Oral minoxidil or Oral Spironolactone for Female Pattern Hair Loss

Should I use oral minoxidil or oral spironolactone?

I’ve selected this question below for this week’s question of the week. It allows us to review some concepts regarding treatment of androgenetic alopecia in women and whether oral spironolactone is better than oral minoxidil

Question

I am 34 year old female with newly diagnosis androgenetic alopecia. I would like to know what is more effective oral spironolactone or oral minoxidil - or should I just use both?

Thank you

Answer

Thank you for the question.

Certainly, the combination of both is likely to be better. But that said, I rarely start both at same time. I start one of the treatments and figure out side effects and effectiveness and decide after 6 months whether to

a) continue it or stop it and

b) whether to start the other treatment.

So, if we start oral minoxidil and find it’s helping, we can decide on adding oral spironolactone after 6 months. If the patient is incredibly pleased with the results of the oral minoxidil, we don’t need to add oral spironolactone quite yet. It’s senseless to start yet another treatment if we don’t need it. We use treatments if we need to. However, if the patient feels the oral minoxidil didn’t quite achieve the desired results, one can consider with their doctor about increasing the oral minoxidil dose or now starting spironolactone. So, if we start oral spironolactone and find it’s helping, we can decide on adding oral minoxidil at the 6 month mark. If the patient is incredibly pleased with the results of the oral spironolactone, we don’t need to add oral minoxidil quite yet. It’s senseless to start yet another treatment if we don’t need it. We use treatments if we need to. However, if the patient feels the oral spironolactone didn’t quite achieve the desired results, one can consider with their doctor about increasing the oral spironolactone dose (if appropriate) or now starting oral minoxidil.

Not everyone tolerates spironolactone and not everyone tolerates oral minoxidil and a lot goes into deciding which to start. Neither medications are safe in pregnancy. Both have potential side effects although the list of side effects is different. Not all women, of course, experience side effects with these medications.

Side effects of oral minoxidil include headaches, dizziness, hair growth on the face and body, heart palpitations, fluid retention in the feet, face and body and others. Side effects are more likely at 1.25 mg than 0.25 mg

Side effects of oral spironolactone include frequent urination, dehydration, dizziness, irregular periods, mood changes, fatigue, breast tenderness, and decrease libido. Side effects are more likely at 100 mg than 50 mg.

Finally, if you are talking about effectiveness you need to always talk about the dose. 100 mg spironolactone probably more effective than 50 mg and 1.25 mg oral minoxidil probably more effective than 0.25 mg. So, when someone asks me “what’s more effective- oral minoxidil or oral spironolactone?”, I need to really ask them to tell me the dose they want to know about or the question can not be answered. 1.25 mg of oral minoxidil is more effective than 25 mg spironolactone but 100 mg spironolactone is more effective than 0.25 mg oral minoxidil.

All in all, both can be good options and so can the combination. It’s important to review side effects and dosing with your doctor and always keep in mind these are lifelong. The treatments don’t help everyone so figuring out if they are really helping is important. I’m not a fan of starting 10 treatments at once and using them all for 50 years with no idea which is helping. This is commonly done, but not what I recommend ever be done.