Spironolactone for Female Androgenetic Alopecia (AGA)

Spironolactone for Female Genetic Hair Loss

Spironolactone has been used off label in the treatment of androgenetic alopecia (also known as female pattern hair loss, FPHL) for approximately two decades.  The medication acts to reduce the effects of androgens in several ways.   It reduces adrenal androgen production and exerts competitive blockade on androgen receptors. 

Although there are yet to be any randomized placebo controlled trials examining the benefits of Spironolactone in FPHL,  case reports, series, and an open-label trial support its benefit. In a small case study, 200 mg spironolactone reduced hair loss by 50%–62.9% and also increased the total number of anagen hairs.  Perhaps the most important study to date was an an open-label study of 80 women with biopsy-proven FPHL who either received spironolactone (200 mg daily) or cyproterone acetate (either 50 mg daily or 100 mg for 10 days per month if premeno- pausal) for at least 12 months. This study showed that 44% of patients experienced visible hair growth (improvement), 44 % had their hair loss stopped. Only 12 % had reduced hair density. Another key finding of this particular study was that benefits did not depend on whether women had high androgens or normal androgens.  Other studies have shown that adding minoxidil to a spironolactone based treatment plan can be additive and some patients will achieve even further benefits. 

Readers may find these links helpful. The pertain to other articles written by Dr. Donovan on Spironolactone:

Spironolactone for FPHL - A UCLA Study

Irregular Periods from Spironolactone

Spironolactone for FPHL

Hormone Levels and Spironolactone Use: Does it matter?

Should one start Spironolactone with Minoxidil?

 REFERENCE

Sinclair R et al. Treatment of female pattern hair loss with oral anti androgens. Br J Dermatol 2005