Spironolactone is a medication that blocks the effects of androgens. It has been used as an off-label treatment for androgenetic alopecia in women for many years. Oral spironolactone is not recommended for men due to side effects such as gynecomastia (enlargement of breast tissue).
In a recent systemic review of 12 studies looking at the efficacy of oral spironolactone for the treatment of AGA in women, it was found that 49.3% of patients had an improvement in hair density. Doses of 100 – 200 mg/day for at least 12 months were needed to see a meaningful benefit.
Potential side effects such as menstrual irregularities, low libido, dizziness, breast tenderness and brain fog, have prompted more studies on the use of topical spironolactone for the treatment of AGA. A recent study by Raouf and colleagues set out to study the effect of topical minoxidil 5% and topical spironolactone gel 1% in the management of AGA in both men and women. Of 60 participants, 20 received treatment with topical minoxidil alone, 20 received treatment with topical spironolactone alone and 20 received both minoxidil and spironolactone. 56% of the patients in the minoxidil or spironolactone alone groups had good or excellent results, compared to 90% in the combined minoxidil and spironolactone groups. Side effects included contact dermatitis, but the side effects seen with oral administration were not noted. While this study is small, it shows us that topical spironolactone deserves further research in the treatment of AGA.
