Spironolactone: Is It Really the Safe Drug for Hormonal Hair Loss?

spironolactone is not safeThis spironolactone post is dedicated to all of my readers and patients who struggle with Pill-induced hair loss and PCOS. If the comments section on my Hair Loss post is to be believed, there are a LOT of you out there.

As a doctor and a human being, I am concerned about the growing magnitude of this problem. More than anything, I am concerned that we try to solve a drug-induced problem by throwing another drug at it.

Here is a question from my reader Ashley:

 I would love your opinion about the drug Spironolactone, one of the most famous drugs prescribed to treat PCOS. My Doctor called it ‘the safe drug’, but I hardly believe this is true.

The cutely nick-named Spiro was mentioned again and again the comments section of my Hair Loss post. Its trade name is Aldactone.  Is spironolactone a safe drug? By safe, Ashley’s doctor presumably meant that it not as likely to cause life-threatening liver-damage as the other anti-androgen drug cyproterone (Androcur).

But spironolactone is not safe. It is a synthetic steroidal drug. Pseudo-steroids intrude into your body’s normal hormone functioing. They fit crudely (like the wrong key for a lock) into your hormone receptors. Spironolactone is just like the pseudo-steroid drugs in the pill. In fact, spironolactone is very similar to the progestin drospirenone used in Yasmin and Yaz Pills.

Spironolactone fits (blocks) your testosterone receptor, which is why it’s used, but unfortunately, it also disrupts ovulation, estrogen metabolism and adrenal function. The drug causes loss of libido, menstrual irregularity, and breast pain. It has been linked with breast cysts, and possibly breast cancer. By interfering with your hypothalamic-pituitary-adrenal (HPA) axis, spironolactone causes low blood pressure, headaches, fatigue, and depression. It increases the risk of blood clots.

I know you want a fast, effective solution for your hair loss, but spironolactone is not it.  To be honest, it does not work all that well anyway. More importantly, it perpetuates the problem of PCOS and hair loss by preventing you from ever reclaiming your own hormones. Your own estradiol and progesterone are—by far!—the best repair for your hair.

220 thoughts on “Spironolactone: Is It Really the Safe Drug for Hormonal Hair Loss?”

  1. Hi Lara-
    I’ve been off of the pill for a little over a year after a LOT of support from your book and blog. Funny enough, I also went on spironolactone on the advice of my dermatologist 5 years ago, after the depo shot gave me severe cystic jawline acne. She told me never to go off of spiro unless I wanted kids, so I thought it was the only thing keeping my acne controlled.

    This year I started getting very irregular periods after being off BC for a year, and I was diagnosed with PCOS after blood tests and a “classic presentation” on my ultrasound. I was not insulin resistant, so I was told to be careful with sugar to prevent weight issues. My gyno also casually mentioned that my dermatologist never should have put me on spiro, because it “makes things worse”, but she told me to stay on it for now.

    I kept thinking about that conversation and decided to do more research. Once I learned (above) that Spiro is close match to the progestin drospirenone found in Yaz and Yasmine birth control, I was angry. All the things I went through to go off birth control felt a little pointless, when I was still taking 100-150mg a day of something chemically similar to drospirenone.

    Against the advice I was given, I weaned off of spiro slowly, taking my last pill about 3 and a half months ago.

    While things aren’t perfect (I sometimes struggle with premenstrual migraines), my cycle has returned to normal. I’m talking clockwork, same day of every month normal. I know everyone is different and this certainly wasn’t the ONLY piece of the puzzle with getting my cycle back to normal, but I feel like I was spared a lot of difficulties by just being my own advocate, reading through a lot of your blog posts, and also reading the book (maybe twice, lol).

    I suspect I don’t really have PCOS at all. My periods have always been normal other than this year of going off birth control and dealing with Spiro changes. Even when I weaned off Spiro, the acne I had was minimal, and now I just practice good skin care and take a DIM supplement. I’m still prone to cystic acne, but my skin feels fine almost 4 months into this journey…. Who’d have thought?

    Anyway, I hope this helps another reader out there who’s going through the same thing!

    Thanks for being a great source of information.

