Spironolactone for hair loss: how it works

We know DHT causes hair loss because drugs that reduce DHT also reduce hair loss. However, drugs that reduce DHT also have terrible side effects. So a topical anti-androgen might be a better option if you don’t want severe side effects. We know DHT causes hair loss because drugs that reduce DHT also reduce hair loss. However, drugs that reduce DHT also have terrible side effects. So a topical anti-androgen might be a better option if you don’t want severe side effects.

I’ve heard reports from hair loss experts that Spironolactone is an androgen receptor antagonist, which means it reduces the number of available androgen receptors for DHT to bind to. When the androgen hormone DHT binds to androgen receptors in the hair follicles, it seems to lead to hair loss. This process is not yet fully understood and is very perplexing for scientists, for the following reason:

Everywhere else on the body (face, chest, arms, legs, etc), hair growth is increased when DHT binds to the androgen receptors.

The hair in the scalp seems to be the reverse, but only in some individuals! When DHT binds with androgen receptors in the scalp, it causes the hairs to stop growing.

Although this seeming contradiction is as yet not understood, we do know that the scalps of bald and balding men have more DHT and more androgen receptors.

So you can see why a treatment like Spironolactone is popular among men suffering male pattern hair loss. Since it reduces scalp DHT as well as reducing the androgen receptor availability.

What are the side effects of Spironolactone?

Spironolactone is an anti-androgen, which means it reduces the male sex hormones. If it’s taken in pill form it reduces androgen hormones in the body. Because oral Spironolactone changes the balance of the sex hormones, it can result in “feminizing” characteristics in men — including the growth of breast tissue and erectile dysfunction. In women

However, topical Spironolactone is much less likely to cause feminizing side effects because it only works on the scalp and so significantly less of the drug is absorbed into the bloodstream.

There are also more serious side effects that occur in rare cases. See here for a full list of possible side effects.

What do people generally think of Spironolactone for hair loss?

From the feedback I’ve had, people generally consider Spironolactone to be a safer alternative to oral Finasteride (with less chance of side effects). Surprisingly though, although a lot of people use Spironolactone, I haven’t heard anyone say it’s made a big difference.

Would I recommend it? Personally I would choose topical Spironolactone over oral Finasteride. I think it’s a better idea to use a topical rather than altering your whole body’s hormonal balance for the sake of your hair. Targeting the scalp is a much better idea in my view.