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Spironolactone And Hair Shedding -- Any Updates?

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#1 Iris9

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Posted 03 July 2012 - 06:13 AM

Hi everyone,

I've been reading for a long time but this is my first post.

I started taking 50 mg/day of spiro about 1.5 months ago. (I'm also on Ortho-tricyclen and Tazorac, both of which I've used years.) For about a week, I've been shedding a lot of hair on my head. Not clumps, but lots of diffuse strands all over my head when I shower or brush my hair. Even if I'm not touching my hair, strands are falling onto my arms and clothing during the day much more often than usual. It's starting to make me really nervous. My skin is FINALLY starting to clear, and I really don't want to stop taking spiro just as it's beginning to work. But I would rather have acne than lose my hair.

I've seen a lot of posts on this site from other women describing a similar phenomenon, and I was hoping for an update on their shedding. For those who experienced hair loss/shedding on spironolactone / Aldactone, did you push through the shedding phase and find that it eventually stopped? Lower your dosage? Stop taking spiro altotgether?

I'd sincerely appreciate any thoughts/advice! Thank you!

#2 Green Gables

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Posted 03 July 2012 - 11:40 AM

I noticed that my hair goes in shedding cycles throughout the year, before I was on spiro. Apparently that is normal, some parts of the year your hair sheds more and some it sheds less. It is normal to lose around 100 hairs a day. I may have noticed a bit of shedding myself, but it's hard to say because you get a bit paranoid on any new medication. I've been on it for 4 months and I don't feel like I have a consistent pattern of hair loss.

I can't find her post, but one lady here had a bit of a shed, and then realized it was all the new baby hairs pushing out the old hairs. The change in hormones can abruptly switch your hair from the static phase to the new hair phase. The net effect: her hair was fine.

Unless you're under 125lbs, I wouldn't say your dose is too high. Here is the caveat: you are also on OTC which is already supposed to change your hormone levels in the direction that would clear your acne. Adding spiro on top of that could be pushing you too far over the edge and giving you a case of estrogen dominance. Is there any way you can go off the OTC?

P.S. Spiro is often prescribed to treat hair loss. I don't think the spiro itself is hurting you, but the combination with your birth control might.

The most notable functions of Spironolactone as a hair loss treatment is that it works as an antiandrogen by decreasing the production of testosterone by the adrenal glands and by preventing DHT from binding to its androgenic receptor. Some have suggested that Spironolactone can bond to the hair follicles before DHT can bind to the receptor. As a result it would be logical to use Finasteride (Propecia / Proscar) in conjunction with Spironolactone. The former reduces the amount of DHT on our scalp while the latter blocks the remaning DHT at the receptor sites.]


Edited by Green Gables, 03 July 2012 - 11:42 AM.


#3 Iris9

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Posted 03 July 2012 - 12:37 PM

Thanks! It is certainly possible that I'm over-analyzing this shedding because, as you said, I've been on high-alert since starting spiro for any weird side effects. I keep holding my hair in a ponytail to try to measure whether it feels thinner. It does, to me, but I also could be imagining it because I'm so freaked out by the volume of hairs coming out of my head. I counted around 20 hairs come out when I washed my hair today and then another 30 when I combed my hair (really gently) immediately afterward. I suppose that's only half of the daily 100, but I'm assuming I'm also losing a lot during the day with my hair down.

I weigh between 120-125 lbs, so I guess I could potentially see results from a decreased dosage of 25mg -- especially because, like you said, I'm already on OTC which regulates hormones. But my derm seemed to think 50mg was already a pretty low dose and appropriate for my size. I've been on the OTC for 9 years without stopping (I'm 26) and even though I don't think it has played much of a role in reducing my cystic acne, I'm honestly too scared of what might happen to my skin without it to stop taking it!

Just read your post again and the "estrogen dominance" line caught my eye. That makes sense to me because my testosterone levels were never elevated before starting spiro. Despite my normal lab results, my derm thought spiro would be a good fit for me because I have cystic acne localized on my chin/jaw and she suspected my androgen receptors could be overly sensitive to even a normal amount of testosterone. So maybe normal baseline testosterone levels + spiro + BC --> heightened estrogen --> hair shedding? Arghh.

Edited by Iris9, 03 July 2012 - 12:28 PM.


#4 bizz

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Posted 04 July 2012 - 10:32 AM

Happened to me too. I hate this drug, and I'm on your dose. However, I adjusted some. I'm not taking this with birth control.

