Spironolactone for hair loss - how effective?

Question

In your practice/experience, how effective is Spironolactone at regrowing hair? I'm female and have been losing my hair for 2 years due to TE + AGA. I started Rogaine for women a year ago and it helped regrow a little but I am still shedding more than normal and I'm considering adding Spiro. My hair loss is all over but maybe more on top and crown. My hairline has not receeded.

Jeff Rapaport, MD · Answer

In my opinion, spironolactone is somewhat effective for female pattern hair loss. Finasteride is far more effective.  Neither will help your telogen effluvium. Consider adding oral minoxidil to your regimen at a dose of .25 milligrams per day.PRPHAIRMD.COM

Sahar Nadimi, MD · Answer

Topical Minoxidil (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 daily. Women with AGA may also consider Spironolactone, but there is much less evidence to back its efficacy compared to Minoxidil and it is not a first-line treatment. It may be a good choice in women with excess body hair, however. Another option is Finasteride (Propecia), which is a medication 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. Another option is oral minoxidil for hair loss. Use of Minoxidil tablets to promote hair growth is currently not an FDA-approved indication and is prescribed off-label, but it does seem to be more effective that the topical form. Patients should be aware of the possible side effect of unwanted hair growth in areas other than the scalp with oral minoxidil. In order to determine which treatment is best for you, a proper history and physical exam by a hair expert is necessary.

Stefan Rene Adair, MD · Answer

Be sure to consult with an expert in hair loss. Results vary, but if you are medically cleared spironolactone may help as well as other treatments.

Jeff Donovan, MD, PhD · Answer

Many female hairlines do not recede during genetic hair loss but rather the hair loss occurs behind this area.  Spironolactone helps about 30 % of women with androgenetic alopecia.

William Rassman, MD (retired) · Answer

Adding spironolactone to your hair loss treatment has a marginal benefit in our experience.  I would assume that you had a full medical work-up for your hair loss as described below.  A reasonable cosmetic treatment that does not solve hair loss issues but cosmetically make the hair look fuller is scalp micropigmentation

Spironolactone for hair loss - how effective?

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