Spironolactones and Hair Loss

Dr. Rassman, I have read on HairLossTalk, the following:

“It’s been firmly established that male pattern baldness is initiated by DHT attaching to the receptor sites on the hair follicles. Genetically, only the follicles on the top of the head are encoded with the receptor sites, which explains why hair along the side of the head and in the back of the head is not lost with age. The attached DHT on the receptor site is perceived as a foreign body and the immune system begins to destroy the hair follicle, shortening the growth phase and causing the hair shaft to become progressively finer in texture. In extreme cases, only a vellus hair remains. The good news is that the follicles have the inherent capacity to mature to their former size.

Encouraged with the success of Propecia (Finasteride) to reduce the amount of DHT in the scalp of patients with male pattern baldness (MPB), doctors and scientific researchers took another look at existing medications that are known to act as anti-androgens.

However, there have to be stringent criteria for an anti-androgen that can be used to combat or even reverse pattern alopecia. The ideal anti-androgen should have the following properties:

(1) It has to have potent anti-androgen activity (2) It should selectively prevent or successfully compete with DHT without changing testosterone levels (3) It should be effective topically, so it can be conveniently applied with minoxidil solutions and (4) Even though it’s easily absorbed into the skin, it should not have any systemic effects.

That’s a tall order. Surprisingly enough, there is such a medication: Spironolactone. For over thirty years Spironolactone has been used as an antihypertensive and a diuretic. More recently, it has been used to treat hirsutism (excess body hair) in women. Using Spironolactone to treat hirsutism may sound contradictory, but body hair (e.g. chest, face, axilla, pubis, etc.) is promoted by testosterone and since Spironolactone is a potent anti-androgen, it’s successfully used to eliminate unwanted hair on the body.

On the top of the head, where the hair is adversely affected by DHT, Spironolactone has just the opposite effect. Spironolactone exhibits anti-androgenic effects in both males and females. Taken orally, it is such a potent anti-androgen that, although it is an effective anti-hypertensive drug, it is rarely used to treat men with hypertension because of its feminizing properties, including painful gynecomastia.

However, applied topically, Spironolactone does not have any systemic side effects. Among its other properties as an anti-androgen, Spironolactone also effectively prevents DHT from attaching to the receptor sites on the hair follicles. As a result, the follicles no longer atrophy and can mature again to their normal size. And it does so without decreasing the circulating levels of DHT in the body. By comparison, Finasteride inhibits the formation of DHT, causing troublesome side effects in many patients.”

What do you have to say about Spironolactones?

Spironolactones have been used for hair loss for decades. Early in my career, I had asked well respected dermatologists about their experience with spironolactones and the results for the treatment of hair loss. The consistent story I got from them was that they were not efficacious and patients who used them, with or without other injectable medications used in the head, had no significant demonstrated benefit. With that knowledge, the written material that you’ve sent me seems to fall flat, missing some elements of science in the practical world of clinical medicine.