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 in the hairlosstalk forum success stories section.  Many of the posters there have signatures that show the drugs they are currently taking or have taken in the past.

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.

16 thoughts on “Spironolactone”

  1. Hey admin, have you heard that oral minox is like super good at growing hair? I had to quit due to irritation after 2 years and I lost a lot of hair along my hairline from it. My derm actually suggested getting on a low dose (5mg) because sides wouldn’t show too much at that dose and I wouldn’t need a diuretic.

    Good post as always. Oral spiro is pretty potent and I don’t usually see too many guys on it due to the gyno and what not. I have read some however of guys actually quitting fin and doing good on spiro. You gotta wonder why some men get the hairlines destroyed on fin and especially dutasteride. Possibly the big testosterone increase especially on Dut? Spiro would take care of that!

    1. Thanks. Yes heard about oral Minox, but never imagined it being worth the sides. So you saw no benefit and it actually worsened your frontal hairline? Or did the hairline only worsen after you quit?

  2. hi admin,I am from China. Do you know any contact information of shiseido?I want more information about RCH-01.

  3. Thanks for your replay and I have sent a email to them。Another question,do you have any information about RCH-01’s phase 2 clinic trial for both shiseido and replicel. thanks

    1. No new info, but they have had many announcements in the past year. Please select “Replicel” from the left “categories” menu and real all my posts as well as blogger comments underneath those posts. Replicel also seems to answer questions on their Facebook page.

  4. Hey admin, sorry didn’t see that message. But yeah, I never saw regrowth from minox. I just kept putting it on my existing hairline. When I had to quit, I guess it was holding my hairline because I lost about a half an inch on both sides in 8 months. Either that or those hairs grew to only be dependent on minoxidil stimulation.

    Btw I contacted replicel earlier in the week and asked about rch-01.. This was the quick conversation..

    –Hello there,

    My name is Luke and after following the company and its research, I have begun to wonder. I understand that in Japan, Replicel has partnered with a company and that particular company has been expanding the research due to more appealing regulations. Being a resident of the United States, I would like to know when the company plans on entering into phase II trials. If you could reveal any new updates or information about RCH-01, I’d be very grateful. If not, thanks you for your time and keep up the great job you are all doing.

    Thank you,

    -I forgot to ask how the 23rd World Congress of Dermatology went? Any new updates that were released during the event? Thanks!–

    Hi Luke,

    Thank you for your questions. We are still working towards conducting a phase 2 trial in Germany for RCH-01 and hope to have it started before the end of this year. You are correct about Shiseido, and we expect that they will be able to get their trial started ahead of the German start date. At this time, we will not be conducting a phase 2 trial in North America, only in Germany. If our phase 2 data is favorable, we will look to sell the data package to a much larger pharmaceutical company who has more experience bring products to market. They would need to conduct a multi-site phase 3 trial which would need to include North America if they wanted to sell RCH-01 in North America.

    The Derm conference was a huge success. Two of our doctors, Dr. Kevin McElwee and Dr. Rolf Hoffmann both presented. I’ve attached a copy of the poster that Dr. McElwee presented, Dr. Hoffmann chaired a session.

    I hope this answers your questions. I hope you have a wonderful day.

    Kind Regards,

    Not so sure about how to take this information. I think 2018 in Japan could still happen, but for the U.S. And else where, we are still a little way out unfortunately. Hopefully they become aggressive in the near future.

  5. Your informative website is the best on the Net unfortunately sometimes I get discouraged from the lack of a real treatment.

    I assume tens of millions has been spent on hair loss and unfortunately we still this disease. Hopefully someday we will have a real treatment and better still if it is before 2020.

  6. I read of a 73 year old that had been completely bald (except for the ‘horse shoe fringe’ since the age of 28, who had been on Spironolactone for 6 years for liver injury (in this case as a potassium sparing diuretic. Then as if from nowhere he grew a full ‘Ronald Reagan’ type full head of hair starting just 3 months ago (no growth before that it would seem).

    I was always of the belief that the hair follicle was dead, but the above suggests not. I did a little googling and it seems that over the many years since I gave up on the MPB struggle, that it is now thought that it is not dead at all, but inactive.

    I too have a liver issue (improving nicely) but am on 25mg Spiro, once per day. I’ve been told that I have started growing hair on my head, though when I look in the mirror I don’t see it at all, just the last of what used to be a head of hair.

    Since I’m on Spiro already, I’m wondering if, although 25mg is a low dose, doing something like a topical, then ‘Deminator’ then apply the topical again if might be more useful (even if not fully solubilized.

    I’ve been at 25mg (for maybe 2 years now), and have had some minor tenderness of the breast area (doctor gave me a single shot of Testoviron per month for the last 2 months) that issue has gone away (I thought he was going to give me an anti-estrogen such as anastrozole/Tamoxifen etc, but since I’ve never had a T-shot before I was curious anyhow. It did the trick even though it was only TRT level and not supra physiological level. None of the blood work I had done involved checking hormone levels, but I did tell the doc that I felt my T levels were through the floor (perhaps making a T / E ratio imbalance?) and having trouble ‘performing’ without assists, but even then the drive wasn’t there. (no noticeable shrinkage down below, though body hair is under the arm pits a lot less dense, beard shaving the same as ever) I’m 75kg with low muscle mass, so although when I stand up you don’t see a belly, it does feel thicker around the belly button area, and 32″ jeans are now a struggle to put on, with 34″ being too loose.

    I have Luteolin and Cordyceps Sinensis which I was considering as a topical fibrinolytic that I could mix in the topical, but from what I’ve read about Taurine that might do also. The first two mentioned there are potent anti-inflammatory and anti-fibrotic anyhow, and I’m taking about 10 grams each of those anyhow since just a couple of days ago.

    I get the impression with Spiro for males you need 100/200mg or even more systemically for any minor hair effect, which would be a dose I would be very concerned about taking, but 25mg I’m comfortable with. It seems to be only partially soluble in water. I do have DMSO but the smell of that stuff makes me want to avoid that route. Since my liver is the main issue and everyone except me thinks it’s alcohol induced, having Ethanol/EtoH around the house would cause some issues, as they would think I’m some kind of closet drinker or something (I don’t drink ‘top shelf’ anyhow, never liked it). I wonder if the version with a blue dye to stop people drinking it would be a suitable solvent?

    I’d be prepared to give it a try for 3-4 months to see if I can pull any of these critters out of telogen phase.


  7. Seems like the “Ronald Reagan” comment was an add on by some over exuberant optimist, and not part of the study of this single phenomenon. The systemic amount of Spiro was/is very high though, and I was only talking about 25mg locally on the scalp, which might achieve much the same but more localized.

  8. It would appear to me that at first look, reducing things like DHT/PDG2 etc are not that helpful since there are multiple pathways, but I did read somewhere else that rats genetically modified to be missing the GPR44 reception were blissfully lacking in any side effects of PDG2 no matter what the level.

    Perhaps we should be looking to downregulate the sensitivity of GPR44 as a one stop shop rather than trying to halt all those that would be deletrious to our goal(?).

  9. i was put on 100 mg of spiro daily for adult female hormonal acne. after 2 yrs on it, started to lose my hair on top/scalp/part/bangs/hairline. after almost 3 yrs now of being put on thyroid meds, taken off spiro, put back on bcp, diagnosed with alopecia, fphl, mpb, i am now on finasteride for almost 6 wks now. been on minoxidil since jan 2014. could spiro have triggered my hairloss & will finasteride help me? im so desperate.

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