What Women Should Know About Topical Spironolactone


Hair loss isn’t a “male only” or “female only” issue — it’s an “everyone” issue! Most people will experience some hair loss as they age. The most common cause of hair loss for both men and women, after all, is the same condition, called androgenetic alopecia. And this hair loss disorder affects 40% of women. (01) Despite this fact, however, most hair loss treatments cater to men. Fortunately, women have their own “women only” medicated treatment in their arsenal— topical spironolactone.

What is spironolactone?

Before discussing topical spironolactone, we should get familiar with the oral version. Oral spironolactone, an FDA-approved medication, is typically prescribed for blood pressure treatment. The medicine is a potassium-sparing diuretic (water pill) that prevents low potassium (which is essential for the heart). (02)

Another off-label use for oral spironolactone is as a women only treatment for hair loss. Spironolactone works as a hair loss treatment for women because it blocks testosterone and prevents dihydrotestosterone (DHT) from forming. DHT is the culprit for both male and female pattern hair loss.

Does oral spironolactone have side effects?

As an oral medication, the effectiveness of spironolactone is highly dose-dependent. This also means that the side effects of spironolactone are dose-dependent, also. (03) So, although higher doses of oral spironolactone are much more effective, those higher doses also result in more severe side effects. In many cases, the individuals stop treatment due to the side effects of oral spironolactone.

The possible side effects of oral spironolactone in women include: (04)

  • Painful periods
  • Painful cramping
  • Irregular periods
  • Breast tenderness
  • Breast enlargement
  • Fatigue
  • Reduced libido
  • Headaches
  • Dizziness
  • Menstrual irregularities

Hyperkalemia is likely the most concerning side-effect caused by oral spironolactone. (04) While hyperkalemia in a healthy young woman is not a significant concern, the condition may pose a danger for older women and in women with heart problems or kidney disorders.

How is topical spironolactone different?

While oral spironolactone is ingested, topical spironolactone is administered onto the skin or scalp. Because topical spironolactone skips the digestive system and doesn’t enter the bloodstream, the topical version’s side effects are milder (or none) but with the same hair growth efficacy. Topical spironolactone also acts directly on the area that needs attention the most — hair follicles. Oral spironolactone, on the other hand, must journey all throughout the body to get to its intended destination.

How does topical spironolactone affect hair follicles?

Hair follicles are critical to hair growth and maintenance. Healthy hair follicles produce and keep hair according to the hair’s natural growth cycle. Too much DHT, however, causes hair follicles to shrink over time until they no longer grow hair.

Spironolactone encourages hair growth by preventing the development of DHT and other androgen hormones. Topical spironolactone also targets the DHT receptors at the hair follicles, preventing — and sometimes reversing — the shrunken follicles.

Why is topical spironolactone for women only?

The exact process that makes spironolactone so successful (blocking DHT and androgens) is also what makes the medication unpleasant for men. Testosterone, for example, is primarily an androgen hormone found in males. Blocking androgens like testosterone in a healthy male may cause undesirable side effects.

To make a vital point, exceptionally high doses of spironolactone are often prescribed to men wishing to undergo gender transition into women. Therefore, oral or topical spironolactone is typically prescribed for women only.

Is spironolactone an effective hair loss treatment for women?

Two studies highlight the effectiveness of spironolactone for hair treatment on women. A 2015 study found that 74% percent of research participants with hair loss found an improvement in hair growth. (05) The authors concluded that spironolactone is an effective treatment for hair loss in females, especially for women with high levels of androgen hormones.

Another study compared topical spironolactone to topical finasteride. A sample of 32 patients was treated with one of either topical solution for six months. When surveyed after treatment, 100% of participants were satisfied with their results. (06) However, topical spironolactone was a viable alternative to topical finasteride, as finasteride generated more side effects.

How long does topical spironolactone take to work?

As with most hair loss treatments, results may take time. Topical spironolactone may take as early as three months and up to six months of consistent treatment for results to show. Sometimes, waiting for changes in hair loss is frustrating, but the results are worthwhile.

Is topical spironolactone safe for women?

Topical spironolactone is safe if taken correctly and under a doctor’s supervision. To avoid side effects or contraindications, women should tell their doctor if they are pregnant or breastfeeding. In addition, women should inform the doctor about any history of:

  • Liver disease
  • Kidney disease
  • High potassium
  • Addison’s disease
  • Electrolyte imbalance

Individuals with kidney (renal) conditions should not take spironolactone. Because the medication is a diuretic (which causes people to urinate), it affects the kidneys and can cause dehydration. (07)

People who take spironolactone must remain hydrated, especially during hot weather. When taking spironolactone, it’s essential to be on the lookout for signs of severe dehydration like: (01)

  • Infrequent urination
  • Dark-colored urine
  • Confusion
  • Extreme thirst

Spironolactone affects the balance of the sex hormones, causing “feminizing” characteristics in men, including erectile dysfunction. In women, however, this topical spironolactone is much less likely to cause such side effects, making topical spironolactone an ideal women only hair loss medication.

Does topical spironolactone cause weight gain?

Because hormones play such a significant role in weight, people often wonder whether specific medications that affect hormones cause weight gain. One side-effect of spironolactone is weight loss, particularly in women who hold a significant amount of water weight.

Spironolactone is a diuretic, therefore the medication flushes out excess water. Reducing fluid retention within the body can result in weight loss. But this weight loss is not the same as healthy weight loss using diet and exercise and may not be sustainable.

How can I get topical spironolactone from Happy Head?

At Happy Head, topical spironolactone for women only is prescribed by a physician after a free consultation with purchase. The consultation consists of a short medical survey, and a physician will review your medical history. A Happy Head physician will collaborate with you to determine your eligibility and find the appropriate medication.

The topical spironolactone dosage is as follows:

  • Spironolactone 1.0%
  • Minoxidil 6.0%
  • Retinoic acid 0.01%
  • Hydrocortisone 1.0%

After approval, a Happy Head physician authorizes your prescription, sent electronically to a pharmacy. The medication is sent to you in a discreet package with FedEx’s 2-day delivery. As part of your package, you’ll also have support from our physicians and staff for any questions and concerns.


(01) https://www.americanhairloss.org/women_hair_loss/introduction.html
(02) https://medlineplus.gov/druginfo/meds/a682627.html
(03) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3315877/
(04) https://www.ncbi.nlm.nih.gov/books/NBK554421/
(05) https://doi.org/10.1016/j.jaad.2015.06.063
(06) https://pubmed.ncbi.nlm.nih.gov/15787815/
(07) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370349/