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Does Spironolactone Change Hair Texture? What to Expect

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At a glance

  • Direct answer / No texture change has been shown; density is what was measured
  • Off-label hair uses / Hirsutism and female pattern hair loss [1]
  • Label hair reaction / Alopecia, a voluntary report with frequency not estimable [1]
  • Approved uses / Heart failure, add-on hypertension, edema, hyperaldosteronism [1]
  • Mechanism / Binds the androgen receptor [1]
  • Hair study design / Open, before-after, no placebo group [2]

Does spironolactone change hair texture?

Spironolactone has not been shown to change hair texture. The available study assessed hair density from standardized photographs, not shaft thickness or curl pattern, so it does not show whether spironolactone changes hair texture [2]. Spironolactone binds the androgen receptor, and the label cites antiandrogenic and progestational effects in animals [1].

What hair changes are documented?

The main hair-density study was an open, before-after study of 80 women aged 12 to 79 with biopsy-confirmed follicle miniaturization. Forty received spironolactone 200 mg daily and 40 received cyproterone acetate. Results did not differ significantly and were combined: 35 women (44%) had regrowth, 35 (44%) had no clear change in density, and 10 (12%) continued to lose hair [2]. The study was not placebo-controlled and judged response from standardized photographs [2]. Hirsutism is another off-label use; the Endocrine Society guideline suggests adding an antiandrogen after 6 months of a combined contraceptive if response is suboptimal, and recommends against antiandrogen monotherapy unless adequate contraception is used [3].

What does the label say?

The current Aldactone label lists heart failure, add-on hypertension, edema and primary hyperaldosteronism as approved uses; acne, hirsutism and female pattern hair loss are not labeled uses [1]. Alopecia is listed as a voluntary adverse reaction, but its frequency cannot be estimated from the label [1].

Frequently asked questions

Can spironolactone make hair thicker?
Thickness of individual hairs was not measured. In an open study of female pattern hair loss with no placebo group, 44% of women had regrowth, 44% had no clear change and 12% continued to lose hair; results combined spironolactone and cyproterone acetate [2].
Does spironolactone cause hair loss?
Alopecia is listed as a voluntary adverse reaction in the Aldactone label, so its frequency cannot be estimated [1].
Is spironolactone FDA-approved for hair loss?
No. Labeled uses are heart failure, add-on hypertension, edema in cirrhosis or nephrotic syndrome, and primary hyperaldosteronism. Hirsutism and female pattern hair loss are off-label [1].
How long before hair changes appear?
The cited study does not report a time to onset. In the female pattern hair loss study, photographs were assessed after at least 12 months of oral antiandrogen therapy [2].
Does spironolactone reduce skin oil?
In a double-blind study of 36 patients with severe acne, spironolactone 50 to 200 mg daily reduced sebum excretion in all female subjects over 3 months; 26 patients completed the study [4].

References

  1. U.S. National Library of Medicine, DailyMed. Aldactone (spironolactone) tablets, Pfizer prescribing information. Aldactone (spironolactone) tablets, Pfizer label
  2. Sinclair R, Wewerinke M, Jolley D. Treatment of female pattern hair loss with oral antiandrogens. Br J Dermatol. 2005;152(3):466-73. Treatment of female pattern hair loss with oral antiandrogens
  3. Martin KA, Anderson RR, Chang RJ, Ehrmann DA, Lobo RA, Murad MH, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline
  4. Goodfellow A, Alaghband-Zadeh J, Carter G, Cream JJ, Holland S, Scully J, et al. Oral spironolactone improves acne vulgaris and reduces sebum excretion. Br J Dermatol. 1984;111(2):209-14. Oral spironolactone improves acne vulgaris and reduces sebum excretion
Evidence overview for spironolactone acne: Does Spironolactone Change Hair Texture? What to Expect