Spironolactone for hair loss: does it work?

Spironolactone is a medication used for many conditions that may be prescribed for women suffering from female pattern hair loss, also called androgenic alopecia. In this article, we’ll discuss spironolactone for hair loss and some important considerations on safety and side effects.

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Spironolactone is a diuretic medication (these are sometimes called water pills because they help your body get rid of excess salt and water). As such, spironolactone is usually prescribed to help treat conditions associated with the body holding onto fluid (like high blood pressure and heart failure). However, it’s also often prescribed off-label to treat female pattern hair loss (alopecia). 

This means that while spironolactone wasn’t developed or FDA-approved to treat hair loss, it’s still considered safe, and clinical trials have shown that it also happens to help treat hair loss. Your healthcare provider or dermatologist has the ability to prescribe it off-label if they think it’s appropriate for you (Burns, 2020). 

This is good news for women struggling with hair loss and thinning. Hair loss is very common—up to 38% of healthy women experience some degree of hair loss—but it can still be hard on a person’s self-esteem (Fabbrocini, 2018). 

Spironolactone is only approved in women because of undesirable side effects that it can have in men (like gynecomastia, or enlarging of breast tissue) (Patibandla, 2021).

Spironolactone is a type of medication called a diuretic, and it helps the body shed excess water and salt. It’s used primarily for health problems associated with swelling and water retention like (Patibandla, 2021):

• High blood pressure

• Heart failure

• Kidney issues

• Liver cirrhosis

Spironolactone is also used for several off-label purposes in dermatology (Vargas-Mora, 2020):

• Hormonally-related hair loss in women (androgenic alopecia, or female pattern hair loss)

• Acne

• Hirsutism (excess facial hair growth in women)

Overall, spironolactone works by competing with certain hormones and affecting the balance of your hormones. 

It works for hair loss by blocking the action of androgen hormones (making it an anti-androgen drug). Androgens are a type of hormone that play a key role in regulating hair growth, hair follicle health, and sebum production (Grymowicz, 2020). 

Although the exact relationship between hormones and hair growth in women is uncertain, high androgen levels are associated with many skin and hair problems, including hair loss, hirsutism, and acne. Taking anti-androgen medications has been shown to help deal with these issues (Vargas-Mora, 2020).Some women have high levels of androgens (due to health conditions like polycystic ovary syndrome, also called PCOS) or have especially sensitive androgen receptors. This may make them more likely to experience hair loss as a result of the androgens in their bodies (Vargas-Mora, 2020).

Spironolactone isn’t known to cause hair loss—it’s used to help treat hair loss. Some conditions that spironolactone helps to treat, like PCOS, do cause hair thinning or loss, and spironolactone helps combat that.

However, because spironolactone suppresses androgen hormones (like testosterone and dihydrotestosterone, or DHT), it has an interesting relationship with hair. It helps hair regrowth on the scalp, but it also works to reduce excess hair growth on the face and body (hirsutism). That’s why it can both treat PCOS hair loss as well as PCOS symptoms like hirsutism. 

You should consider a few things if you’re thinking about taking spironolactone to treat your hair loss.

Is your hair loss hormonally related?

Because spironolactone is an anti-androgen drug, it’s used to treat women whose hair loss has hormonal (specifically, androgenic) causes (Azarchi, 2019; Goldstein, 2022). Your provider can easily check to see if your androgen levels are off with a simple blood test. If your hair loss is due to other causes, like stress, spironolactone may not be helpful.

It takes at least six months to see results

Most clinical trials showing that spironolactone can help with hair loss took place over the course of 6–20 months (Vargas-Mora, 2020). It’s important to be patient and to have realistic expectations of when you can hope to see improvement.

Some side effects are possible

While it has a good safety profile, spironolactone still carries a risk of certain side effects. These include hyperkalemia (high potassium level), breast tenderness, and menstrual irregularities. It’s also unsafe to take during pregnancy, so it’s essential to be on reliable birth control like an IUD or oral contraceptives while taking it if you haven’t yet reached menopause (Patibandla, 2021).

You can also use treatment options like Rogaine (minoxidil)

It’s often recommended to start hair loss treatment with minoxidil, a topical hair loss treatment (Grymowicz, 2020). But if that isn’t enough, talk to your healthcare provider to see if spironolactone could be a good addition to your hair loss treatment plan.

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Current version

May 18, 2022

Written by

Nancy LaChance, BSN, RN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.