Oral Spironolactone for Female Pattern Hair Loss: 50 % of Women Improve with Spironolactone Alone

Systematic Review Points to Benefit of Oral Spironolactone

A systemic review in the Journal of the American Academy of Dermatology set out to establish the efficacy and safety of oral spironolactone for the treatment of AGA in women. We have reviewed the topic in prior articles (see Spironolactone for Female Pattern Hair Loss: How Good It It?)

A new review set out to comprehensively examine all prior studies. In total, the authors reviewed a total of 12 studies with 286 participants. Spironolactone was used as the only treatment (ie “monotherapy”) in 67 (23.4%) of the 286 patients across all studies . The drug was used in combination with topical minoxidil, oral minoxidil, low-level laser therapy, or iron supplementation in the remaining study participants. Topical minoxidil was most common.

Patients in these studies were treated with spironolactone at doses ranging between 25 mg and 200 mg for a duration of 6 months to 4 years.

When employed as a “monotherapy”, 33 (49.3%) of the 67 patients using monotherapy achieved improvement in follicular density and hair loss on spironolactone. In terms of proper dosing, spironolactone seemed best at doses 100-200 mg. Notably, spironolactone was largely ineffective in studies where the dosage was maintained below 100 mg but offered improvement after at least 12 months of use at 100 mg to 200 mg daily.

Conclusion

This is a nice review which helps set the stage for how well spironolactone works in female androgenetic alopecia. It’s not effective in all patients and doses above 100 mg daily are probably needed for most to see any meaningful benefit.

REFERENCE

James JF et al. Efficacy and safety profile of oral spironolactone use for androgenic alopecia: A systematic review. J Am Acad Dermatol. 2021 Aug 2:S