Spironolactone for hirsutism: Everything you need to know

In a nutshell

Hirsutism is a common problem affecting around 4-11% of women, mainly those diagnosed with PCOS. This condition causes excessive growth of dark or coarse hair in the face, chest, and back. Affecting appearance, this condition can cause a lot of insecurities, making women seek effective treatment solutions. And the use of spironolactone for hirsutism is one of them.

Spironolactone is a potassium-sparing diuretic known for having anti-androgen effects. It inhibits essential enzymes responsible for the synthesis of testosterone and its conversion to a DHT hormone. Studies show the high effectiveness of this medicine with documented improvements in 19 out of 20 patients with both PCOS-related and idiopathic hirsutism

Hirsutism is a condition affecting women that results in excessive, male-pattern growth of dark or coarse hair in certain areas, such as the face, chest, and back. It’s a rather common issue facing about 4-11% of females in the world, with the highest prevalence (65-75%) among women who have polycystic ovary syndrome (PCOS). Needless to say, this condition can cause insecurity and social anxiety by affecting a female’s appearance and body image. Hence, women who face it are actively seeking solutions that work.

In this article, we’ll review one of the popular treatments–spironolactone for hirsutism and its effectiveness.

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Understanding Hirsutism and Underlying Hormonal Issues

Hirsutism causes excessive hair growth atypical for females. It has a male-pattern nature, stimulating the growth of darker or coarser hair in areas typical for men, such as the face, upper lip, chin, chest, abdomen, back, arms, buttocks, or thighs.

Naturally, this male pattern issue is caused by male hormones, such as testosterone. In women, these hormones are called androgens and although they are naturally present in your body in small amounts, their excess can create a hormonal imbalance and lead to various problems, including excessive hair growth. This is the reason why hirsutism is especially common among women with PCOS because this condition usually implies increased androgen levels.

Apart from high androgens and PCOS, hirsutism can also be stimulated by:

• Congenital adrenal hyperplasia (CAH) 
• Androgen-secreting tumors
• Certain medications (e.g. minoxidil, danazol, phenytoin, etc.)
• Excessive cortisol
• Insulin resistance
• Increased sensitivity of hair follicles (in this case, even small amounts of androgens can cause excessive hair growth)

Why Do Women Need to Treat Hirsutism?

Hirsutism is a condition that affects your physical appearance. Respectively, it has both physical and psychological effects on you. Having to deal with excessive hair, especially on the face, can be incredibly distressing for a woman and cause a range of psychological issues, such as self-consciousness, anxiety, and even depression.

What’s more, hirsutism is almost always a sign of deeper underlying medical problems, such as a hormonal imbalance, PCOS, or others. That’s why diagnosing the cause and finding effective treatment is crucial both for your health and mental well-being.

How to Treat Hirsutism

If you are dealing with excessive hair growth, you can address this issue both on the inside and outside. The most common treatment methods include:

• Lifestyle changes - An adjusted diet and regular exercise can help you to manage weight and address hormonal imbalances. This is especially important for women with PCOS, whose symptoms can worsen due to weight gain and insulin resistance, which can be treated through lifestyle changes.
• Hair removal - Shaving, laser hair removal, waxing, and electrolysis can help you treat the consequences of hirsutism and get rid of the hair you already have.
• Natural remedies - Some natural supplements, such as spearmint, saw palmetto, zinc, and others, have been linked to a pronounced anti-androgen effect and thus, can help reduce your levels of male hormones and stop (or slow down) hair growth.
• Medical treatment - Finally, receiving proper medical treatment for the underlying health problems is also crucial to stopping hirsutism. It’s possible to use oral contraceptive pills, anti-androgen medications (such as spironolactone for hirsutism), and insulin sensitizers to medically address the problem.

What Is Spironolactone?

Spironolactone is a potassium-sparing diuretic approved by the FDA for treating high blood pressure and heart failure, as well as hypokalemia–a condition in which you have a potassium deficiency in the blood. It works by preventing your body from absorbing too much salt and thus, helps to keep potassium at a healthy level.

