What is spironolactone?

Spironolactone is a prescription treatment that blocks androgen receptors. By preventing testosterone from binding to its receptor, it prevents the conversion of testosterone to DHT. The net result is inhibition of hair loss, thinning, and shrinking of the hair follicle. 

Why is spironolactone part of my treatment plan?

Your genetic testing indicates one or both of your SR5DA genes is more active. This enzyme turns testosterone into DHT, which promotes hair loss. By blocking the androgen receptor with spironolactone, less testosterone is converted to DHT, encouraging hair growth.

Is topical spironolactone effective in Alopecia?

Clinical studies with topical spironolactone 1% to 5% have shown increased hair diameter, growth, and density.1-4 

Are there adverse effects while using topical spironolactone?

Treatment with topical spironolactone is well tolerated. It does not appear to affect systemic testosterone or DHT levels.3 Contact dermatitis manifested by itching, burning, and scaling has been reported.4 Topical therapy reduces the risk of systemic side adverse effects. Oral spironolactone can cause low blood pressure, electrolyte abnormalities, dizziness/fainting, changes in menstrual periods, breast tenderness/enlargement in women, and gynecomastia (growth of breast tissue) in men. Topical therapy reduces the risk of systemic adverse effects. 

Why do I need to keep taking spironolactone?

Spironolactone should be used once or twice a day as prescribed by your physician. Continuous use for four months is recommended before evaluating treatment response. Hair shedding may occur at the initiation of treatment as hair follicles are being stimulated to reenter the growth phase, but this frequently subsides within two months. Hair growth usually occurs within four to eight months and stabilizes over 12 to 18 months. Hair loss will occur over several months if treatment is stopped because of the nature of the hair growth cycle. Spironolactone is not a cure for hair loss; it is a treatment.

Drug Summary: Spironolactone


  1. Famenini Shannon, BS, Slaught Christa, BS, Duan Lewei, MS, and Goh Carolyn, MD. Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy, J Am Acad Dermatol. 2015 Oct; 73(4): 705–706.
  2. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152(3):466–73)
  3. Hamza Abdel-Raouf, Usama F. Aly, Walid Medhat, Shimaa S. Ahmed, Rasha T. A. Abdel-Aziz. A novel topical combination of minoxidil and spironolactone for androgenetic alopecia: Clinical, histopathological, and physicochemical study. Dermatologic Therapy. 2021;34:e14678.
  4. AYMAN E. YOUSEF, MD. AHMED S. ABDELSHAFY, MD and MOUSA AS ALMABROUK, M.Sc. Topical Finasteride versus Topical Spironolactone in the Treatment of Androgenetic Alopecia. Med. J. Cairo Univ., Vol. 88, No. 3, June: 1017-1022, 2020