How Does Topical Spironolactone Work?
Oral spironolactone has been used as a potassium-sparing diuretic since 1960s, marketed under a variety of brand names, including Aldactone, Novo-Spiroton, Aldactazide, Spiractin, Spirotone, Verospiron and Berlactone. It is often shortened as spiro. It was serendipitously discovered to reduce hair in female who had too much hair (hirsutism) in 1990s. Soon it was used off-label to treat female pattern hair loss by experts in hair loss field. It appears to be counter-intuitive that a substance can be used to treat both excessive hair and hair loss at the same time. In fact, oral spironolactone works for hirsutism treatment by reducing the testosterone level (female with hirsutism have high male hormone testosterone); while it works as an effective hair loss treatment due to the same reason– reducing testosterone level. As we know, female and male pattern hair loss is caused by excessive dihydrotestrone (DHT). Testosterone is a precursor for DHT. By reducing testosterone level, it lowers DHT level. In addition, spironolactone binds to DHT receptor of the hair follicles so DHT cannot bind to it and do any damage to the hair.
Topical Spironolactone results:
Sinclair et al performed a clinical study with 40 female taking oral spironolactone (200mg daily). It showed 88% of women receiving oral spironolactone either stopped the progression of their hair loss or saw improvement [Reference 1].
Carolyn et al did a retrospective study and found that 73% of the subjects (29 out of 39) with female pattern hair loss who received oral treatment (~110mg daily) reported stabilization or improvement of their hair loss [Reference 2].
Adamopoulos et al studied the effect of oral spironolactone in 4 young people (age from 19-23 year old) . The four people (two female and two male) took 100 mg spironolactone twice daily for 6 months. Results showed hair loss was reduced significantly and more hairs are in growing phase (anagen phase) in all 4 people. The study also showed a considerable degree of relapse post the treatment, which indicates the continuous use of spironolactone is necessary to keep the result [Reference 3].
Although there is no official study reported in peer review articles to demonstrate how well topical spironolactone works, there is little doubt it works just as efficient as oral spironolactone. Hair loss experts have used topical spironolactone for hair loss treatment in women and men for long time. Dr. Richard Lee, a Los Angles based dermatologist, was probably the most famous one. He used it to treat his male and female customers for more than 10 years until his retirement.
Spironolactone vs finasteride
Spironolactone is a weaker DHT blocker compared to finasteride. However it is generally considered to be safer than finasteride. See here for the possible finasteride side effects.
Topical spironolactone side effects?
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. .
What is the drawbacks to the use of topical spironolactone?
Although topical spironolactone is pharmacologically one of the very effective topical treatments for male and female pattern baldness, there are inherent drawbacks, e.g. spironolactone has a disagreeable odor if it is not formulated right. We spent years of research and development and made this product completely free of any unpleasant odor. See Maxogen-S for details
Topical Spironolactone Ingredients
Although all topical spironolactone creams have 5% spironolactone, the rest ingredients vary from one brand to another. Maxogen-S has additional active ingredients such as retinol, caffeine and copper-tripeptide.
How to apply topical spironolactone?
Dab some of spironolactone cream on your fingertip and work it in around the base of the hairs. You just need a thin film covering your hair loss area. It can be used with a topical minoxidil product. For example, you can apply Maxogen-S first and wait for half an hour to allow it to be absorbed before applying Minoxidil product.
Conclusion
Topical spironolactone works as an effective hair loss treatment by two mechanisms (1) lowering testosterone level locally in the scalp; (2) blocking follicle DHT receptors. It is a very good alternative to finasteride. It can be safely used by men and women. It is particularly suitable for those who are concerned about the side effects of finasteride. It is often used together with minoxidil.
Reference 1: British Journal of Dermatology, 2005, V152, issue 3, page 466-273, Treatment of female pattern hair loss with oral antiandrogens.
Reference 2: J AM ACAD DERMATOL, 2015, v73, issue 4 page 704-705,Demographics of women with female pattern hair loss and the effectiveness of spironolactone therapy.
Reference 3: Clin Endocrinol (Oxf). 1997 Dec;47(6):759-60.Beneficial effect of spironolactone on androgenic alopecia.)