I recommend buying a biotin-based thickening/strenghthening shampoo from Whole Foods or online at a site like iherb.com. Don't use the typical drugstore "strengthening" shampoos--in my experience (and admittedly I have weird hair--coarse, thick, oily at roots, dry at ends), it just weighed hair down and didn't really help because the "strengthening" ingredients were at the bottom of the list. The health food store shampoos are better and not much more expensive, if you shop around. You can also look on ebay.

I bought a CVS thinning hair treatment set (shampoo, conditioner, serum) and still shed a lot in the shower, but I think I always have. The set unfortunately is discontinued, but one of the major ingredients is biotin. It helped subtly, but I noticed.

Take a multivitamin, too. There are vitamins out there specifically for hair, skin and nails.

Good luck!

Edited by bizz, 04 July 2012 - 10:33 AM.


#5 Green Gables

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Posted 04 July 2012 - 10:45 AM

Thanks! It is certainly possible that I'm over-analyzing this shedding because, as you said, I've been on high-alert since starting spiro for any weird side effects. I keep holding my hair in a ponytail to try to measure whether it feels thinner. It does, to me, but I also could be imagining it because I'm so freaked out by the volume of hairs coming out of my head. I counted around 20 hairs come out when I washed my hair today and then another 30 when I combed my hair (really gently) immediately afterward. I suppose that's only half of the daily 100, but I'm assuming I'm also losing a lot during the day with my hair down.

I weigh between 120-125 lbs, so I guess I could potentially see results from a decreased dosage of 25mg -- especially because, like you said, I'm already on OTC which regulates hormones. But my derm seemed to think 50mg was already a pretty low dose and appropriate for my size. I've been on the OTC for 9 years without stopping (I'm 26) and even though I don't think it has played much of a role in reducing my cystic acne, I'm honestly too scared of what might happen to my skin without it to stop taking it!

Just read your post again and the "estrogen dominance" line caught my eye. That makes sense to me because my testosterone levels were never elevated before starting spiro. Despite my normal lab results, my derm thought spiro would be a good fit for me because I have cystic acne localized on my chin/jaw and she suspected my androgen receptors could be overly sensitive to even a normal amount of testosterone. So maybe normal baseline testosterone levels + spiro + BC --> heightened estrogen --> hair shedding? Arghh.


A lot of dermatology is educated guessing. You may want to try cutting your dose in half for a few weeks and see what happens.

Also I am surprised she put you on 50mg straight away. When I started, I was instructed to start on 25mg for a week before I upped to 50mg. Your body needs time to adjust to a dose.

By the way I did not see real results from spiro until month 3...but now my jaw is clear...it has NEVER been clear since I was 13!! It takes patience. Hormones are a slow and tricky process.

I second the other poster's recommendation for biotin. Not something I currently do, but a few years ago I was trying to grow my hair out. I found the best results with high potency biotin and MSM supplements. I actually like the MSM supplements better...the high potency biotin made me irritable.

Edited by Green Gables, 04 July 2012 - 10:48 AM.


#6 Iris9

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Posted 04 July 2012 - 02:25 PM

Green Gables, I'm happy you've seen such good results!! This is why I'm not ready to give up on spiro. After a bit of an initial breakout, my skin is clearing now and it's amazing. I haven't had any cystic acne in weeks, which is atypical and awesome. I have experienced some smaller, regular-looking zits, but they are the kind that clears in 2 days with some benzoyl peroxide, so I'm still thrilled.

Happened to me too. I hate this drug, and I'm on your dose. However, I adjusted some. I'm not taking this with birth control.

I recommend buying a biotin-based thickening/strenghthening shampoo from Whole Foods or online at a site like iherb.com. Don't use the typical drugstore "strengthening" shampoos--in my experience (and admittedly I have weird hair--coarse, thick, oily at roots, dry at ends), it just weighed hair down and didn't really help because the "strengthening" ingredients were at the bottom of the list. The health food store shampoos are better and not much more expensive, if you shop around. You can also look on ebay.

I bought a CVS thinning hair treatment set (shampoo, conditioner, serum) and still shed a lot in the shower, but I think I always have. The set unfortunately is discontinued, but one of the major ingredients is biotin. It helped subtly, but I noticed.

Take a multivitamin, too. There are vitamins out there specifically for hair, skin and nails.

Good luck!


Bizz, thanks so much. Do you have any suggestions for brands of biotin shampoos that worked for you? Also, has the amount of shedding changed at all as time went on, or has it been consistent? And have you noticed thinning of your hair, or do you think you are making new hair that's rapidly replacing the shedding hair?

