Beyond Boundaries: The Transformative Potential of Spironolactone in Female Pattern Hair Loss

Female Pattern Hair Loss (FPHL) is a common, progressive, non-scarring alopecia characterized by diffuse thinning over the crown with preservation of the frontal hairline. It results from androgen-mediated follicular miniaturization, shortening of the anagen phase, prolongation of telogen, and progressive reduction in hair shaft diameter. Beyond cosmetic concern, FPHL significantly affects psychological well-being and quality of life. Spironolactone, a potassium-sparing diuretic with antiandrogenic activity, has emerged as an effective systemic therapy in FPHL. It exerts its effects through competitive inhibition of androgen receptors, partial suppression of 5-α reductase activity, reduction of circulating androgens, and stabilization of the hair growth cycle. Clinical studies demonstrate improvement in hair density, decreased shedding, and disease stabilization, particularly in women with features of hyperandrogenism. The drug is generally well tolerated, cost-effective, and associated with good long-term adherence under appropriate monitoring. Although therapeutic benefits are maintained during treatment, recurrence is common after discontinuation, indicating the need for sustained therapy. Novel topical formulations and combination approaches may further enhance outcomes. Larger, well-designed trials are required to clarify optimal dosing strategies and long-term safety.