FAQs - Spironolactone

Q. Are there any other topical medications that are effective as anti-androgens and that will prevent or reverse MPB? 
A. Yes.  There are several, but not all are safe. The two safe and effective ones are preparations of spironolactone and solutions of azelaic acid.  Some are not safe. Cyproterone is a potent anti-androgen and has been tried as a treatment for women with acne, but Cyproterone is not available in the U.S.  Flutamide® is also a very potent anti-androgen, but has not been proven safe as a topical medication.  Flutamide® is a potent anti-androgen, but can have very serious, even life-threatening side effects.

Q. What is spironolactone? 
A. It’s a medication that has been used for more than 30 years to treat hypertension and fluid retention. Regrowth offers a 2% spironolactone in 60 mL bottles with a dabber applicator and a 2oz jar of 5% Spironolactone Lotion. The pharmaceutical effects of topical spironolactone are local to the skin where it is applied and there are no systemic effects from its use on the scalp.

Q. What does spironolactone have to do with treating male pattern baldness? 
A. There are three distinct benefits of topical spironolactone in its use as a treatment for MPB.  (1). Spironolactone significantly reduces the amount of DHT in the scalp by inhibiting the conversion of precursor steroids to DHT.  (2). Spironolactone reduces  DHT in the scalp by converting localized testosterone into estrogen, which is thought to be protective of the hair follicles.  (3). Spironolactone blocks the follicular androgen receptor sites, thereby rendering any residual or circulating DHT harmless to the hair follicles.

Q. What are topical spironolactone’s side effects? 
A. Spironolactone is rapidly and completely metabolized in the skin and does not affect any other organ system. In about 1% of patients, a rash can develop. If this happens, the patient should discontinue use of topical spironolactone. .

Q. Why haven’t other doctors used topical spironolactone to treat male pattern baldness? 
A. Since Regrowth, LLC made topical spironolactone available to treat MPB in 2001, numerous other medical practices have also offered it.

Q. Are there any drawbacks to the use of topical spironolactone?
A. Although topical spironolactone is pharmacologically one of the most effective topical treatments for MPB, there are inherent drawbacks, e.g. spironolactone has a disagreeable odor, which is enhanced by evaporation of the alcohol when it’s in solution form

Q. Why didn’t you put spironolactone directly into your minoxidil solutions, so it would have been more convenient to use? 
A. When minoxidil and spironolactone are combined in the same solution, they will chemically react and degrade each other, causing a particularly offensive odor. Since this chemical reaction requires many hours to occur, the reaction does not occur if minoxidil and spironolactone are applied to the scalp one after the other, from separate containers.

Q. Will my hair have an unpleasant odor if I use spironolactone? 
A. It may. We've worked with a well-known pharmacologist and a reliable biochemical laboratory to produce a 2% a Spironolactone solution that minimizes the offensive odor and remains under control at room temperatures. Nevertheless, do not apply spironolactone solutions before strenuous exercise, as excess body heat can degrade the spironolactone resulting in an unpleasant odor. To avoid this odor, apply the spironolactone solution only before going to bed at night, and then shampoo your scalp in the morning.  If you apply 2% spironolactone in the morning, you may swim, rinse, wash or shampoo your hair an hour after application. Most of the medicines that absorb into the dermis do so within an hour after application.

Q. Does the 5% Spironolactone Lotion have an unpleasant odor associated with it? 
A. We seldom have complaints regarding odor associated with the 5% spironolactone lotion, although a few patients, who have a heightened sense of smell, have complained.  When spironolactone is incorporated into a lotion form, the odor is minimized because there is no volatile substance to disperse the scent.