On this blog, I have discussed the only two (Finasteride and Minoxidil) FDA approved drugs to treat hair loss many times in the past. Finasteride is an oral drug that inhibits the enzyme 5α-reductase, which in effect then reduces the harmful-to-hair dihydrotestosterone (DHT). Minoxidil is an antihypertensive medication that also happens to benefit scalp hair when used topically.
However, when it comes to hair loss medications, one area that I have neglected is anti-androgens. I did discuss RU-58841 in one post at the start of this year, but there are numerous other anti-androgens out there. In general, the potential side effects from anti-androgens are more severe than from Finasteride and Minoxidil, while scalp hair regrowth from anti-androgens is typically less significant than from Finasteride (although there are some exceptions). Note that while some strict definitions consider Finasteride to also be an anti-androgen due to its inhibition of DHT, I only consider drugs that inhibit the binding of testosterone to androgen receptors as being anti-androgens. Finasteride, while reducing DHT, actually raises testosterone levels by around 10 percent! Also worth noting is that the popular Ketoconazole (Nizoral) shampoo might have some anti-androgenic properties per several recent studies.
In this post I will discuss the most popular “true” anti-androgen in the world: Spironolactone.
Spironolactone (generally sold under the brand name Aldactone) is also referred to as “Spiro” and is a synthetic drug available via prescription. It belongs to a class of drugs known as potassium-sparing diuretics, and is used primarily as a diuretic and antihypertensive in the treatment of heart failure and hypertension. However, secondary anti-androgenic applications have become more prevalent in recent decades. Spironolactone can stop hair loss, reduce body hair (hirsutism), reduce acne, help women with polycystic ovary syndrome (PCOS) and improve seborrheic dermatitis.
Spironolactone Side Effects
While this drug may seem like a miracle product that can kill many birds with one stone, potential side effects are significant and plentiful. For men, feminization is a real danger when taking Spiro, meaning that you can developed gynecomastia (larger breasts) and see your testicles shrink. Men can also develop premature ejaculation and become infertile (although in most cases it seems like this side effect is not permanent) when taking Spiro. Less traumatic side effects include drowsiness, dry skin, excess urination, headache, nausea and vomiting. Spiro can potentially even lead to death from severe allergic reactions, hyperkalemia, kidney failure and more, although I have not read about this happening to any hair loss forum members. In general, the doses that hair loss patients take tend to be on the lower side. You can learn a lot more about Spiro and its use to treat hair loss by tracking patients that take Spiro and post in the various online hair loss forums. I have never tried to take Spironolactone since I am very cautious when it comes to taking any kind of drug.
Spironolatone for Male-To-Female Transsexuals
I first learnt about Spironolactone when I read testimonials and forum posts from numerous male-to-female (MTF) transsexuals out of my own curiosity many year agos. It seems like estrogen and spironolactone are the two main drugs that MTF transsexuals are almost always given. Moreover, transsexuals often have to take a much higher dose (100-200 mg per day to start, and considerably higher doses if ineffective) of Spiro compared to men or women who are “just balding”. It is therefore important for you to visit transsexual/transgender forums on the internet and ask questions if you ever intend to take Spiro.