Thank you for your question.
You’re asking if spironolactone damages your kidneys and is it safe to take for 6
months to a year. Well certainly, you submitted a question that is appropriate for female
pattern hair loss and is a common question that is often discussed in our practice with
patients with this condition.
A little bit of background, I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial
plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island
for over 20 years. I am also the founder of TrichoStem™ Hair Regeneration Centers, a
system we developed for men and women with androgenetic alopecia using Acellular matrix
and platelet-rich plasma (PRP) and we’ve doing this treatment since 2011. And we developed
a system that is essentially working both with patients who are already on spironolactone
as well as with most of our female patients who have never been on spironolactone.
So to understand the thinking behind the use of spironolactone, when I see patients who
come to me who have female pattern hair loss and typically, a dermatologist has prescribed
spironolactone as a way to block testosterone with the working diagnosis that androgenetic
alopecia is due to testosterone sensitive hair follicles so they suppress the testosterone.
Now it is known that this drug is a diuretic, it works in the kidneys. And I think the way
this question is most appropriately answered is to discuss the impact of spironolactone
on the kidneys with your doctor. It is routine to have lab tests done to check kidney function.
But I can tell you that I have patients who have been on spironolactone for years. In
fact, it is also part of many birth control pills to have spironolactone as part of the
birth control pill as a way to help, for example, patients with acne. Acne is also associated
with an imbalance in testosterone and testosterone blockade has certainly helped patients with
acne.
I can tell you that from a clinical perspective that when we treat patients with Hair Regeneration
and to go back to the origins of this treatment, we developed this treatment after using a
material called extracellular matrix with platelet-rich plasma (PRP) to help patients
with hair transplants have better healing. In other words, we wanted the donor area to
heal better and we wanted the hair grafts to survive. And so this stem cell based technology
also resulted in thinning hairs becoming thicker.
Well, it has been a significant benefit for our patients for women who have come to us
from around the world with female pattern hair loss. And until this point, when we’ve
taken on this challenge, there really was not much available for female pattern hair
loss. Besides the use of spironolactone, there was also the use of minoxidil and I can tell
you that most of our patients who have tried minoxidil who were women didn't seem to find
much value in it.
Now as far as the effectiveness of spironolactone, I can tell you just anecdotally from the feedback
I get from my patients, there’s a large percentage of our patients who are on the
drug who aren't sure that the drug is helping. And there’s a certain percentage of patients
who say that they did see an improvement being on the spironolactone. Since I don't prescribe
spironolactone and I leave it up to their dermatologist to decide whether or not to
continue the drug. I don't interfere with that process.
What we do is we do our treatment of Hair Regeneration which is an injection treatment
that has consistently resulted in regrowth of hair, thickening of thinning hair and prolongation
of the hair growth cycle. And with data now it’s going on beyond 7 years, it has had
a very high rate of success essentially about 99.9% or more for female pattern hair loss.
And this is actually interesting because it was a challenge as it was for both male and
female pattern hair loss to develop an algorithm and a system of dosing and placement so that
we would get good results. And with women, we’ve had many challenges in the early years
and ultimately, it’s become quite a really gratifying benefit to our patients to be able
to help treat a condition which unfortunately, there’s no other medical intervention in
contrast to men for the option of taking finasteride.
So I would say that there is an opportunity for you to have this discussion about your
concern about kidneys with your doctor about the dosage. In fact, because the drug is a
diuretic, a lot of our patients would mention that they had to get up at night frequently
to go to the bathroom because they're on a diuretic while others felt that they can tolerate
the drug without any problem. It is a discussion to have with your doctor. It’s in the context
of your general medical profile and of course, with routine lab tests to see kidney function
and also monitor that effect.
It’s important to also, in my opinion, to explore other options for the treatment of
female pattern hair loss. As I said, we’ve made a big impact with Hair Regeneration.
And with a long history of experience, I can tell you that in our practice, it is also
very straightforward with the exception of some diagnostic unknowns where patients come
with a presentation of female pattern hair loss and may have other conditions where we
still have to do biopsies and look at other possible causes. But for androgenetic alopecia,
Hair Regeneration has worked out very well and has been a sustainable approach without
the use of other drugs. It doesn't mean that there isn't value because I also explain to
our female pattern hair loss patients that women are particularly sensitive to hormones,
hormone balance where testosterone, estrogen, progesterone as well as thyroid as well as
other important variables in the blood such as iron levels, Vitamin D. Further, women
appear to also be sensitive to stress induced hair shedding which is a distinction from
genetic pattern hair loss.
So I always say that it’s important to have a team approach when it comes to managing
hair loss. That means being followed by a medical doctor, OB-GYN in terms of hormone
levels and optimizing hormone therapy if appropriately, endocrinologist, dermatologist. And from our
end, we can stimulate hair growth with Hair Regeneration and we have a certain understanding
as to the predictability based on a patient’s profile. And so essentially, spironolactone
may have a value in your situation depending on your doctor’s opinion on the impact of
testosterone on your hair loss.
So I hope that was helpful, I wish you the best of luck and thank you for your question.