Doctor’s Note: Your Essential Guide to Spironolactone

As dermatologists, we often prescribe spironolactone to women for skin and hair issues. It’s especially helpful for treating hormonal acne and certain types of hair loss.

Watch the video to the right for a quick overview, or keep reading to learn more about how spironolactone works and who it helps!

What Is Spironolactone?

Spironolactone is a prescription pill that belongs to a group of drugs called "diuretics," or water pills. It was originally designed to help the body get rid of extra salt and water. Doctors often prescribe spironolactone for people with heart failure, where the heart cannot pump as well and fluid can build up and cause swelling. Spiro makes you pee out extra fluid to reduce any swelling.

Beyond its role as a water pill, spironolactone also affects certain hormones in the body, particularly androgens (”male hormones”). Androgens are hormones that play a role in things like oil production in the skin and hair growth. Because it can reduce androgen levels, spironolactone has been found to help with other conditions linked to these hormones, such as hormonal acne and some types of hair loss.

Spironolactone Pills

What Does Spironolactone Treat?

Spironolactone can be used to help with a variety of health issues. Here are some of the main ones:

Spironolactone Uses

Hormonal Acne

Spironolactone is often prescribed for women with hormonal acne. This type of acne usually flares up around the menstrual cycle or doesn’t respond well to regular acne treatments.

Hair Loss

Spironolactone may help reduce hair loss that’s related to hormones. Some people find it slows hair shedding and supports thicker hair growth over time.

Unwanted Hair

Spironolactone can help reduce unwanted hair on the face or body. It works by lowering certain hormones that increase hair growth. This effect may take a few months to show results.

PCOS

Though not specifically approved for PCOS, spironolactone can help manage symptoms like acne, thinning hair, and unwanted hair growth associated with PCOS.

Heart Conditions

Spironolactone is also used to treat heart failure. It works as a diuretic, helping the body remove extra fluid. This is why spiro can sometimes make you pee more and cause dizziness!

For each of these uses, doctors will monitor patients closely, especially if spironolactone is needed long-term. For those dealing with acne or hair issues, spironolactone can be a helpful option when prescribed and managed by a healthcare provider.

Spironolactone is prescribed to two main groups:

Young Women: Healthy young women often take a long-term daily dose of spironolactone to help with acne, hair loss, and symptoms of PCOS. In these cases, it works by balancing hormones.

Older Adults: Both men and women may take spironolactone for heart failure. Here, it’s used as a diuretic (water pill) to reduce fluid buildup.

How Spironolactone Works

Spironolactone works by blocking androgens, hormones that can affect skin and hair in various ways:

  • Reduces Oil Production: Lowering androgen levels reduces sebum (oil) production in the skin, which helps prevent clogged pores and breakouts.

  • Balances Hormones: This can also benefit those experiencing hormone-related hair thinning or loss.

  • Supports Long-Term Results: Many people find spironolactone effective for managing acne and hair shedding over time.

Benefits of Spironolactone

Reduces Hormonal Acne: Spironolactone can be helpful for persistent acne tied to hormone changes.

Decreases Oiliness: By lowering oil production, spironolactone can improve skin’s overall texture.

Potential Hair Benefits: It may reduce hair shedding for some people with androgen-related hair loss, though results vary.

Post Inflammatory Erythema

How Do You Know if Your Acne is Hormonal?

Hormonal acne often appears around the jawline and chin, flares up during your period, and includes deep, painful pimples. (Basically where men get a beard, this is where women get hormonal acne!) If this sounds like your acne, it may be hormonal.

Spironolactone vs Accutane

Both spironolactone and Accutane (isotretinoin) are acne treatments, but they work differently. Accutane permanently shrinks oil glands, making it effective for severe acne but with a short treatment period (usually ~4 - 6 months). The results are longer-lasting. Spironolactone is typically used for longer-term treatment and is often preferred for hormonal acne. Spiro’s effects on the skin are not permanent (meaning your hormonal acne might return if you stop). Accutane is also more intensive, with specific requirements around monitoring and pregnancy prevention. A dermatologist can help decide which treatment fits best.

Side Effects of Spironolactone

The side effects of spironolactone can change depending on the dose. Higher doses may increase certain side effects. Here’s what to expect at different doses, but always talk to your doctor about any concerns.

Low Doses (25-50 mg daily):

  • Mild Dizziness or Tiredness: Feeling a little dizzy or tired is common but usually mild at low doses.

  • More Bathroom Trips: Even at a low dose, spironolactone can make you urinate more often.

  • Small Changes in Potassium: Potassium levels can go up a bit, though major changes are rare at low doses.

Moderate Doses (50-100 mg daily):

  • Breast Tenderness: You might feel mild tenderness or slight swelling in your breasts.

  • Changes in Periods: Menstrual cycles may become a bit more irregular.

  • Higher Potassium Levels: Potassium is more likely to increase at this dose, so blood tests may be needed.

High Doses (100-200 mg daily):

  • Big Changes in Potassium: High doses can raise potassium a lot, so frequent blood checks are important.

  • Increased Breast Tenderness or Swelling: Breast changes can become more noticeable.

  • Irregular Periods: Periods may become more irregular or have spotting.

  • Low Blood Pressure: You may feel dizzy or faint, especially when standing up quickly.

Natural Alternative to Spironolactone

For those seeking a more natural route, several options might help manage acne and hair loss:

  • Spearmint Tea: Known for its mild anti-androgen effects, spearmint tea may reduce hormonal acne.

  • Green Tea Extract: This antioxidant-rich extract may help balance hormones and reduce oiliness.

  • Dietary Adjustments: Limiting sugar and dairy may benefit those with hormonal acne.

While these alternatives may not be as powerful as spironolactone, they can support hormone balance and improve skin over time.

Spearmint Tea

FAQs About Spironolactone

Does spironolactone change body shape?
Spironolactone does not directly change body shape. However, it can reduce water retention, leading to a temporary reduction in bloating, which may affect how the body appears.

What happens if you get pregnant on spironolactone?
Spironolactone is not recommended during pregnancy as it can affect fetal development, potentially leading to birth defects. If you suspect you are pregnant, stop taking the medication and consult your doctor immediately.

Can you take spironolactone while pregnant?
No, spironolactone should not be taken during pregnancy due to the risk of harm to the developing fetus. Discuss alternative treatments with your doctor.

How much water should I drink when taking spironolactone?
When taking spironolactone, drink enough water to stay hydrated, typically 8-10 cups (64-80 ounces) per day. However, avoid excessive water intake to prevent electrolyte imbalances.

Does spironolactone make you lose your period?
Spironolactone can cause menstrual irregularities, including missed periods, particularly at higher doses. These changes are reversible upon stopping the medication.

Does spironolactone cause weight gain?
Spironolactone does not typically cause weight gain. It may reduce bloating and water retention, which can make some individuals feel lighter.

Does spironolactone cause hair loss?
No, spironolactone is often used to treat hair loss caused by hormonal imbalances, such as androgenetic alopecia. It reduces the effects of androgens that contribute to hair thinning.

Is 50 mg of spironolactone enough for acne?
A 50 mg dose of spironolactone may be sufficient for mild acne. However, for moderate to severe acne, higher doses (up to 100-200 mg) are commonly prescribed. Consult a dermatologist for the appropriate dosage.

How long does spironolactone take to work for acne?
Spironolactone typically takes 6-12 weeks to show noticeable improvements in acne. Consistency and patience are key, as results may vary between individuals.