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Spironolactone is commonly used in the treatment of hirsutism in women, and is considered to be a first-line antiandrogen for this indication. [68] Spironolactone can be used in the treatment of female-pattern hair loss (pattern scalp hair loss in women). [69] There is tentative low quality evidence supporting its use for this indication. [70]
The Randomized Aldactone Evaluation Study (RALES) trial is a landmark clinical study that assessed the impact of spironolactone, an aldosterone antagonist, on morbidity and mortality in patients with severe heart failure due to systolic dysfunction. [1] The findings from this trial significantly influenced the treatment guidelines for heart ...
The AR antagonism of spironolactone mostly underlies its antiandrogenic activity and is the major mechanism responsible for its therapeutic benefits in the treatment of androgen-dependent conditions like acne, hirsutism, and pattern hair loss and its usefulness in hormone therapy for transgender women.
However, spironolactone is metabolized to three active metabolites, which give it prolonged activity (13.8 – 16. 5 hours). Spironolactone has a long half-life and is excreted 47-51% through kidneys. Patients with chronic kidney disease therefore require close monitoring when taking the drug. Spironolactone is also eliminated through feces (35-41%
The steroidal aldosterone antagonists can also be used for treatment of primary hyperaldosteronism. Spironolactone, a steroidal aldosterone antagonist, is also used in management of female hirsutism and acne from PCOS or other causes. [4] [5]
As with androgen-dependent skin and hair conditions, the most commonly used antiandrogens in the treatment of hyperandrogenism in women are cyproterone acetate and spironolactone. [13] Other antiandrogens, like bicalutamide, may be used alternatively.
Treatment depends on the underlying cause. [4] Symptoms of hyperandrogenism can be treated with birth control pills or antiandrogens, such as cyproterone acetate or spironolactone. [1] [4] Other measures may include hair removal techniques. [3] The earliest known description of the condition is attributed to Hippocrates. [5] [6]
In some cases, other medications like spironolactone may be prescribed off-label for hair loss. This is typically only used in women and not in men, because in men it can lead to gynecomastia ...