Spironolactone is a common second-line treatment for female pattern hair loss.

Spironolactone is one of the workhorses for female pattern hair loss when topical minoxidil alone is not enough.

It is an anti-androgen: it blocks the action of androgens (including DHT) at the receptor level. Doses for hair are 50 to 200 mg/day, usually titrated up over months. Prescribed off-label by dermatologists in the US, EU, and UK; the FDA-approved indications are for high blood pressure and edema, not hair loss.

Who it is for: women with female pattern hair loss, especially those with associated androgen-driven features (acne, hirsutism). Often combined with topical 5% minoxidil or low-dose oral minoxidil for additive effect.

What to know: it is a potassium-sparing diuretic, so kidney function and potassium need to be monitored, especially in older patients or those on other medications. Common side effects include menstrual changes, breast tenderness, increased urination at higher doses.

Absolutely not safe in pregnancy. Reliable contraception is required throughout treatment. Not used in men because it can cause feminisation.