Are Prescription Tablets Effective for the Treatment of Female Pattern Hair Loss?

Female pattern hair loss (FPHL, or ‘androgenetic alopecia’) can be extremely distressing for women. I have many patients who start noticing thinning at their parting or crown of the head in their thirties. We think this type of hair loss is due to too many androgens or an imbalance in hormones or even an increased hair follicle sensitivity to androgens.

So can ‘anti-androgen’ type tablets work? The most common one used in dermatology is called spironolactone. One way it works is by decreasing the amount of testosterone in the blood.

Searle et al just published a short review article about the use of spironolactone in dermatology (June 2020 – doi: 10.1111/ced.14340). They found only 4 studies published, all in the last 5 years, about the use of spironolactone for FPHL, none of which were randomised controlled trials. A total of 279 women were included in all 4 studies and the results across the board were fairly inconclusive. One of the studies looked at combination treatment of spironolactone and oral minoxidil. One of them compared spironolactone to cyproterone acetate (another anti-androgen) and found no difference between the two.

However, it is important to note that spironolactone is relatively safe and well-tolerated by most patients so if you are really struggling with your hair loss it is worth discussing with your doctor to see if it is something you can try. Note also that there is no consensus on dose required but generally it is 100-200 mg a day and it takes time to see any benefit if you are going to see a benefit (we are talking 12+ months at least).

Bottom line: There is currently no evidence that there is an effective prescription tablet treatment for female pattern hair loss.