Hair plays an important role in identity, self-perception, and psychosocial functioning. Hair loss can be a devastating experience that decreases self-esteem and feelings of personal attractiveness while also leading to depression and anxiety. Although increasingly popular, surgical hair restoration, including hair transplantation, is costly and carries considerable risk. In this case, spironolactone helps a lot. let’s see “What is spironolactone? and How spironolactone help in hair loss?”
What is spironolactone?
Spironolactone also is known by its trade name Aldactone is a medication that has been used for almost 60 years and has a number of benefits. Spironolactone helps in many applications. One such application is the reduction of DHT found in the body or more specifically the scalp. It is a topical cream that is effective in the treatment of certain hormonally related conditions for adult acne, unwanted facial or body hair and hair loss.
How spironolactone mechanism works.
Spironolactone is a drug that undergoes metabolism to give the active metabolite which runs into competitive blocks. The binding of the aldosterone to the mineral corticoid receptor inside the cells of the collecting duct of the nephron inhibits the activity of the receptor and consequently decreases the expression of the genes that encode proteins of the sodium channels.
This leads to the inactivation of the sodium channels as well as the sodium, potassium, ATPase pump and stops the production of new channels on the apical surface. This ultimately reduces reabsorption from the lumen into the blood and decrease in potassium secretion into the urine.
Fair Conditions for Spironolactone use.
First is acne. Women who suffer from acne, hair loss, spironolactone has been found to be an effective treatment. Short and long term has been deemed safe. It is also used to treat excessive hair growth. Hirsutism also knew as excessive hair growth is a common symptom in women who suffer from polycystic ovarian syndrome or PCOS.
This condition is caused by an excess amount of androgens such as DHT in the body and spironolactone has been proven to effectively reduce the level of androgen present in the body. A study was performed on 1500 patients suffering from heart failure.
700 patients received a daily dose which was 25 milligrams of spironolactone. It was found that the patients who received the spironolactone had a 35 % less frequency of required hospitalization and also had a 30 % decrease in the risk of death.
DHT, the androgen hormone is also responsible for excessive hair growth in women and also responsible for baldness which can occur in both men and women. Spironolactone has been shown to reduce the levels of DHT in the body and has found to be an effective treatment for those suffering from hair loss.
What is DHT? How is the production of DHT useful for hair growth?
DHT is a chemical that’s produced when testosterone, the male sex hormone comes into the contact with an enzyme called sulfa reductase. When someone suffers from androgenetic alopecia also referred to as male pattern baldness, the production of DHT leads to the miniaturization of hair follicles in DHT sensitive regions of the scalp.
To understand this concept, first, we have to understand how our hair grows. There are three phases associated with hair growth- anagen, catagen, telogen. Anagen is the phase of active hair growth and this phase has a length between 2-6 years. Catagen is also known as the transition between active growth and breast.
What is telogen?
Telogen is the phase in which the follicle is at rest and is most commonly associated with the shedding of hair. What happens during the above three phases is that the hair follicles are minimized by DHT. As the follicles miniaturize by DHT, the growing phase shortens. This means that over time shorter and shorter hairs will be produced.
At the same time, the telogen phase lengthens. Eventually, the hair becomes so short that they will no longer peek through the follicles and the follicles stay in a perpetual state of rest. Those individuals suffering from male pattern baldness, the reduction of DHT is vital in this case in order to prevent further hair loss and stimulate hair growth.
What causes your hair to fall out?
Female pattern hair loss (FPHL) is one of the most common causes of hair loss encountered in clinical practice. FPHL is a complex polygenic disorder characterized clinically by diffuse hair thinning over the scalp and increased hair shedding. FPHL is caused by a combination of genetic and hormonal factors.
The hairs produced become smaller and smaller in diameter, shorter in length and lighter in color by the follicles until eventually the follicles shrink completely and stop producing hair. Histologically, the hallmark is site-specific hair follicle miniaturization. Site specificity may result from epigenetic modification of the androgen receptor gene.
The proportion of miniaturized follicles increases with the severity of hair loss. Age-related, so-called alopecia also shows hair follicle miniaturization and is indistinguishable from FPHL. FPHL adversely impacts on quality of life. FPHL is progressive and the risk, prevalence, and severity of FPHL increase with age.
Results effectiveness of Spironolactone treatment
In a population study of over 700 women, FPHL, defined as Sinclair stage 2, it was found in 12 % of women aged 20-29 years and 57 % of women aged 80 years. Severe hair loss, defined as Sinclair stages 3, 4 and 5, increased from 4 % among women aged 20-29 years to 30 % among women aged 80 years.
Approximately 60 % of these women will have histological evidence of alopecia on scalp biopsy with a terminal to vellus hair ratio is greater than 4:1. 100 women with Sinclair stage 2-5 female pattern hair loss were treated with a daily capsule containing 0.25 mg minoxidil and 25 mg spironolactone. Results: So it was found that the mean age of 49 years old.
Mean hair loss severity at baseline was Sinclair 3.79. The mean hair shedding score at baseline was 5.82. The mean duration of diagnosis was 7.5 years.
While the majority of research surrounding the use of spironolactone in the treatment of androgenetic alopecia has been performed on women, the visuals can still be used to show the effectiveness of treatment.
Once the study was performed on a 53-year-old woman with clinical evidence of female pattern baldness which is similarly linked to DHT, the subject was initially treated with a 200-milligram overdose of spironolactone daily and she had documented hair re-growth at the 12th month.
