Spironolactone for hair loss: the London women's guide
Spironolactone is finasteride's counterpart for women — off-label, effective, and increasingly the first thing a London trichologist prescribes.
Dr. Amara Okafor
Consultant Trichologist · Harley Street
In short
- Originally a blood pressure drug — it blocks androgen receptors as a secondary effect.
- Standard dose for hair: 100–200mg daily.
- First results at 4–6 months; verdict at 12.
- Must not be taken if trying to conceive; contraception is required in reproductive-age women.
Spironolactone is the workhorse of London female hair loss prescribing. Licensed for blood pressure and heart failure, prescribed off-label for hair since the 1980s. It works by blocking androgen receptors — the same biology that drives the female pattern of thinning.
Who it suits
Female pattern hair loss, PCOS-driven thinning, acne accompanying either. Post-menopausal women can take it without contraception concerns; reproductive-age women need reliable contraception due to fetal risk.
Dosing and monitoring
Standard London protocol:
- Start at 25–50mg daily for 2 weeks.
- Titrate to 100–200mg daily by week 6.
- Check blood pressure and potassium at 4 weeks and 3 months.
- Combine with topical minoxidil for stronger response.
Side effect profile
Most commonly: increased urination, breast tenderness (usually settles), menstrual irregularity, occasional dizziness on standing. Serious side effects (high potassium) are rare in healthy women but require the blood monitoring above.
Spironolactone is the drug that made female hair loss treatable at scale.
Frequently asked
Common questions
Can men take spironolactone for hair loss?+
Almost never — it causes breast tissue development in men. Finasteride is the male equivalent.
What if I want to switch from finasteride?+
In women, spironolactone is usually first-line; finasteride second. Switching is straightforward under a prescriber.
How much does it cost in London?+
Generic spironolactone is inexpensive — £8–£20 per month on private prescription; free on NHS if prescribed.
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