Efficacy of oral spironolactone in the treatment of androgenetic alopecia in female patients: A case series of 11 patients

Androgenetic alopecia (AGA) affects nearly half of all women and is characterized by progressive hair thinning due to follicular miniaturization driven by dihydrotestosterone. Current FDA-approved treatments, such as topical minoxidil and off-label oral finasteride, offer limited efficacy, prompting interest in alternative therapies. Spironolactone, an aldosterone antagonist with anti-androgenic properties, has shown potential in reducing androgen-mediated follicular damage. This prospective case series evaluates the efficacy and safety of oral spironolactone in 11 female patients with AGA. Patients received spironolactone at daily doses ranging from 25 mg to 100 mg, alongside combination treatments including topical minoxidil, platelet-rich plasma, low-level laser therapy, and nutritional supplementation. Over a treatment duration of 6 to 36 months, ten patients demonstrated a one-grade improvement on the Sinclair scale, while one patient with severe AGA showed no response, potentially due to poor adherence. Treatment was generally well tolerated, with mild side effects such as mastodynia, menstrual irregularities, and dizziness reported in a minority of patients. The findings suggest that spironolactone is a safe and effective option for managing female AGA, although its efficacy may be limited in advanced cases. Further large-scale randomized controlled trials are warranted to establish optimal dosing strategies and long-term safety profiles.