#7 Iris9

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Posted 11 July 2012 - 07:14 AM

As an update, in case anyone is in a similar situation: I went to my derm and she said she said the shedding is telogen effluvium. She doubts it was triggered by the Aldactone because telogen effluvium usually starts 2-3 months after the trigger, and my shedding started only a month after I started Aldactone. Just to be safe, though, she recommended lowering my dose to 25 mg/day for awhile to see how that goes. She also put me on a high dose of biotin (5mg), which won't stop the hair loss, but hopefully will make the new baby hairs grow back more quickly.

I've been on 25 mg/day for a week and I'm still shedding. Thankfully, reducing my dose hasn't caused me to break out at all and my skin is still almost completely clear.

Hopefully the shedding stops soon--and if the 25mg continues to keep my acne at bay, that would be great too. I'd love to stay on this low dose!

Edited by Iris9, 11 July 2012 - 07:16 AM.


#8 bizz

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Posted 15 July 2012 - 04:39 PM

@Iris9: Try on a site like this.

I tried the CVS brand only because I got it on clearance and am finishing it off, but makeupalley should have reviews on stuff like the Avalon shampoo. You can search for certain shampoos by condition to (e.g. go to Amazon and put it "thinning hair", it'll have the same ingredients--biotin, horse chestnut, etc.)

I'm thinking of buying saw palmetto (which is supposed to do what the spiro does, and yet, here I am, thinning at the crown) or horse chestnut supplements to help.

Just be wary of the ingredients in any shampoo, I was lucky enough that the CVS had no sunflower oil or anything, but a lot of these stupid organic shampoos do, even for stuff that's meant to add body. http://www.iherb.com...shampoo&x=0&y=0

Good luck!

#9 Iris9

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Posted 08 August 2012 - 05:17 AM

Another update: my hair is back to normal -- the shedding stopped!

I'm so happy I stuck it out and didn't stop taking spiro. The shedding lasted for a little over a month, and I was panic-stricken almost every day. In other good news, I switched from 50 mg/day to 25 mg/day when the shedding began, and after being on 25 mg/day for over a month, my skin is still really clear. I haven't had any cystic acne since the initial breakout I had during my first week of starting spiro. I do get an annoying little pimple ("regular-people acne") every now and again, but they heal so quickly (1-2 days) compared to the cystic acne I would get before (weeks + scarring).

I think I will stay on the 25 mg/day for now since it seems to be working and only increase my dose if I start breaking out.

Just wanted to provide an update because I was so close to stopping spiro altogether when the shedding started and I'm happy I didn't. I think that my body just needed some time to adjust to shift in hormonal activity.

#10 Green Gables

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Posted 08 August 2012 - 11:09 AM

Congrats!!

#11 rosasharon40

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Posted 11 August 2012 - 10:28 AM

Hi there, thank you so much for these posts. I'm in a similar situation.... been on 100 mg of spiro for about four months now. The upside: I'm definitely seeing significant improvement in my skin, plus - I've lost about 10 pounds! The downside: I thought it was just me, but it does seem as though my hair is thinning right around my forehead. I'm really concerned and have considered not taking it anymore, but perhaps I'll try a lower dosage or wait it out a few more months before making any changes. This is such a frustrating situation to be in, particularly when I'm seeing such great results in my skin. It's comforting to know that other folks understand my dilemma.

#12 Green Gables

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Posted 12 August 2012 - 11:13 AM

Hi there, thank you so much for these posts. I'm in a similar situation.... been on 100 mg of spiro for about four months now. The upside: I'm definitely seeing significant improvement in my skin, plus - I've lost about 10 pounds! The downside: I thought it was just me, but it does seem as though my hair is thinning right around my forehead. I'm really concerned and have considered not taking it anymore, but perhaps I'll try a lower dosage or wait it out a few more months before making any changes. This is such a frustrating situation to be in, particularly when I'm seeing such great results in my skin. It's comforting to know that other folks understand my dilemma.


Definitely try a lower dose. 100mg was too high for me. 50mg has been great.

#13 Iris9

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Posted 13 August 2012 - 05:26 AM

Thanks, Green Gables!

rosasharon, I totally know what you mean. To find something that finally works for your acne and then discover that it might be causing other problems is incredibly frustrating. Did you notice that your hair started coming out a lot more than usual (in the shower, in your hands when you touched your hair, etc.) or have you just gradually noticed thinning without increased shedding?

I agree with GG that you should talk to your doctor about lowering your dose. On the other hand, if your doctor thinks that the thinning itself is caused by excess androgens, the maybe increasing your dose is the way to go. Did you have your hormone levels checked before you started taking spiro?

