Efficacy and Safety of Oral Spironolactone for Female Pattern Hair Loss in Premenopausal Women: A Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Pilot Study

September 2025 in “ International Journal of Women’s Dermatology ”

Pimpakarn Werachattawatchai, Saranya Khunkhet, Sarawin Harnchoowong, Chotinij Lertphanichkul

spironolactone minoxidil female pattern hair loss FPHL hair density hair diameter terminal hair irregular menstruation Aldactone Rogaine

From the encyclopedia

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Minoxidil →

An essential vasodilator with some anti-androgenic effects

Studysummary This study found that oral spironolactone 100 mg daily for 24 weeks improved terminal hair counts and diameters in premenopausal women with female pattern hair loss when used alongside minoxidil, despite a higher incidence of menstrual irregularities. Our plain-language summary of this paper — not a Tressless recommendation.

This study assessed the efficacy and safety of oral spironolactone (100 mg daily) combined with topical minoxidil for treating female pattern hair loss (FPHL) in premenopausal women. Conducted as a randomized, double-blind, placebo-controlled trial with 48 participants, it found that spironolactone significantly increased hair density and diameter, with improvements in total and terminal hair counts. However, irregular menstruation was a common side effect, affecting about one-third to 50% of users. Despite these side effects, spironolactone was generally well-tolerated and effective in promoting hair growth, suggesting it as an alternative treatment for mild-to-moderate FPHL. The study's limitations include a small sample size and short duration, indicating the need for further research.

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Research cited in this study

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research Retrospective Analysis of the Risk of Hyperkalemia in Women Older Than 65 Years of Age Prescribed Spironolactone for Female-Pattern Hair Loss

October 2022 in “British Journal of Dermatology”

In this retrospective study, the incidence of hyperkalaemia within the first year of spironolactone use was assessed among women over 65 with female-pattern hair loss, highlighting a potential safety concern.

research Efficacy and Safety of 5% Minoxidil Alone, Minoxidil Plus Oral Spironolactone, and Minoxidil Plus Microneedling on Female Pattern Hair Loss: A Prospective, Single-Center, Parallel-Group, Evaluator-Blinded, Randomized Trial

2 citations , July 2022 in “Frontiers in Medicine”

This study found that combining topical minoxidil with microneedling improved hair density more than either minoxidil alone or with spironolactone for women with mild-to-moderate female pattern hair loss.

research Efficacy and Safety Profile of Oral Spironolactone Use for Androgenic Alopecia: A Systematic Review

8 citations , August 2021 in “PubMed”

This review found that oral spironolactone is an effective and well-tolerated treatment for androgenic alopecia in women, especially when used with topical minoxidil, with generally minimal side effects reported.

research Spironolactone for Treatment of Female Pattern Hair Loss

15 citations , April 2020 in “Journal of The American Academy of Dermatology”

This article notes the lack of physician-reported outcome studies supporting the efficacy of off-label spironolactone in treating female pattern hair loss, despite its common prescription alongside FDA-approved topical minoxidil.

research A Randomized Trial of 5% Minoxidil Versus Combination of 5% Minoxidil and Oral Spironolactone in Treatment of Female Pattern Hair Loss

October 2019 in “International Journal of Research in Dermatology”

This study found that combining topical minoxidil with oral spironolactone improved hair loss outcomes in women with female pattern hair loss when compared to minoxidil alone, but benefits plateaued after 6 months.

research Minoxidil 1 mg Oral Versus Minoxidil 5% Topical Solution for the Treatment of Female-Pattern Hair Loss: A Randomized Clinical Trial

53 citations , August 2019 in “Journal of The American Academy of Dermatology”

This study observed that low-dose oral minoxidil and topical minoxidil 5% solution both improved hair density in women with female-pattern hair loss, but oral minoxidil may offer advantages in reducing hair shedding.

research Female Pattern Hair Loss: A Clinical, Pathophysiologic, and Therapeutic Review

