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QUESTION OF THE WEEK


Spironolactone for Female Pattern Hair Loss: How good is it?

Spironolactone for Female Androgenetic Alopecia: Studies are Small Studies but Benefits Seen Across All Studies

Spironolactone has been used for many years in the treatment of female pattern hair loss, also known as female androgenetic alopecia or “AGA.”

The drug is not formally approved for treating AGA, but is commonly used “off label” for this indication. On Jan 21, 1960 Spironolactone received FDA approval as a diuretic. Women with acne and women with hirsutism (increased facial hair) commonly use this medication as well - again as an off label indication.


Three Small Studies Share the Same Message: Spironolactone Has A Chance of Helping

To date, there have been three studies which have attempted to examine just how well spironolactone works. The first was in 2005 by Sinclair and colleagues and the last was in 2020 by Burns and colleagues. Most of these studies suggest that about 40-50 % of female patients using spironolactone for treating their female pattern hair loss can be expected to have some sort of an improvement. A further 30-40 % can be expected to have their hair loss halted with no further loss.

Spiro-studies

 

CONCLUSIONS

Spironolactone remains an option for treating female pattern hair loss. The medication has unique side effects which must be carefully reviewed by the prescribing physician.

See previous article on Side Effects of Spironolactone.  

I generally start 50 mg and move to 100 mg after 2-8 weeks and maybe 150 mg or 200 mg depending on the patient, their age, side effects experienced and other medications being used (ie oral minoxidil may limit going up on spironolactone to maximum doses). It takes 18 months to see full benefits but many see some changes by 6 months. Spironolactone, like all antiandrogens, must never be used by women who are pregnant or who may become pregnant.



REFERENCES

Burns et al. Spironolactone for treatment of female pattern hair loss. J Am Acad Dermatol. 2020 Jul;83(1):276-278. 

Famenini S et al. Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy.  J Am Acad Dermatol. 2015 Oct;73(4):705-6. doi: 10.1016/j.jaad.2015.06.063.

Sinclair R et al. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005 Mar;152(3):466-73.



This article was written by Dr. Jeff Donovan, a Canadian and US board certified dermatologist specializing exclusively in hair loss.



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