On this blog, I have often discussed the only two (Finasteride and Minoxidil) FDA approved drugs to treat hair loss. 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. This post covers a hair growth medication called Spironolactone (brand names Aldactone or Carospir).
Update: March 9, 2023 — A systemic review of the efficacy and safety of oral and topical Spironolactone in the treatment of androgenetic alopecia.
Anti-Androgens
When it comes to hair loss medications, one area that I have neglected is anti-androgens such as Spironolactone, which have many favorable reviews. I did discuss RU-58841 in one post at the start of this year. However, there are numerous other anti-androgens out there, such as Fluridil and Flutamide.
In general, the potential side effects from anti-androgens are more severe than from Finasteride and Minoxidil. Moreover, scalp hair regrowth is typically more significant with Finasteride and Dutasteride.
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 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 for Hair Loss
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.
In 2020, a study found topical Spironolactone 1% gel and Minoxidil 5% gel to be an effective combination treatment for hair loss. An older study from 1998 concluded that topical Spironolactone inhibits dihydrotestosterone receptors in human sebaceous glands
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 Spironolatone, 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 this drug.
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 this product and post about it 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.
Mechanism of Action
Aldactone (Spironolactone) is a specific pharmacologic antagonist of aldosterone. It primarily acts through competitive binding of receptors at the aldosterone dependent sodium-potassium exchange site. Aldactone causes an increase in sodium and water excretion rates, while potassium is retained. The drug therefore acts as both a diuretic as well as an antihypertensive via this dual mechanism.
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 ago. It seems like estrogen and Spiro are the two main drugs that MTF transsexuals are almost always given.
Moreover, transsexuals often have to take a much higher dosage (100-200 mg per day to start, and considerably higher doses if ineffective) of Spiro compared to men or women who are only tackling 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.
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!
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?
hi admin，I am from China. Do you know any contact information of shiseido？I want more information about RCH-01.
HI 6666, here is their contact info:
https://corp.shiseido.com/en/inquiry/
They also have a China location:
https://corp.shiseido.cn/
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
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.
SPIRO? NO WAY! shrinkage of genitals and increase of boobs…
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,
-Luke
p.s.
-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.
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.
Amen brother
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.
Comments/Ideas?
Hi Paul Bond, I have not taken anything that you take or plan to take so can’t offer any advice. However, this might be worth a read:
https://www.hairlosscure2020.com/so-it-seems-like-totally-balding-areas-of-the-scalp-can-regenerate-long-lost-hair/
Am curious where you read about the old guy regrowing Ronald Reagan type hair.
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.
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(?).
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.
The same for me!! As long as I took it with Diane it worked out great but I stopped taking Diane and just spiro I have lost almost my hair.
I’ve noticed the same with myself! I was put on Spiro for adult hormonal acne as well, and since being on it for the last 5 years, I’ve noticed my hair thinning in my bang region. I can’t part my hair down the middle anymore without being self conscious of looking slightly bald. I spoke to my derm about it last year and she laughed at me and told me that Spiro was used for hair regrowth and that it was just aging or something else (I was 25 at the time, with no history of female hair loss in my family). I then assumed that it was because of the intense amount of stress I’ve been under these past 3 years (graduate school…the many wonderfull side effects of a PhD program I thought). Seeing that others are experiencing the same thing as myself has me thinking that there is something to it, though.
I meet with my derm this Thursday. I’ll ask about Spiro maybe reacting negatively for those women who need it for hormonal acne (it would make sense, our hormones are out of whack enough to cause adult acne so why wouldn’t the Spiro react differently in our systems than most people?) and relate if she has anything worth sharing. If I don’t respond again, assume that she gave me her normal answer of “Spiro can’t do that.” Good luck to all.
It appears that your suspicions may be correct. Spironolactone may primarily behave as an anti-androgen by behaving as an androgen receptor antagonist. However, it can also behave as an androgen receptor partial agonist. This means that it can have androgenic effects. Especially in women. This is actually explained in the spironolactone Wikipedia article.
“Direct blockade of androgens from interacting with the androgen receptor.[91][55] It should be noted however that spironolactone, similarly to other steroidal antiandrogens such as cyproterone acetate, is not a pure, or silent, antagonist of the androgen receptor, but rather a weak partial agonist with the capacity for both agonist and antagonist effects.[92][93][94] However, in the presence of significant enough levels of potent full agonists like testosterone and DHT,[94] the cases in which it is usually used even with regards to the “lower” relative levels present in females, spironolactone will behave similar to a pure antagonist. Nonetheless, there may still be a potential for spironolactone to produce androgenic effects (i.e. act as a receptor agonist) in the body at sufficiently high doses and/or in those with low enough endogenous androgen concentrations. As an example, one condition in which spironolactone is contraindicated is prostate cancer,[95] as the drug has been shown in vitro to significantly accelerate carcinoma growth in the absence of any other androgens, and was found to do so at the relatively high rate of approximately 32%, which was about 35% that of DHT (thus also indicating that its potential intrinsic activity at the androgen receptor may be somewhere around one-third that of endogenous full agonists).[92] In accordance, two case reports have described significant worsening of prostate cancer with spironolactone treatment in patients with the disease, leading the authors to conclude that spironolactone has the potential for androgenic effects in some contexts and that it should perhaps be considered to be a selective androgen receptor modulator (SARM).[96][97]”
Hello Dear Admin
I’m taking spiro because I’m suffering from PCO . I take it in 10 days after my mens. But I see that i get more hair fall . Could it be a side effect of spiro ?!!!! I’m really upset with my hair fall spiro couldnt help me. Thanks for your time
Hi Hadis, sorry to hear about your troubles.
I am not a doctor and would recommend you contact a dermatologist to see if he/she can help you diagnose the issue.
Spironolactone works for sure, but it is not enough by itself. At least that was my experience.
Hi, Golden Locks, may I ask ,a s I have just started Spiro, what additionally you had to use or take besides the Spiro? I am waiting to see if the Spiro is useful for me. whatever I can do, I will do to get my hair back. thank you for any info.
I have been using Spiro for 4 yrs now, after the liver and stroke I woke up to no hair and i screamed when I saw all my hair had fallen out. I asked my family what happened to my hair, and no one could tell me. I cryed for days, but the Spiro grew it all out and then some. It’s longer now than it’s ever been. Thanx Spiro!!!
Suzanne C., what dosage was prescribed for you per day? just curious as I just started Spiro…
thanks
A 73-year-old male who was bald since the age of 28 developed liver cirrhosis and had been treated with spironolactone for the last 6 years. For the last 3 months, his scalp hair started to regrow, possibly due to the antiandrogenic effect of spironolactone.
https://pubmed.ncbi.nlm.nih.gov/1977262/