Does adding the anti-androgen pill spironolactone to topical minoxidil help women with female pattern hair loss more than minoxidil alone?

Adding spironolactone to topical minoxidil may give women a better overall look of improvement than minoxidil alone by doctor assessment, though the actual hair-count data was not statistically convincing in this small trial -- and a substantial share of women may experience menstrual side effects worth discussing with a doctor before starting.

What they did

Premenopausal women aged 18-45 with mild-to-moderate female pattern hair loss were randomized to spironolactone 100 mg/day plus topical minoxidil 3% twice daily, or placebo plus the same topical minoxidil, for 24 weeks, with hair counts, diameter, and photographic assessment as outcomes.

What they found

The spironolactone group had numerically greater increases in hair count and diameter, but the difference in hair count did not reach statistical significance. On doctor-rated photographic assessment, significantly more women on spironolactone showed moderate-to-marked improvement (38%) versus placebo (9%). Side effects: menstrual irregularities occurred in roughly 38-50% of the spironolactone group (mostly mild; two women withdrew over this, and cycles returned to normal after stopping). Transient high potassium occurred in two spironolactone patients and one placebo patient, resolving without intervention.

Limitations

Small pilot study (48 participants) likely underpowered to detect a true difference in hair counts; only 24 weeks of follow-up; the primary journal page could not be accessed directly (paywalled), so details come from a dermatology newsletter's summary of the published abstract rather than the original article; author list and funding/conflict-of-interest disclosures could not be confirmed.

Who paid for it

Not disclosed in the accessible secondary source

Read the original

Efficacy and safety of oral spironolactone for female pattern hair loss in premenopausal women: a randomized, double-blind, placebo-controlled, parallel-group pilot study ↗ · Not confirmed from accessible secondary source (author list unavailable) · we summarised this from the abstract