Oral spironolactone for female pattern hair loss

Oral spironolactone (an antiandrogen) can be used as monotherapy for mild to moderate female pattern hair loss. It can also be used in combination with topical minoxidil for more severe female pattern hair loss, or in mild to moderate cases if the patient requests initial combination therapy.

Spironolactone is contraindicated in pregnancy because of the risk of defective virilisation of the male fetus. Exclude pregnancy before starting treatment and ensure use of effective contraception during therapy. Stop spironolactone when planning pregnancy, or when pregnancy is suspected or confirmed.

For female pattern hair loss in a female who requests treatment, use:

Adverse effects of spironolactone include dizziness, diuresis, irregular menstrual bleeding (the combined oral contraceptive pill reduces this risk and provides reliable contraception, if this is being used by the patient concurrently), postmenstrual spotting, and breast tenderness or lumpiness. There is no evidence that spironolactone use for female pattern hair loss increases the incidence of breast cancer or breast cancer recurrenceBiggar, 2013Mackenzie, 2012Wei, 2020. If in doubt, for patients with recently treated breast cancer, check with the treating oncologist for approval of spironolactone use.

In all patients, measure blood pressure, kidney function and liver biochemistry before starting spironolactone, then every 6 to 12 months. Older females may need more frequent monitoring if clinically indicated.