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Can spironolactone be used for hair loss in women in the UK?
Short answer
Doctors sometimes prescribe spironolactone for female pattern hair loss, but it is not licensed for that in the UK: its licence covers heart failure, liver and kidney-related fluid retention and a hormone condition called primary aldosteronism. The British Association of Dermatologists lists it among unlicensed oral options. It needs blood tests, and it must be avoided in pregnancy. WMG Meds does not prescribe it.
Key facts
- Spironolactone is licensed in the UK for heart failure, cirrhosis with fluid, nephrotic syndrome and primary aldosteronism. Hair loss is not an indication, so this use is off-label.
- The BAD says spironolactone and similar anti-androgens are not licensed for female pattern hair loss and should be avoided in pregnancy and breastfeeding.
- The product information requires potassium and kidney blood tests, because high potassium can be dangerous.
- Evidence for its use in hair loss is mostly from retrospective studies.
- Licensed minoxidil is the treatment with a UK licence for women. Finasteride is not recommended for women.
What spironolactone is, and its licence
Spironolactone is a diuretic (water tablet) that also blocks the action of androgens, the "male" hormones that everyone has. The Aldactone summary of product characteristics (SmPC) lists congestive cardiac failure, cirrhosis of the liver with fluid, malignant ascites, nephrotic syndrome and primary aldosteronism as its indications. Hair loss, excess hair growth and acne are not listed.
Because of its anti-androgen effect it is used by some doctors, including dermatologists, for female pattern hair loss. The British Association of Dermatologists (BAD) says spironolactone, cyproterone acetate, flutamide and bicalutamide can block the action of androgens on the scalp and may bring some improvement, but are not licensed for female pattern hair loss. When a doctor prescribes a licensed medicine for a condition outside its licence, that is off-label prescribing; the doctor takes responsibility and should explain the risks. The BAD adds that, without a licence, funding is a matter for local NHS decisions, so availability varies.
What the evidence shows
The evidence for spironolactone in female pattern hair loss is real but modest. Most of it comes from retrospective studies of patients treated in clinics, which can show that many women improve or stabilise but cannot prove the tablet caused it. One 2026 single-centre retrospective study of 187 women followed for 24 months found that 54.4% of those taking spironolactone (128 women) improved by at least one grade on the Sinclair scale. Another 2026 network meta-analysis of 27 articles (3,012 patients) ranked a combination of minoxidil and spironolactone highest, but its authors urged caution and called for more multicentre studies.
Neither is a randomised licensing trial, so what these figures can tell an individual woman is limited. Hair treatments of all kinds work only for as long as they are taken, and results vary.
Safety: what a prescriber must check
Potassium and kidneys. The Aldactone SmPC warns that high blood potassium (hyperkalaemia) can cause heart rhythm problems that "may be fatal", and requires potassium and creatinine to be checked after starting or increasing the dose and regularly afterwards. It is contraindicated in people with hyperkalaemia, Addison's disease or significant kidney impairment.
Other medicines. Several interact. The SmPC says ACE inhibitors should not routinely be used with spironolactone, and lists potassium supplements and potassium-rich salt substitutes, lithium, digoxin and anti-inflammatory painkillers (NSAIDs) as interactions.
Pregnancy and breastfeeding. The SmPC says it should not be used in pregnancy unless the benefit justifies the risk, or during breastfeeding. The BAD says spironolactone and cyproterone acetate should be avoided in pregnancy because they can cause feminisation of a male foetus. Reliable contraception is therefore usually discussed.
Common effects. The SmPC lists menstrual disorder and breast pain in women, dizziness and nausea among its undesirable effects. In men it can cause breast enlargement (gynaecomastia), and other treatments are licensed for male pattern hair loss.
Report a suspected side effect through the Yellow Card scheme.
What is licensed for women, and what WMG Meds does
Minoxidil applied to the scalp is the treatment with a UK licence for female pattern hair loss: a 2% solution used twice a day and a 5% foam used once a day. See can women use minoxidil and the female pattern hair loss guide. The NHS says finasteride is generally not recommended for women; see can women take finasteride.
WMG Meds does not prescribe spironolactone. If you are considering it, the right first step is your GP or a dermatologist, who can check your blood pressure, kidneys, potassium and medicines, look for causes such as PCOS, thyroid problems or iron deficiency, and decide whether it suits you. For other causes of shedding, see does stress cause hair loss and telogen effluvium. If you would like a doctor's view on which treatments we can offer you, start the free online assessment.
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Start your free assessment →Related questions
Is spironolactone licensed for hair loss in the UK?
No. Its UK licence covers conditions such as heart failure and primary aldosteronism. The BAD says spironolactone is not licensed for female pattern hair loss, so use for hair loss is off-label.
Can I get spironolactone for hair loss on the NHS?
Some NHS dermatologists or GPs prescribe it off-label, but availability depends on local funding and policy. Ask your GP or dermatologist.
Do you need blood tests on spironolactone?
Yes. The product information requires potassium and kidney function (creatinine) to be checked after starting or increasing the dose and then regularly, because raised potassium can be dangerous.
Is spironolactone safe in pregnancy?
No. The SmPC says it should not be used in pregnancy unless the benefit justifies the risk, and the BAD says to avoid it because it can cause feminisation of a male foetus. Tell your doctor if you are pregnant or trying to conceive.
Can men take spironolactone for hair loss?
It is not a standard treatment for male pattern hair loss. Breast enlargement (gynaecomastia) is a listed side effect in men, and other treatments are licensed for men.
Sources
- Aldactone 25 mg film-coated tablets: summary of product characteristics (eMC, revised January 2026)
- British Association of Dermatologists: Hair loss, female pattern (patient information leaflet, October 2024)
- Gil-Redondo R et al. Spironolactone versus bicalutamide for female pattern hair loss: a 24-month unicenter retrospective comparative study. Dermatol Ther (Heidelb) 2026 (PMID 42565959)
- Bai Y et al. Combination therapy in androgenetic alopecia: a network meta-analysis of minoxidil and other pharmacological agents. Aesthetic Plast Surg 2026 (PMID 42168420)
- NHS: About finasteride
- MHRA Drug Safety Update: Off-label or unlicensed use of medicines, prescribers' responsibilities
Facts checked against these sources on 22 October 2026. This page is general information, not personal medical advice. Read our editorial policy.