Hi all,

I was reading a few entries people had posted about trying two common drugs out there which affect hormones and can be helpful for treating women's hair loss; Spironolactone and BCPs.  Before you read this, take a salt pill!  I'm not giving specific medical advice and as with everything in medicine, remember that issues are complex!  Some aspects of a drug are good, some aspects are bad!  Nothing in medicine is pure black and white and I think when we are looking for answers to our hair loss questions we wish for a definitive answer where none exists.  That being said, on to the shades of gray...

I'm about to make some gross generalizations, but just for a primer, testosterone is bad for hair, estrogen is good and protective.  The reason testosterone is bad likely has to do with the fact that it makes a tiny little hormone called DHT  (DiHydroTestosterone).  DHT causes hair loss in men almost every time.  Its role in female hair loss is less defined, mostly because so many different medical conditions (stress, thyroid problems, menopause and pregnancy, low protein, low iron, different medications, and on and on...) can cause hair loss in women!

Spironolactone is a drug that has been around for a long time and has a good safety profile.  It is a "potassium-sparing diuretic" which means it is commonly used to treat blood pressure and it works by making you pee a lot more.  Normally when you pee, one of the things you pee out is potassium.  Because it is "potassium-sparing" some patients can experience an increase in their potassium levels.  At its worst, this can cause your heart to beat in irregular ways (among other things - but this is the main one), but mild increases are not a problem.  It can actually be a good thing in patients who are LOSING potassium or have low levels.

The reason we use Spironolactone in women's hair loss is because it lowers testosterone (didn't know your kidney was involved, did you?), and testosterone/DHT can be a cause of or simply exacerbate hair loss in women.

BCPs (Birth Control Pills, also known as OCPs - Oral Contraceptive Pills) are used to help with hair loss in women mainly because they raise or stabilize estrogen levels (among other hormones, but this is the main one).  There are very few studies which establish when this may be an effective medication for women's hair loss, and the formulation that is most often used (Yasmin) has not been studied extensively either.  However, we have case studies and patient experiences which tell us that it can be helpful!  So, we doctors try it because we want to help...!  BCPs have a good safety profile and can be beneficial for more than just hair loss.  Remember that if you are a smoker you should not be taking them since they would increase your risk of blood clots - very dangerous!

If your doctor puts you on either of these medications, it is a fair bet your doc thinks your hair loss is caused at least in part by hormones.

Incidentally, if you are a smoker, STOP!  It is WELL ESTABLISHED that smoking contributes to hair loss!

Finally, remember that due to the cycles of hair growth, you need to take these medications for at least a year before you can say they are working!  This may seem like a while but be patient, you can get through it and the results will be worth it for you!  There is hope!  Stick with it!  Think of it like a new vitamin you are trying...

Hope all this helps everybody!  I send a lot of my patients to this site so thank you for being such a supportive community!

Warm Regards,
Dr. Sara

Dr. Sara Wasserbauer
drwasserbauer@californiahairsurgeon.com
1.877.8.HAIRMD