Spironolactone for Acne - Health Tips

Thoughts on Spironolactone for Acne by Dr. Angela Bowers, MD
November 2020

Spironolactone has been widely used for over 50 years to treat fluid retention, mild high blood pressure, and a few rare hormonal problems. In 1991, it was found to be highly effective in the treatment of certain hormonally-related conditions of women. It cannot be used by most men because of side effects.

What are “hormonally-related conditions”?

  1. Adult acne
  2. unwanted facial or body hair, and
  3. “pattern” hair loss of the scalp account for the vast majority.

It is not uncommon for a woman to have two, or even all three of these hormonal problems. They are almost never caused by abnormally high (or low) hormone levels. In fact, hormone levels are usually normal. The problem is not with how much hormone is made, but how much hormone is used at its destination, in this case your oil glands and hair follicles. If your oil glands and/or hair follicles are too sensitive to normal fluctuations in your hormones, you “overreact” to those fluctuations. The result is one or more of the problems listed.


  1. Adult acne is NOT the same as teenage acne, and does not usually respond to teen acne treatments.
  2. “Pattern” hair loss is as common in women as baldness is in men. However, women do NOT go bald the way men do; their hair just becomes thin in the same, central area of the scalp.
  3. The same hormones can cause hair LOSS on the scalp and hair GROWTH elsewhere. How could that be? Because different hair follicles have different hormone receptors.

Spironolactone does not change your hormone levels, because as mentioned, hormone levels are not the problem. It works by preventing hormones from binding to your hair follicles and oil glands, blunting the unwanted effect. Since your hormone levels remain the same, hormone-associated side effects are avoided. Of course, no drug is completely free of side effects, but in our years of experience with this therapy, side effects have been quite rare, and those we have seen have been quite mild. Less than 5% have noticed irregular or frequent menstrual periods, which can be easily controlled with birth control pills or other methods. The package insert lists breast tenderness and fatigue as other possible side effects. Very few of the several thousand women we have treated with spironolactone has experienced either of these but they are possible.

The package insert also mentions reports of ”tumors in laboratory animals." This is outdated and misleading information. Spironolactone has been prescribed for over 50 years, with many people taking it daily for years at a time, yet there is no evidence that it has caused a single tumor in a human, even after many years of continuous treatment. It is our opinion that any such risk is negligible. You must not get pregnant while taking this drug or use it with the birth control pill Yasmin. We recommend 2 forms of birth control if one is sexually active.

If your blood pressure is normal, spironolactone will not affect it. However, if you are taking any other blood pressure medicines, spironolactone may increase their effect. If you are being treated for high blood pressure now, please tell us. We may be able to substitute spironolactone for one or more of your present medicines. Please ask your internist or family doctor about any potential problems with blood pressure medicines (or any other medication you are taking), or ask him or her to call me to discuss it. Spironolactone should NOT be taken with drugs known as ACE inhibitors.

Most people must take spironolactone regularly for a minimum of 4 months to have a beneficial effect. If it proves to be effective, you can count on remaining on spironolactone for 6 to 12 months. While taking spironolactone, do not eat LARGE AMOUNTS of whole-grain cereals, bananas, potatoes, tomatoes, carrots, celery, orange or grapefruit juices, clear broths, or salt substitutes such as "Nu-salt". REASONABLE AMOUNTS of any of these foods is not usually a problem.

Source: Vivacare
Last updated : 2/10/2023

Spironolactone for Acne - Health Tips originally published by Vivacare