66 citations , June 2018 in “International Journal of Women's Dermatology”

This article discusses treatments for female pattern hair loss, highlighting that oral antiandrogens and topical minoxidil can effectively arrest progression and reverse miniaturization in many patients with mild-to-moderate cases, but it reports no new clinical results.

research Efficacy and Safety of Once-Daily Minoxidil Foam 5% Versus Twice-Daily Minoxidil Solution 2% in Female Pattern Hair Loss: A Phase III, Randomized, Investigator-Blinded Study

1 citations , July 2016 in “PubMed”

In this study, once-daily 5% minoxidil foam and twice-daily 2% minoxidil solution both promoted hair regrowth in women with female pattern hair loss, but noninferiority of the foam was not established.

research Demographics of Women with Female Pattern Hair Loss and the Effectiveness of Spironolactone Therapy

26 citations , September 2015 in “Journal of The American Academy of Dermatology”

In this study, spironolactone was reported to stabilize or improve female pattern hair loss in 74.3% of treated women, especially those with signs of hyperandrogenism.

research Factors Associated With Female Pattern Hair Loss And Its Prevalence In Taiwanese Women: A Community-Based Survey

33 citations , November 2012 in “Journal of The American Academy of Dermatology”

This study reported that female pattern hair loss was prevalent in 11.8% of women aged 30 and older and was associated with high fasting glucose, fewer childbirths, oral contraceptive use, and excessive ultraviolet exposure.

A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

research A Randomized, Single-Blind Trial of 5% Minoxidil Foam Once Daily Versus 2% Minoxidil Solution Twice Daily in the Treatment of Androgenetic Alopecia in Women

100 citations , June 2011 in “Journal of The American Academy of Dermatology”

This study found that a once-daily 5% minoxidil topical foam is as effective as a twice-daily 2% minoxidil topical solution for hair growth in women with androgenetic alopecia, with fewer side effects and greater styling convenience.

research Innovative Use of Spironolactone as an Antiandrogen in the Treatment of Female Pattern Hair Loss

53 citations , May 2010 in “PubMed”

This paper discusses spironolactone as a potential off-label treatment for female pattern hair loss, noting its ability to halt hair loss progression and induce partial regrowth in a significant number of women but reports no new clinical results.

research Successful Treatment of Female-Pattern Hair Loss with Spironolactone in a 9-Year-Old Girl

26 citations , April 2009 in “Australasian Journal of Dermatology”

In this study, a 9-year-old girl with female pattern hair loss showed clinical improvement and hair regrowth after six months of daily oral spironolactone.

research Treatment of Female Pattern Hair Loss with a Combination of Spironolactone and Minoxidil

21 citations , January 2007 in “Australasian Journal of Dermatology”

This case report describes how a 53-year-old woman with female pattern hair loss experienced further hair regrowth when topical minoxidil was added to her spironolactone treatment after initial results plateaued.

research Treatment of Female Pattern Hair Loss With Oral Antiandrogens

179 citations , March 2005 in “British Journal of Dermatology”

This study found that 88% of women with female pattern hair loss who received oral antiandrogens saw no progression or improvement in their condition.

research Female Pattern Hair Loss

226 citations , September 2001 in “Journal of The American Academy of Dermatology”

Hair loss in women is genetic, diagnosed by examination and biopsy, and treated with minoxidil, finasteride, or transplantation.

research The Prevalence and Types of Androgenetic Alopecia in Korean Men and Women

157 citations , July 2001 in “British Journal of Dermatology”

In this study, the prevalence of androgenetic alopecia among Korean men and women was found to be lower than in caucasians, with Korean men showing more frontal hairline preservation and a higher incidence of 'female pattern' hair thinning.

research Quantitative Assessment of Spironolactone Treatment in Women with Diffuse Androgen-Dependent Alopecia

7 citations , January 1990

This study found that spironolactone at doses of 75 or 100 mg per day did not improve hair density after six months in women with female pattern hair loss, suggesting that higher doses may be necessary.