Spironolactone and Hair Loss in Women: Here’s a Review of the Research

Female-pattern hair loss (FPHL), also called androgenetic alopecia, is the most common form of hair loss in women. It usually begins after age 40, and more than half of women will eventually experience it. While the exact cause isn’t fully clear, research suggests that it usually happens as women go through menopause. Hair spends less time growing, which can lead to hair thinning. Hair follicles themselves can also become smaller. Genetics can play a role, too.

Some hair-loss experts have explored spironolactone (Aldactone, CaroSpir) as a potential hair-loss remedy for women. This prescription medication was originally developed to treat high blood pressure and fluid retention, but studies show that it may help hair loss, too. 

Here, we’ll review the research on spironolactone's effectiveness and recommended dosages for hair loss in women. We’ll also detail the potential risks to keep in mind.

How does spironolactone work for hair loss?

Spironolactone may help you achieve thicker, fuller hair over time, especially if your hair loss is related to hormonal changes. It’s thought to work in a variety of ways by doing the following: 

• Blocking androgen hormones: Helps to lower the effects of testosterone and dihydrotestosterone (DHT) on the hair follicles

• Prevents hair loss: Slowing hair loss by stopping DHT from attaching to hair follicles 

• Targets follicles: Enhancing hair density and regrowth by keeping hair follicles from shrinking

Does spironolactone help with hair loss in women?

It can. Spironolactone is sometimes prescribed off-label for FPHL. Although it’s not FDA approved for treating hair loss, your dermatologist may recommend it based on study data. 

In a small study of women with FPHL, about 75% of participants saw improvements in hair shedding, thickness, and regrowth with spironolactone. Another review of several clinical studies suggested that spironolactone may effectively treat hair loss in women when used alone or in combination with other hair-loss medicines. 

More research is needed to confirm how well spironolactone works. But it’s a promising option for women who haven’t found success with other treatments. If you're considering it, talk to your dermatologist to determine if it’s a good option for you.

How effective is spironolactone for female-pattern hair loss?

Spironolactone seems to be relatively beneficial for treating FPHL. It does this by blocking certain hormones, such as androgens like testosterone. These hormones can make hair follicles shrink, leading to hair loss or thinning. By reducing the effects of these hormones, spironolactone can help slow down hair loss and may even improve hair growth over time. 

In addition to the studies mentioned above, other small studies have shown promising results. For instance, one study published in the Journal of Cosmetic Dermatology found that 43% of women saw an improvement in hair loss after 4 months of using spironolactone and topical minoxidil (a common hair-loss medicine) — with no serious side effects reported. 

If you’re considering spironolactone for your hair loss, talk to your dermatologist to see if it's the right treatment for you. Keep in mind: Success rates and results can vary with any medication, especially hair-loss remedies. Talk to a dermatologist to find the best approach tailored to your hair-loss needs.

What’s the recommended spironolactone dosage for female-pattern hair loss?

Since spironolactone isn’t approved for FPHL, there isn’t a standard dosage for it. Instead, the recommended spironolactone dosage for hair loss in women depends on a few factors, like:

• Your overall health 

• Your hormone levels

• The extent of your hair loss

In a study of women treated with spironolactone for FPHL, though, the average dosage was 100 mg once daily for at least 6 months. Daily doses varied from 25 mg to 200 mg.

Your dermatologist may prescribe a lower spironolactone dose at first to see how well you tolerate the medicine. If all goes well, they may increase it to a target dose of 100 mg to 200 mg daily with careful monitoring. 

For reference, spironolactone tablets come as 25 mg, 50 mg, and 100 mg. The oral suspension comes in a 25 mg / 5 mL concentration.

How long does it take to see hair growth results with spironolactone?

Hair takes time to grow, and spironolactone isn't a quick fix. For example, in one case report, a woman noticed an improvement in hair growth after about 1 year of taking spironolactone 200 mg. But these results came in stages. Early signs of regrowth, such as reduced hair shedding, appeared within the first few months. New hair growth in thinning areas typically showed after around 6 months. Full results took up to a year or longer.

It's important to note that everyone responds differently to the medication, and the timeline for visible results can vary. If you’re considering spironolactone for hair loss, make sure to ask your prescriber about the time it’ll likely take to see improvements.

Can you combine spironolactone with minoxidil or other hair-loss medications?

Yes, spironolactone is often used in combination with minoxidil (Rogaine) — a topical over-the-counter (OTC) hair-loss medication. Minoxidil helps increase blood flow to the hair follicles, which can help hair grow.

Depending on the extent of your hair loss, a dermatologist or healthcare professional might suggest additional options, such as platelet-rich plasma (PRP) therapy or a hair transplant. Studies have shown that combining treatments can lead to better results. 

Before using any hair-loss treatments, always talk to your prescriber to ensure they're safe and suitable for your needs.

Possible side effects of spironolactone for hair loss in women?

Spironolactone has a few risks to keep in mind. It most often causes mild side effects that get better or go away as your body adjusts to the medication. These spironolactone side effects include: 

• Headaches

• Dizziness

• Breast tenderness

• Decreased sex drive

• Muscle cramps in the legs

• Low sodium levels

• Menstrual irregularities

• Stomach issues

• Electrolyte imbalances

• Fatigue

Some less common, but more serious spironolactone side effects include: 

• Stomach bleeding

• Excessive electrolyte changes

• Severe skin rashes

Always talk to your prescriber if you start to experience side effects while taking spironolactone.

Does spironolactone help with hair loss in men too?

Spironolactone may help with hair loss in men. However, it's generally not recommended. Spironolactone decreases testosterone levels, which can cause unwanted side effects. It can also cause men to develop breast tissue over time, a condition called gynecomastia.

Men who have hair loss usually benefit from medicines like oral finasteride (Propecia) and topical or oral minoxidil.

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Written by:

Goldina Erowele, PharmD, MBA

Goldina Ikezuagu Erowele, PharmD, MBA, is a transformative leader in healthcare with a distinguished record of advancing medication safety, operational efficiency, and cost management.

Edited by:

Karla Robinson, MD

Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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