  2. Hello! ***I did post this as well in the blog “The 4 types of PCOS” but then discovered this one and found it fit well here)*****
    I am currently reading (audible version) the Period Repair Manual book. I am a woman in my early 40’s and have been off of birth control pills for about a year. I started at 21 years old for pregnancy protection and did a clinical trial so it would be free. I had always had a light version of “period acne” before this pill (Loestrin FE 1/20) but after about a year on it my acne turned into horrible cystic acne that plagued my skin and body for a few years. After using antibiotic treatment to help it and get me through my wedding I decided it was enough and I stopped both the pill and antibiotic (At that time in my mid 20’s) and went back to vegetarian and exercised. Allot of exercise…I even trained for a marathon. For that 1 year I felt great and did fairly well with little acne. Then after my marathon I took a break and got off my very strict diet and the acne came back even worse. Having dealing with this for a second time my parents brought me to a dermatologist they used for my sister and she prescribed spironolactone to me. Spironolactone had been mentioned before to me along with Accutane but I always shut those ideas down due to what it may do to my body. But in complete desperation I went on Spironolactone (the lesser evil in my mind) along with a steroid to help with the initial heavy cysts. The steroid was stopped quickly due to bad side effects and I just waited to see what spironolactone would do. And it was the magic pill that finally cured me of my cystic acne. I was amazed at how my skin looked and felt and how spironolactone along with birth control was finally my answer for life for this issue. But I was young and desperate to just be normal and take the easy route. I then continued with that duo of spirono and BC for a few years then we decided to have children. I basically went off that combo twice to have 2 children one delivered in 2008 and one in 2013. I went off a few months before conceiving very quickly with both and then stayed off until 1 year post delivery due to breastfeeding. Breastfeeding to me was my natural acne cure. With both pregnancies I had the most debilitating cystic acne I have ever had. Face, Back, chest and arms….it was very bad the 1st pregnancy and just a little better the 2nd time. Each time the breastfeeding helped to naturally cure the acne I had but it came back as soon as I stopped breastfeeding. I would pray it would not come back and as soon as it did I would go right back on my magic pill combination. I always pressed the doctors for help on how to naturally mimic my breastfeeding hormones and they would just laugh. Of course no period during my breast feeding year was great but that always came back right on cue after I was done as it always has. Which is why PCOS is always confusing to me since I have always had a period since I started at age 11. I have rarely been irregular just a handful of times in over 30 years. I have never smoked cigarettes and have tried to eat healthy and be active if not exercise for most of my life.

    Now I have a 5 and 11 year old and I am 42 and I am ready to take control of my life and hormones which I have always known from the beginning of my adult life story that they needed better balancing. I just happened to ignore that and never was able to find the right doctor to help me and I feel like I messed up beyond repair. I am now currently only on Spironolactone at 50 mg per day and it is keeping my cystic acne away. I am trying to slowly wean myself off and hope to be off in another week or so. I am very scared to get off of it and see what lies ahead of me in trying to naturally reverse my years of damage. But I am ready to try and stick with a natural plan and get off this last piece of the puzzle that has made my hormones unhappy for so long. I have been told that I am just sensitive to the normal level of androgens in my body. Which may be true. I have seen PCOS written in my Dr reports before but the type that I have is still unclear to me. I have never shown high levels of androgen or testosterone in blood work. But I am hairy (genetics) not certain if excessive is correct for me but I feel like its excessive….since I pluck coarse hairs daily from my chin. The acne has always been there since puberty but became cystic and chronic in my 20’s after BC started. I don’t fall into many other categories in regards to major issues but the mood swings I have and the overall feeling of daily tiredness, bloat, fatigue and just plain unhappiness makes me realize its the accumulation of many years of neglecting my hormones. The only major steps I have taken since having my children is now currently I am finally starting to get out and run again for exercise. I am not overweight at all. I have not weighed myself in months but I am around 100 -103 pounds and just under 5ft tall so I am very petite minus my constant bloated belly.

    So my hope is that now that I have begun to read more on how to get natural help that I can have someone guide me along. I am ready to feel to take back control of my life. I don’t know where I am now in regards to perimenopause since I am almost 43 but I want to get my hormones more balanced so I can go through that stage a little more sanely. The ups and downs have become too much to bear. I feel like right now I have put my hormones through a constant roller coaster ride and I am impressed I haven’t gone on anti depressants. I do believe birth control pills are just as toxic as tabacco and I pray both my girls will learn from my mistake and never go on it.
    Thank you for your time and I do hope to hear from you as to how I can get help.

  3. I am currently suffering endless HORRIBLE side effeects from Spironolactone! EVERYTHING you mentioned, I am dealing with, still, and I’ve been off the med for over a year now. It had an adverse affect on my collagen which, in turn, created a whole NEW list of problems! I have aged what feels/looks like 10 yrs in less than 2yrs. It has RUINED MY LIFE!! I have lost my beautiful locks, pretty skin; I started growing hair EVERYWHERE! My body stays dehydrated! Now, I may have PCOS. I have chronic fatigue as well as lupus-like symptoms. I was told that not only should I have NEVER been given this drug, BUT I was given too much! I had rapid muscle wasting! I went from having very little body fat percentage, to pretty much all fat – now considered “skinny fat”. I developed neuropathy, BP issue’s, major cortisol spikes. I have issue’s with blood sugar/insulin resistance symptoms…you mane it, I am dealing with it! I went from 100% confident to 100% self-conscious & imsecure…I very rarely leave my house. I feel HOPELESS!! And I CANNOT afford to keep seeing doctor’s & BEGGING them to help me! I have no idea what to do anymore!! I also have Raynaud’s Syndrome now thanks to the lack of/poor blood circulation I now have.