It was at this point that a twice-daily dose of minoxidil, 5 % solution was prescribed and further hair growth was documented. The starting dose for spironolactone usually is 25 mg twice daily and increased by 50 mg daily up to 200 mg daily as tolerated. History shows that spironolactone supplementation is effective not only for stopping the hair loss but also for hair re-growth. This combination treatment can be effective for those with male pattern baldness also.
How Uses of minoxidil severe in hypertension
Minoxidil is an antihypertensive derivative and a potent vasodilator that is effective orally for severe hypertension. When applied topically, minoxidil has been shown to arrest hair loss or to induce mild to moderate hair re-growth in approximately 60 % of women with FPHL.
A clinical trial comparing 5 % and 2 % formulations of minoxidil found a mean increase in nonvellus hair counts after 48 weeks of 18 % and 14 % respectively. Topical minoxidil was approved by the FDA in 1992 for the treatment of female pattern hair loss.
It appears to be a safe therapy with side effects only of local irritation and hypertrichosis of the temples, and there is a low incidence of contact dermatitis. Clinical regression occurs within 6 months, to the state of baldness if the treatment is stopped that would have existed if the treatment had not been applied. For patients to maintain any beneficial effect, applications must continue indefinitely.
Benefits of Spironolactone
Spironolactone is an aldosterone antagonist-
It has been used as a potassium-sparing diuretic for over 50 years. It is structurally asteroid, with basic steroid nuclei with four rings. Its primary metabolite, canrenone, is the active antagonist of aldosterone and contributes to the diuretic action.
Drug is absorbed quickly-
This drug is absorbed quickly and metabolized by the liver to canrenone and potassium canrenoate. It is available in 25 and 100 mg tablets. No dermatologic indications for spironolactone have been approved by the FDA; however, it is widely used off-label in the treatment of FPHL and has been shown to arrest progression in over 90 % of women.
You may be wondering if androgenetic alopecia is more common in men and why are the majority of studies are androgenetic alopecia are performed on women? Well, there’s a very good reason for this. Because the supplementation of spironolactone in men is connected to feminization.
Cannot men use spironolactone to treat hair loss?
According to a 2004 study entitled gynaecomastia and antihypertensive therapy or supplementation of spironolactone has a number of side effects. These effects include gynecomastia which is basically the male breasts. The incidence and severity of these effects are dependent on being given dosage. Though even and low overdosage of 25 milligrams a day had a 10 % incidence of gynecomastia and all breast pain.
Does this mean that men cannot use spironolactone to treat hair loss? Absolutely not! Although supplementation has been linked to gynecomastia and other feminization effects, topical supplementation was found to be highly effective in the treatment of alopecia and the side effects were minimal or even non-existent.
While oral supplementation may be a viable option for women suffering from androgenetic alopecia, the best course for men is the topical supplementation of spironolactone. Oral minoxidil was approved by the FDA for the treatment of hypertension in 1979.
It was first noticed to improve hair loss in male androgenetic alopecia in 1980. Topical minoxidil received FDA approval for male androgenetic alopecia in 1988 and for female pattern hair loss in 1992.
Oral minoxidil is not often used in the treatment of AGA, largely because of the side effect profile seen at standard doses.
Women are much happy with this treatment-
The women’s hair loss clinic was established in 1995 and it currently treats over 750 women with FPHL. The mainstay of therapy was an oral antiandrogen such as cyproterone acetate or spironolactone used either alone or together with topical minoxidil.
Over the years, the clinic had accumulated a number of women who were either not satisfied with the results achieved by conventional therapy, or who were intolerant of topical minoxidil. Off-label use of a half or quarter tablet of oral minoxidil led to a noticeable improvement in hair density in most of these women but was complicated by postural hypotension, fluid retention, and hypertrichosis.
How to reduce the risk of fluid retention?
To reduce the risk of fluid retention and to augment therapy by the addition of an oral antiandrogen, 25 mg of spironolactone was added to the capsule. For women with low blood pressure, 50 mg of sodium chloride was also added to the capsule. The combination of spironolactone and minoxidil is likely to have an additive benefit in FPHL. Most women noticed a reduction in hair shedding at 3 months and an increase in hair density at 6 months.
When applied topically to the scalp, spironolactone appears to have only a localized effect. This is a great treatment for men who would like to try spironolactone but wary of their more common oral side effects. Unfortunately, spironolactone is not available over the counter so the help of a doctor in obtaining the treatment is required.
How do we apply spironolactone to the scalp? There’s no right or wrong way to apply spironolactone. Some individuals who are using to treat male pattern baldness can apply to problem areas while other individuals can apply to the scalp.
Possible side-effects of Spironolactone
Spironolactone can also cause side-effects like all the medicines, although not everybody gets them. The side effects depend on the doses and the duration of treatment. The most common side-effects are hyperkalemia, reproductive system, and breast disorders, including gynecomastia.
Although hyperkalemia is a known side-effect of spironolactone, one study of 974 male and female participants receiving spironolactone found that only 0.72 % of participants experienced mild hyperkalemia (5.1-6.0 mEq/L) with no patients experiencing moderate or severe hyperkalemia. Regardless, providers may consider checking potassium levels within 4 to 8 weeks of initiating treatment with spironolactone.
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