Good luck and let us know how it goes.

#14 jaydeec

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Posted 22 August 2012 - 02:50 PM

For the most part I shed alot of hair when I shower. I don't know if it has to do with The medication because I was shedding before. Sometimes it comes out in lil clumps Posted Image i definately feel like my hair is thin now and not thick and beautiful as everyone used to say to me Posted Image. I'm starting to become obsessed with it. IDK if its's the PCOS either. I upped my dosage to 75 mg's from 50's mg's. It has dramatically reduced the oil production of my face which I am happy about. BUT i don't want to keep losing hair, I feel like i'm going bald though. i think the fact that I constantly wear my hair in a bun and rarely brush it is making it worse. Because by the time I wash my hair (every other day, or two days) my hair is kind of knotty , so that might be making it worse. i heard some girls say Biotin helped with the growth . I think i'll try this.

Edited by jaydeec, 22 August 2012 - 02:50 PM.


#15 Green Gables

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Posted 22 August 2012 - 03:07 PM

For the most part I shed alot of hair when I shower. I don't know if it has to do with The medication because I was shedding before. Sometimes it comes out in lil clumps Posted Image i definately feel like my hair is thin now and not thick and beautiful as everyone used to say to me Posted Image. I'm starting to become obsessed with it. IDK if its's the PCOS either. I upped my dosage to 75 mg's from 50's mg's. It has dramatically reduced the oil production of my face which I am happy about. BUT i don't want to keep losing hair, I feel like i'm going bald though. i think the fact that I constantly wear my hair in a bun and rarely brush it is making it worse. Because by the time I wash my hair (every other day, or two days) my hair is kind of knotty , so that might be making it worse. i heard some girls say Biotin helped with the growth . I think i'll try this.


Are you using shampoos with harsh detergents (usually sulfates)? If you have a tender scalp or fine hair strands, harsh detergents can irritate the hair follicle.

Personally I wouldn't recommend grabbing the first sulfate-free shampoo you see on the shelf, though...big companies are jumping onto the sulfate-free bandwagon but are usually just putting in other non-sulfate detergents that are just as harsh. Whatever it takes to make a buck right?

Here are my personal brand recommendations:
-SheaMoisture
-Burt's Bees (the real Burt's Bees, not the "GUD" spinoff brand)
-As I Am (pricey)
-DevaCare (pricey)

#16 jaydeec

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Posted 22 August 2012 - 03:19 PM


For the most part I shed alot of hair when I shower. I don't know if it has to do with The medication because I was shedding before. Sometimes it comes out in lil clumps Posted Image i definately feel like my hair is thin now and not thick and beautiful as everyone used to say to me Posted Image. I'm starting to become obsessed with it. IDK if its's the PCOS either. I upped my dosage to 75 mg's from 50's mg's. It has dramatically reduced the oil production of my face which I am happy about. BUT i don't want to keep losing hair, I feel like i'm going bald though. i think the fact that I constantly wear my hair in a bun and rarely brush it is making it worse. Because by the time I wash my hair (every other day, or two days) my hair is kind of knotty , so that might be making it worse. i heard some girls say Biotin helped with the growth . I think i'll try this.


Are you using shampoos with harsh detergents (usually sulfates)? If you have a tender scalp or fine hair strands, harsh detergents can irritate the hair follicle.

Personally I wouldn't recommend grabbing the first sulfate-free shampoo you see on the shelf, though...big companies are jumping onto the sulfate-free bandwagon but are usually just putting in other non-sulfate detergents that are just as harsh. Whatever it takes to make a buck right?

Here are my personal brand recommendations:
-SheaMoisture
-Burt's Bees (the real Burt's Bees, not the "GUD" spinoff brand)
-As I Am (pricey)
-DevaCare (pricey)


To be quite honest I don't pay attention to ingredients when it comes to shampoos. As of right now I'm using that new Garnier line ''Fall fight'' It's probably hype though, biotin seems to be at the bottom of their ingredient list. Before I was using Neutrogena (can't think of the name but they come in light orange tube ''bottles'') that made my hair really soft. I've usually always used shampoo and conditioner for dry, thick/coarse hair. Everyone has always said ''You have so much hair, it's so thick'' I can feel the difference, i feel it when i grab my hair in a ponytail, when i put it in a bun :( I would say that I definately lose 100 hairs a day..when I wash it. i rarely brush it, I know sounds bad : ( lol, but my hair is frizzy and should be naturally curly so if I brush it, let's just say it looks bad, lol. All dry and unhealthy. I'd rather not brush and keep some curls. I will look into the brands you've recommended. I've seen and heard of Shea mositure and of course burt's bee's. Have you tried Biotin or Iron, which they say also helps?