Apart from affecting your potassium levels, this medicine is also known for interacting with your hormones. In particular, spironolactone is shown to inhibit the 17α-hydroxylase enzyme, which is crucial for the biosynthesis of testosterone. It also inhibits 5-alpha reductase–the enzyme responsible for converting testosterone to a more potent DHT hormone and inhibits aldosterone that binds mineralocorticoid receptors in the adrenal glands. All these hormone-related features make it an effective anti-androgenic medicine. That’s why it’s possible to use spironolactone for hirsutism and the treatment of other androgenic issues, such as acne, alopecia, and others.

Effectiveness of Spironolactone for Hirsutism

Although there are a number of different medical treatments, the use of spironolactone for hirsutism has been shown to be one of the most effective ones. This method has been used for many decades and meticulously researched in many studies and clinical trials. Clinical and endocrine evaluations have shown a significant effect on the quantity and quality of hair growth in 19 out of 20 patients after the treatment with spironolactone. The trials have been conducted on patients with moderate to severe hirsutism cases, which shows the high effectiveness of this medication.

It has also been shown that spironolactone has a positive effect on people with different causes of hirsutism. Namely, the treatment was effective for women who have hormone-induced or PCOS-related hirsutism. At the same time, this medicine has shown a positive effect on idiopathic hirsutism–a condition when excessive hair growth does not have any specific cause but rather an increased sensitivity of hair follicles.

Spironolactone Dose for Hirsutism

Now that you know that using this medication for excessive hair is proven to be effective, let’s briefly review the existing recommendations on the right spironolactone for PCOS dosage:

• Although it’s possible to start with 50 mg per day, currently the recommended dose for effective treatment is between 100-200 mg/day.
• The daily dosage is recommended to be divided into 2 doses.
• For long-term treatment, the max dose of spironolactone for PCOS is 400 mg/day. 

To find the perfect dosage, it’s important to assess the severity of hirsutism and the underlying issues that contribute to it. It’s highly recommended to consult with a healthcare provider to develop the optimal treatment plan.

Spironolactone for Hirsutism: Evaluating the Safety and Potential Side Effects

Generally, using spironolactone for hirsutism is considered safe. The majority of possible side effects are considered not dangerous, though they can cause certain inconveniences.

The primary side effects include:

• Fatigue
• Breast tenderness
• Menstrual irregularity
• Increased urination
• Electrolyte imbalance

Some people who should not take this medicine are those with an allergic reaction to spironolactone, severe kidney problems, and Addison’s disease. Pregnant women may also want to postpone treatment due to the existing risk of feminizing male fetuses.

There also might be sexual side effects, such as vaginal dryness or lower libido. 

FAQ

What Is Spironolactone?

Originally, spironolactone was a potassium-sparing diuretic used to keep potassium at a healthy level and treat high blood pressure, heart failure, and hypokalemia. However, this medicine is also known for its pronounced anti-androgen effect, which makes it suitable for treating PCOS and hirsutism.

How effective is spironolactone for hirsutism?

Compared to other available treatments spironolactone has been shown to have a rather high effectiveness. Studies show significant improvements in the quality and quantity of hair in 19 out of 20 patients with medium to severe cases of hirsutism. This treatment is also equally effective for PCOS-related and idiopathic hirsutism.

What is the max dose of spironolactone for PCOS?

Generally, the optimal spironolactone for PCOS dosage is between 100 and 200 mg per day. The maximum dosage for long-term treatment is 400 mg/day. However, the perfect dosage should be identified individually with a healthcare provider.

Conclusion

Hirsutism is a rather common condition that affects many women across the globe. Still, despite its commonness, this condition still remains very high-impacting, especially on the emotional level. Naturally, women who have excessive hair growth tend to feel insecure, anxious, and distressed about their condition. That’s why finding the optimal treatment is crucial both for your physical and mental health.

Spironolactone for hirsutism is considered one of the most effective medical treatments. Thanks to its anti-androgen features, this medicine can help you restore your hormonal balance and effectively battle excessive hair even in idiopathic hirsutism. However, though this medicine is generally considered safe, it’s important to receive personalized guidance from a healthcare provider.

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