidil

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
I have actually had decent results using Spironolactone starting at 50mg per day and increasing up to 100mg twice a day.  As far as Minoxidil, I have never been a big fan.  Despite being over the counter, Minoxidil should be used with caution as it can make some scalp conditions worse while doing very little for the hair.

John E. Frank, MD
New York Hair Restoration Surgeon
4.9 out of 5 stars 57 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.