#17 Green Gables

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Posted 22 August 2012 - 03:41 PM



For the most part I shed alot of hair when I shower. I don't know if it has to do with The medication because I was shedding before. Sometimes it comes out in lil clumps Posted Image i definately feel like my hair is thin now and not thick and beautiful as everyone used to say to me Posted Image. I'm starting to become obsessed with it. IDK if its's the PCOS either. I upped my dosage to 75 mg's from 50's mg's. It has dramatically reduced the oil production of my face which I am happy about. BUT i don't want to keep losing hair, I feel like i'm going bald though. i think the fact that I constantly wear my hair in a bun and rarely brush it is making it worse. Because by the time I wash my hair (every other day, or two days) my hair is kind of knotty , so that might be making it worse. i heard some girls say Biotin helped with the growth . I think i'll try this.


Are you using shampoos with harsh detergents (usually sulfates)? If you have a tender scalp or fine hair strands, harsh detergents can irritate the hair follicle.

Personally I wouldn't recommend grabbing the first sulfate-free shampoo you see on the shelf, though...big companies are jumping onto the sulfate-free bandwagon but are usually just putting in other non-sulfate detergents that are just as harsh. Whatever it takes to make a buck right?

Here are my personal brand recommendations:
-SheaMoisture
-Burt's Bees (the real Burt's Bees, not the "GUD" spinoff brand)
-As I Am (pricey)
-DevaCare (pricey)


To be quite honest I don't pay attention to ingredients when it comes to shampoos. As of right now I'm using that new Garnier line ''Fall fight'' It's probably hype though, biotin seems to be at the bottom of their ingredient list. Before I was using Neutrogena (can't think of the name but they come in light orange tube ''bottles'') that made my hair really soft. I've usually always used shampoo and conditioner for dry, thick/coarse hair. Everyone has always said ''You have so much hair, it's so thick'' I can feel the difference, i feel it when i grab my hair in a ponytail, when i put it in a bun Posted Image I would say that I definately lose 100 hairs a day..when I wash it. i rarely brush it, I know sounds bad : ( lol, but my hair is frizzy and should be naturally curly so if I brush it, let's just say it looks bad, lol. All dry and unhealthy. I'd rather not brush and keep some curls. I will look into the brands you've recommended. I've seen and heard of Shea mositure and of course burt's bee's. Have you tried Biotin or Iron, which they say also helps?


If your hair is naturally curly, you really should look into changing your shampoo...tons of curly girls have shed issues...The Curly Girl Handbook is a great resource.

I looked at the ingredients for Fall Fight, and it's just another Laureth Sulfate based shampoo. Most of the big names are. They slap a new name onto the same product.

Ingredients: http://www.makeupbea...Ingredients.JPG

I have tried biotin and iron. I did notice biotin at a high potency (5000mg, I believe) made my hair grow faster, but it also made me irritable and anxious, so I stopped.

Edited by Green Gables, 22 August 2012 - 03:53 PM.


#18 jaydeec

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Posted 22 August 2012 - 05:31 PM

Thank you for looking that up. Yeah you'd think that with the millions of dollars l'oreal makes they would make some quality products but....alas, just another big name company making money. I figured it was crap, but I like the smell and was suckered in by their dumb gimmicky commercials, lol.

Edited by jaydeec, 22 August 2012 - 05:31 PM.


#19 bizz

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Posted 27 November 2012 - 11:18 PM

You are absolutely not the only person to deal with this.

I tried taking saw palmetto to help but it made my hair greasy. I've been on this for three years. My hair is thinner at the crown and I find hair serums gross and my hair generally greasier even if I wash every other day. This leads to zits. Aldactone has not been good for my post-Accutane skin/hair. I was on Accutane for two and a half years and this for three. Aldactone was a mistake and I wish I could have seen its effects coming.

But that's me. I'm anemic and have other issues. There are hair supplements out there; most have biotin, which break me out like crazy, but I'm trying one from Swanson with Insitol, PABA, and horsetail to help. (Just got it.)

Tell your doctor. It is NOT just you, but you might be able to head this off nutritionally.

By the way--I use Suave clarifying and dandruff shampoo because I've always had greasy hair. If you can get off sulfates, that's great, but sulfates and my usual shampoos never gave me trouble till this drug. I noticed hair thinning about six months in. I'm 25, so maybe it would have happened that way anyway, but I just don't think it was age alone.

Edited by bizz, 27 November 2012 - 11:20 PM.