Spironolactone and decreased libido

Does spironolactone affects libido (sex drive)?

 
I’ve selected this question below for this week’s question of the week. It allows us to review some concepts in the effects of spironolactone on sex drive

Question

I am a 33 woman and have been taking spironolactone 100 mg for my androgenetic hair loss for about 6 months. It’s helping my hair but I feel that it might be lowering my sex drive. I know there are many factors that affect this aspect of health (stress, medications, etc) but I’d like to get more of an understanding.

Answer

Thanks for the important question. I’d recommend you consider reviewing a prior article I wrote last year on the topic. There is a lot of good information in there:

Article: Does use of oral Spironolactone Affect Libido?

Spironolactone can certainly affect many aspects of sexual health. A number of studies have addressed sexual type side effects but clear estimates of the frequency of these issues are not available. I would estimate the following proportion of women who use spironolactone experience these side effects

a) decreased libido (sex drive) - about 10-15 % of users
b) vaginal dryness or changes in lubrication - 15-25% of users
c) reduced ability to achieve an orgasm - 1-2 %

d) vulvar (vestibular) irritation and pain - risk unclear

e) vulvar atrophy - risk unclear

f) dyspareunia (painful intercourse) - risk unclear

We really do need better studies to understand these proportions better.

Sexual Side Effects are Often Dependent on the Spironolactone Dose Chosen

These changes is sexual health are often dose dependent. In other words, some women will notice fewer side effects on 50 mg than 100 mg and fewer on 100 mg than 200 mg. (The optimal dose for hair loss is not clear but 100-200 mg doses may be slightly better for some than 50-100 mg doses).

What to do with spironolactone associated sexual dysfunction?

Sexual health has many components and I often recommend patients speak with their primary care physician or gynecologist to ensure a proper evaluation can be done. There are several options that can be considered if spironolactone is implicated in the changes in sexual function:

1) The spironolactone dose can be reduced.

As mentioned above, many female patients find they have fewer side effects on lower doses of spironoactone. A patient on 150 mg may find improvements in various aspects of sexual health by reducing to 100 mg or 50 mg. There is a risk of hair loss by doing this but the risk is low and some women will choose to introduce another hair loss treatment (like topical or oral minoxidil) with the hopes to compensate for the reduced spironolactone.

Changes in sexual function, such as a return to prior levels of libido can occur in 2 weeks to 4 months. It does vary from patient to patient. In some, it is quite rapid, in others it takes many months.

2) Spironolactone can be stopped for 2 weeks and reintroduced at a lower dose.

I generally recommend that medications that give side effects be stopped until side effects clear and then reintroduce if that is an option. Stopping spironolactone for 2 weeks will not be an issue for hair loss for most patients (2 weeks is very short) but can give time for the medication to clear from the body and side effects to resolve (or at least improve somewhat).

There is an option to stop completely until side effects are gone as well. That carries the highest risk of causing hair loss but it is an option too.

3) The medication can be stopped and alternative treatments discussed.

The option also exists to stop spironolactone and review other options for treating female pattern hair loss. These would include topical minoxidil, oral minoxidil, topical spironolactone, PRP, laser and hair transplantation.

4) In the case of vulvar pain and dyspareunia (painful intercourse), Spironolactone can be stopped and estradiol 0.01% /testosterone 0.1 % gel can be used twice daily.

This is the protocol reported by Mitchell and colleagues as we reviewed together last year.

Summary

Thank you again for this question. It’s such an important question as there are many women who use spironolactone without a clear understanding of side effects on sexual health. Reduced libido does occur in a proportion of spironolactone users and not everyone is aware of the link back to the medication they are using. For some women, it can taken months or years before a link back to the drug is questioned. An improvement in libido and other aspects of sexual health (lubrication, orgasm) can occur within a few weeks to up to 3-4 months of reducing or stopping spironolactone. Although the effects on sexual health can be troublesome, there is reason to be hopeful as changes can occur very quickly in some patients. A return to normal levels of sex drive and prior abilities to achieve orgasm can often occur in a matter of 1-2 weeks.

Patients should be sure to speak to their practitioners as reducing the dose of spironolactone does carry the risk of causing hair loss in those patients using it for treating androgenetic hair loss.

The key here is to have a good plan in place to address these issues and monitor improvement.