I want to thank Kate for emailing me this Case Report about the use of spironolactone and minoxidil in treating female pattern hair loss. The Case Report appeared in the Australasian Journal of Dermatology Volume 48 Issue 1 Page 43-45, February 2007

CASE REPORT

Treatment of female pattern hair loss with a combination of spironolactone and minoxidil

Carlijn Hoedemaker, Sylvia van Egmond and Rodney Sinclair

Summary

A 53-year-old woman with clinical evidence of female pattern hair loss and histological evidence of androgenetic alopecia was initially treated with the oral antiandrogen spironolactone 200 mg daily. Serial scalp photography documented hair regrowth at 12 months; however, the hair regrowth plateaued, and at 24 months there had been no further improvement in hair density. Twice daily therapy with topical minoxidil 5% solution was then introduced and further regrowth documented, confirming the additive effect of combination therapy.

Introduction

Female pattern hair loss is a common, psychologically distressing, age-related, androgen-mediated condition that presents with increased hair shedding and reduction in hair volume over the mid-frontal scalp.¹

Binding of dihydrotestosterone to cellular androgen receptors induces susceptible scalp hairs to undergo a progressive and orderly transition from terminal to vellus hairs to produce patterned baldness. Antiandrogen therapy with either spironolactone or cyproterone acetate is commonly used to treat FPHL, as is topical minoxidil.² The mechanism of action of minoxidil is unknown, but does not involve androgen pathways.³ The use of topical minoxidil together with an oral antiandrogen might have an additive effect; however, combination therapy has not been previously reported. [click to continue...]

Wow, I’m so happy I just found this site…I’m 20 years old, have had been genetic hair loss for four years now. About 2 years ago I had a biopsy done and my derm told me it was probably genetic, he put me on Rogaine, Spiro and Yasmin. I was on those meds for about a year… and they did absolutely nothing. Last year in the fall my hair loss was getting really bad and I was getting so desperate for something, so I spent over $1000 on getting Invisible Hair extensions. I was assured by so many people that they would be safe, and definitely the perfect solution. The extensions were great! I loved having so much hair and planned on having the extensions put back in. Well when I got them removed for the first time I was SO devastated, more than half of my already thin hair was gone.

Its been since January now since I’ve had them out and I feel like I’ve hit the bottom. I’m in college and can’t concentrate on anything. I’m always way too focused on everyone else’s hair and I feel like I’ll never feel normal again…I haven’t been able to wear my hair down since I got the extensions taken out. My poor hair is
still falling out like crazy… it’s so thin I can’t even wear it in a ponytail, I feel like I will be bald soon.

I’m so scared, nobody seems to understand. My best friend and my family just tells me to cope with it like its no big deal. I feel like I have no where to turn. That’s why I was so glad I found this forum…I really sometimes feel like I’m the only one experiencing this and it’s comforting to hear everyone’s story. I’m not sure what to do with myself, I hate going out, even going to school because I just feel so ashamed…I don’t even know where to start looking for a wig around here (I’m from Portland, OR). And I feel like seeing another doctor would also be pointless. Anyways, Thanks a lot for listening to my story.

~Veronica

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Dear Veronica,

Thank you for writing and sharing your story, I’m so sorry you are having to go through this. It probably is of mild comfort, but know you definitely are not alone and there are A LOT of women who start to lose their hair at young age. Who knew? I definitely didn’t until I started going through it. Here comes my usual disclaimer I provide on every question I respond to. I am not a doctor and cannot provide medical advice or treatment, this is just my opinion. Ok…

After reading your story I have so many questions. Did your dermatologist put you on Rogaine, Spiro and Yasmin all at the same time? You said you are 20 and have been experiencing hair loss for 4 years, so you started losing your hair at 16 and saw your doctor at 18. Did he provide any explanation as to what might have trigged your hair loss at such a young age? You stated that after a year the medications did nothing, but you didn’t say whether or not you stayed on them or took yourself off. I’m curious because if you took yourself off after a year and the following year noticed a rapid decline in your hair, then perhaps the drugs were doing more than you thought. Sometimes all the drugs can do is slow the hair loss process down and help you maintain the hair you have,. Not all women experience a phenomenal regrowth after treatment. Even after I started treatment, I never regained the hair I had and was pretty convinced the treatments weren’t working so I eventually took myself off of aldactone around 2003… I think. The dates get fuzzy. Anyways, my hair loss increased dramatically. That could have just been from getting off the drug and it may have re-stablized eventually, but that scared me enough to get back on. Not only did I get back on aldactone, but when I got back on, I had my dose increased from 100mg to 200mg a day.

If you would have asked me then about my hair, I would have complained about the hair I once had and that it was so thin and continuing to fall out. But looking back it was doing fairly well after the 200mg increase. [click to continue...]

Hi! First of all I want to say that this is a GREAT forum/blog and I give you a lot of credit for starting it, sharing your stories, and wanting to help others. THANK YOU, and I really appreciate all you’ve done and gone through. Stay strong, continue helping others and you will get through this!

I want to ask you about your thoughts on Spirinolactone, but should provide you some context first. I am 28 years old and started losing my hair around August of 2006. I was under a lot of stress with my job and not taking very good care of myself nutritionally either. So, I started with a family physician and had blood work done. Everything came back fine. She recommended I take a daily multivitamin. She also recommended me to a dermatologist. I finally saw a derm in January of 2007 (it takes FOREVER to get in) and they did some additional blood work and told me to start taking biotin as well as the daily multivitamin. Again everything was “normal” and that was it. In March of 2007 my excessive shedding stopped and my hair felt better again. So I thought the vitamins and biotin were helping and
thought stress had a lot to do with it, too.

THEN, in August of 2007 I started losing a lot of my hair again and am continuing to shed excessively. This time around the hair loss is more noticeable and my scalp is much more noticeable than the first episode. I did just move to a new state, change jobs, sell our house, etc., etc. I thought maybe it was stress again but knew I needed to see a derm to be sure. I live in Winston-Salem, NC and they have an excellent dermatology practice at Wake Forest University School of Medicine and Medical Center. They have doctors that specialize in female hair loss!! So, I finally went early this week (after getting an earlier appointment because of a cancellation). I saw 2 doctors that were fantastic. They spent a lot of time talking through everything and came to the conclusion that it’s likely androgenic alopecia. BUT, they had me take every blood test possible in case it’s related to low iron, thyroid, etc. I’m still awaiting those test results. They also think some stress could be involved, but when they performed the hair pull test on me it was positive in some areas and not in others, likely female pattern hair loss (androgenic alopecia). I am supposed to start using Rogaine for men and they will prescribe Spirinolactone if all of my blood work comes back “normal.”

So, do you know much about this drug? Does anyone else on the site know? [click to continue...]