How Effective is Spironolactone for Female Hair Loss?

Question

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

William Ting, MD · Answer

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.

Anil R. Shah, MD · Answer

Hello,There are multiple solutions to hair loss for women that are nonsurgical including:
Rogaine- There is a specific formulation for women
Supplements- This includes but not limited to Viviscal and Nutrafol which contain marine extract and anti-inflammatory substances to promote hair growth
PRP- Platelet rich plasma can promote hair growth and is a nonsurgical procedure in the office
Low level laser- Can promote hair growth in some patients
Regenerative medicine- There are additional growth factors which can be injected to promote hair growth
Seek advice from an expert or team of experts. 
Best,
Dr. Anil Shah

Jae Pak, MD · Answer

Medications for hair loss is generally a life time commitment.  This goes for Propecia, Rogaine, and Spironolactone.  I do not recall ever meeting a patient where Spironolactone really helped for them to say: "it was worth it". It is always a good idea to discuss treatment options with your doctor to weigh out the pros and cons.

Matthew Richardson, MD · Answer

Spironolactone for female hair loss is an option, but not one of the first options that I present to most of my patients for several reasons. First, the evidence that patients get significant improvement in hair loss or hair density from spironolactone is limited. Secondly, this requires an oral pill to be taken indefinitely, or the results will be lost, and there are side effects of spironolactone and potential medication interactions. Finally, there are several other options that I usually recommend for women instead of spironolactone, including topical minoxidil, PRP injections, hair transplant, and other topical therapies.
All the best,

John E. Frank, MD · Answer

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.

Daniel Danyo, MD · Answer

Spironolactone in women is a commonly prescribed medication. I see more Spironolactone written by dermatologists and primary care physicians who aren't necessarily in the hair restoration business but obviously they see people that have hair thinning. And it's kind of a trigger response to say, let's put you on Spironolactone and give this a try. 
I've seen probably hundreds of patients that have been on Spironolactone and I have not had a lot of patients have tremendous results. There are some women that feel it stopped the shedding which stopped some of the hair thinning and kept them stable but I can't think of anyone offhand that's had just a dramatic improvement with Spironolactone. So it's not something that I generally prescribe and I have other tools, such as PRP , laser light therapy, hair transplant or scalp micropigmentation to address the hair thinning. The other thing to consider would me Minoxidil or even topical Finasteride. With that said Spironolactone, theoretically should block the testosterone and DHT issues but I have not found it to be tremendously effective.

Frank Barone, MD, FACS · Answer

Although spironolactone has been shown to help reduce hair loss in some women, it also is a continued or ongoing commitment as is minoxidil (Rogaine).  Depending on the actual cause of your hair loss, you may want to consider other proven options such as phototherapy with red light, oral or topical finasteride (Propecia), research proven oral supplements (Viviscal Pro) and longer lasting treatments using platelet rich plasma, micro needling and stem cell growth factors that have the potential to provide more sustained growth and restoration in hair rejuvenation.

Bradford S. Patt, MD · Answer

Spironolactone can be effective for women with thinning hair.  It has variable results but with low side effects but has to be taken long term and loses effect if stopped.  It can be combined with other therapies for hair loss in women including 5% minoxidil which works at improving hair density and follicle stimulation through a different pathway than spironolactone. They can be taken together.  Also consider use of low level laser light to stimulate your hair follicles and injection of Platelet rich plasma(PRP).

Benjamin C. Paul, MD · Answer

Thanks for asking this question. Female hair loss is a hot topic. There are roughly 40% of women who are concerned their hair has lost density. Female hair loss involves thinning without a full loss of the hairline.. For females, spironolactone can be very helpful - though there are concerns. As a potassium-sparing diuretic, so you should have labs checked periodically to ensure that your electrolytes are balanced. The medicine takes 2-4 months to influence hair growth. There is a rule of 1/3s with spironolactone: 1/3 improve, 1/3 stay the same and 1/3 progress with their hair loss. Ultimately, your doctor should guide you.  When it comes to minoxidil, you can stage use to see if you need it. Best of luck.

Robert Whitfield, MD · Answer

In female patients it is a little tricky because of the hair loss pattern.  The spironolactone doesn't work for everyone.  Your hair density in the back needs to be evaluated for other options like SmartGraft.

How Effective is Spironolactone for Female Hair Loss?

Answers (17)

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