  4. Dear Lara,

    I have been on spiro for 3 years and it works for my acne. I had been on a pill for 13 years (Diane) before spiro and after I came off it my skin was a nightmare for a year.
    I would like to get off spiro but I am afraid that the same thing will happen as after stopping the pill.
    I don’t thik I could bare it mentally if I break out again, since I am 40 and have been strugglin with acne since I was 12.
    I have started taking mio inositol and now plan to buy a supplement that contains mio inositol and chiro inositon.
    What do you thing of inositol?
    Is there a way to get off spiro and not break out again?
    That you in adavance.

  5. This is so important to know! I don’t have PCOS, but I have hirsutism and apparently, it’s idiopathic. My doctors have done all types of test, not finding a cause for it, so both of them prescribed spiro on a low dose to treat my hirsutism. After reading this, I’m so stopping this! Thank you so much!

  6. I’ve been taking Spironolactone for 2 years now to treat my comedogenic acne. About 8 months ago, I’ve lost ALL interest in sex. I’ve been married for over 8 years and no issues before up until this time. Could long term use of this medication potentially be a factor in this?

  7. Hi Lara, I had a few questions regarding Aldactone. I was on BC that was causing hormonal acne so my dermo switched me to a different BC and put me on 50 mg of Aldactone. I stopped taking my BC this past March (thought it was causing weight gain but in reality it was the Aldactone) and continued with just the Aldactone which eventually got bumped up to 75mg. (I was told the only side effect of this is fatigue). Then my internal med doctor wrote me a prescription for 100mg Spironolactone (different brand& higher dose .. realize it’s essentially the same thing). However, once I made the switch in dosage and brand … I started to experience an increase in acne and a drastic change in mood (anxiety, depression, paranoia). My doctor told me those are not typical side effects of spiro but after much personal research I realize it definitely can be. I wasn’t getting a period when I was on spiro/ Aldactone but I made the decision to stop spiro cold turkey bc the anxiety/ depression was way too much. After reading it’s not best to do that but my dermo and doctor advised it (realizing they have no idea about the damage of this medicine) It’s been two months since I’ve stopped and my mood is slowly getting better… but it is very inconsistent. Is this typical? And does it eventually go back to how I was before I took spiro? Are there things I can do to accelerate the process? Coming off has been one of the the hardest things so I would greatly appreciate any advice or information. I am dairy free, gluten free , I take zinc magnesium vitamin D and a multivitamin packed w B vitamins. My skin is horrible which is too be expected but I guess I didn’t realize the mood changes , anxiety etc to linger this long after?? I would seriously beyond appreciate any words on this! I do not want to go on hormonal BC or back on Aldactone to solve this. I’ve read your blog and book about progesterone as well bc I had blood tests done and I don’t produce any… could this be because spiro suppresses ovulation and it hasn’t been 100 days since stopping the medicine??? I just want my skin and my normal mood / personality back!!!! Thank you in advance if you have the time to read this and respond. I’m sorry this post is so long (just desperate for answers).

  8. This may sound crazy but I took Spironolactone for only a few months at 44 or 45 years of age because of acne. I had tried everything else and a dermatologist prescribed it for me. I did not realize it was a androgen blocker or a bp lowering med. Or that it would affect me as much as it did. I was told it was safe. I didn’t have any major hair loss. My periods were normal. I have always had some facial hair….seems more ethnicity related or familial. I have no idea if I have PCOS. I really feel like I have more of a folliculitis situation. On the medication I felt horrible. Lethargic, headache, breast extremely tender and swollen, began gaining weight (which had not been an issue before), and kind of a burning or less ability to urinate and my period started coming every 2 weeks. I have very low blood pressure and was not even warned that this could be a problem. I went off of the drug because of side effects but I never felt quite back to the way I was before I took it. I thought maybe menopause was coming and that was why I had no energy and weight never really came off. Fast forward… I had been called back in after 2 mammograms. 1st time they said it was nothing and sent me home even though I did say I felt something was different in this breast. Next mammogram age 47, I was called back in and I had breast cancer stage 2B spread to 1 lymph node HER 2 positive. (Which is particularly aggressive) Grade 2-3 ( 3 being the worst). I ate healthy and exercised since my 20’s. Didn’t have high bp or diabetes or anything. BMI of 19. So…..I may sound crazy, but I feel like Spirolactone did change something. I’m not a Dr so I have no idea what that something was? I hate to tell people not to take something if they have a problem that seriously needs treating, but first the problem must outweigh the risk. Now, I am left dealing with all of the effects of chemotherapy, radiation, surgery, etc. which is so not good. Btw, no one has ever contacted whoever you would contact to say I got breast cancer and I did take Spirolactone. I’m sure they would never think taking it for a short time would or could do anything….but no matter if it did or did not….no one is keeping track in real life.

