Oral spironolactone is classified as an anti-androgen and is the most commonly prescribed oral anti-androgen in the Untied States for the treatment of female patter hair loss. IT is not FDA approved for hair loss so its use is 'off label.' Topical spironolactone is not FDA approved for androgenetic alopecia either and has not had much study. Any use of topical spironolactone should be prescribed only in conjunction with a physician.
Is topical spironolactone effective?
Well, few such studies have been done but there may be some minor benefit. A 1997 study studied 60 women using 1 % topical spironolactone. A minor degree of benefit was seen. Side effects from topical spironolactone are potentially similar to oral spirinolactone pills (albeit at a lower incidence).
Women should be aware of breast tenderness, mood changes, electrolyte imbalance, fatigue, dizziness, swelling, Women of child bearing age should speak to their physician about pregnancy concerns. One must never get pregnant while using spironolactone or the developing fetus could be seriously harmed. Topical antiandrogens do get absorbed into the blood stream. It would be unwise to think otherwise.
Overall topical spironolactone may have minor benefit in the treatment of androgenic alopecia. More studies are needed however, before its use becomes routine.
Dill-Muller D, Zaun H. Topical treatment of androgenetic alopecia with spironolactone. J Eur Acad Dermatol Venereol. 1997 Sep;9(Suppl 1):31.
Dr. Jeff Donovan is a Canadian and US board certified dermatologist specializing exclusively in hair loss. To schedule a consultation, please call the Vancouver office at 604.283.9299