Spironolactone for Female Hair Loss: Aleissa 2023
This is a plain-language summary of the original published research. We do not add conclusions or opinions of our own. This is not medical advice — consult a certified healthcare practitioner before making any decision.
Original research published in Cureus, 2023
The Efficacy and Safety of Oral Spironolactone in the Treatment of Female Pattern Hair Loss: A Systematic Review and Meta-Analysis
Study conclusion
Oral spironolactone improved hair loss in 56.6% of women across the studies reviewed. Women taking spironolactone combined with another treatment (usually minoxidil) had a higher improvement rate (65.8%) than those on spironolactone alone (43.2%). However, 37.8% of all patients saw no meaningful improvement. The evidence varied considerably between studies. Spironolactone is not FDA-approved for hair loss and is used off-label.
Strength of evidence
Based on a meta-analysis that included both RCTs and observational studies. Score is low because including observational studies reduces confidence, heterogeneity in outcomes was significant, and spironolactone doses and concurrent treatments varied considerably. No comparison against FDA-approved treatments was included.
Who it applies to
Who was studied
Women diagnosed with female pattern hair loss. Studies used doses of oral spironolactone ranging from 25mg to 200mg daily, with most studies using 80 to 110mg daily. Some patients received spironolactone alone; others received it combined with minoxidil or other treatments.
Who was NOT studied
Men (spironolactone causes feminising side effects in men). Women with other types of hair loss. No study directly compared spironolactone against FDA-approved treatments for female pattern hair loss.
What to look for when shopping
Oral spironolactone at doses typically between 100 and 200mg daily. The primary outcome was the rate of improved hair loss based on physician or patient assessment. Adverse events tracked included scalp itching, menstrual changes, facial hair growth, and drug discontinuation rate.
What research cannot help you decide
Whether spironolactone is as effective as minoxidil on its own. The optimal dose. Who is most likely to respond to treatment. Whether benefits persist long-term. How results compare to finasteride in women.
Key findings
- Overall improvement rate for oral spironolactone across all studies: 56.6% of women.
- Combination therapy (spironolactone plus another treatment, usually minoxidil) improved hair loss in 65.8% of women.
- Spironolactone monotherapy improved hair loss in 43.2% of women.
- 37.8% of all patients showed no improvement or only modest improvement.
- Most commonly reported side effects were scalp itching or increased flaking (18.92%) and menstrual disorders (11.85%).
- Drug discontinuation rate due to side effects was low at 2.79%.
- Spironolactone is not FDA-approved for hair loss. It is used off-label based on its anti-androgen properties.
- Doses below 100mg daily were generally not found to be effective for hair growth in the included studies.
What they did
The researchers searched PubMed, Web of Science, Embase, and Scopus in March 2023 for studies assessing oral spironolactone in women with pattern hair loss. Both RCTs and observational studies were included. The primary outcome was the proportion of patients who showed improvement in hair loss. Results were pooled statistically. Significant heterogeneity was present in efficacy outcomes, meaning results varied considerably between studies.
What they found
| Comparison | Result | Significant? |
|---|---|---|
| Overall improvement rate: all patients on oral spironolactone | 56.6% of women showed improvement | Yes |
| Improvement rate: combination therapy (spironolactone plus other treatment) | 65.8% of women showed improvement | Yes |
| Improvement rate: spironolactone monotherapy | 43.2% of women showed improvement | Yes |
| No improvement or modest improvement | 37.8% of all patients | No |
| Scalp pruritus or increased flaking | 18.92% of patients reported this side effect | No |
| Menstrual disorders | 11.85% of patients reported this side effect | No |
| Drug discontinuation due to side effects | 2.79% of patients discontinued | No |
Limitations
- 1.Both RCTs and observational studies were included, which lowers overall evidence quality compared to RCT-only analyses.
- 2.Significant heterogeneity in efficacy outcomes across studies.
- 3.Spironolactone doses, treatment durations, and concurrent treatments varied considerably between studies.
- 4.No comparison against FDA-approved or other established treatments for female pattern hair loss.
- 5.No trial assessed long-term outcomes or what happens after stopping treatment.
- 6.Spironolactone is used off-label for hair loss in all countries.
Who funded it
Not reported. No conflicts of interest declared.
Used in these articles
Links added as fact-checks and articles citing this study are published.