  9. Hello. My name is Denise. I’m 54 and have been on Aldactone for 9 years due to ascites from cirrhosis. I had an undiagnosed hepatitis infection for 30+ years. In the 9yrs I’ve gone from 50mg to 300mg daily with a 40mg lasix chaser. That’s a lot I know. My kidneys have coped well and are normal. I dont drink or smoke & eat very healthy. I’m aware of the machinations of my disease but cant seem to get any answers regarding certain medicine effects. When I started Aldactone I was 45 but still having regular albeit changing, periods. From the second I took Aldactone all periods ceased. I was told I would probably never go through menopause and up until this year I thought they were right. But now I get little heat spurts. I dont know if that is a hot flash or a new symptom in an old disease. I was given a 2yr prognosis once ascites hit but as its been 9 and my condition has improved somewhat with the clearing of the virus 2 yrs ago, I was wondering if you thought that these heat spurts might be a bit of menopause? If so, who should I speak to about it if the gyno says she doesn’t know and the liver doc says the same? I usually feel cold all the time so these little spurts are obvious when they hit, only it doesn’t happen every day and usually only happens once I’m warm be that in bed or doing tasks. Apologies for the longwinded nature of the message but I thought you might need the backstory. Any help or advice woukd be deeply appreciated. Kind regards, Denise.

  10. I have irregular periods but in the aspect of they come a week early my cycle can range from 22-29 days and they are usually heavy can last 5-9 days. I’ve been losing hair for a while since the age 25 but it’s increased over the years bald spots by 28 and increasing now that I’m 30. I do have an increased amount of body hair and recently started to get acne for the first time. My dermatologist did a biopsy no scarring or inflammation, my TSH is normal so she said it must be hormonal. Blood work showed normal hormone levels. H&H and RBC cell count normal. She prescribed spiro 25 to start and increase to 50 after 7 days. I’ve been on 25mg for a few days, my hair fell out in chunks while in the shower this morning. At this point I don’t know if androgen is the cause or what I need to do.

  11. I was first prescribed 100 mg of spironolactone per day by a world-renowned expert in female hair loss at The Cleveland Clinic. I could not tolerate the gastrointestinal side effects (pain, constipation), sleep-depriving bathroom trips to urinate several times per night, or constant thirst/dehydration while exercising/ on long runs. However, it worked astonishingly well. It didn’t just stop my excessive hair loss, I was absolutely re-growing hair I had lost in the months and years prior (high-resolution/magnification photographic images confirmed this). o, I tried to stay with it…but the side effects were insurmountable. My doctor suggested a lower dose: 50 mg/day. The side effects were still too much to bear. I tried every possible other way to restore my hair as it fell out and thinned once again after discontinuing the spironolactone: rigid low glycemic diet, metformin, biotin, iron, vit D, etc. I have always been a fit athlete who loves to exercise, so that was never an issue. Nothing worked at all- for 6 years. Then, depressed after a trip with college friends who all had their hair as full in their forties as it was in their twenties (I had had the thickest hair of all- ridiculously thick in fact), I decided that I had to give my obvious, visible scalp another chance with spironolactone. I started with 50 mg only twice per week and after a month, went to 50 mg once per week. Though I do experience some excessive urination 24-48 hours after I take the 50 mg dose as well as some breast cysts and under eye puffiness, it is tolerable. Amazingly, I have enough re-growth on 50 mg/wk to satisfy me, yet it is 1/14 the original dose prescribed to me! I share this information with you because I think there must be others seeking a solution to the very depressing problem of female hair loss who may see results from a much lower and safer dose than what their term/endo has read is necessary. I cannot be the only individual this sensitive to the med. On the other hand, it may contribute to gallstones as other estrogen therapies do, but that doesn’t get much press in the literature either.

    I would appreciate your reply.

    • thanks for sharing your story and great news that such a low dose works for you!

      And just to clarify, spironolactone is not an estrogen therapy. It’s a hormone-suppressing therapy and a diuretic.

  12. I think it is a bit disingenuous to suggest there is a link between spironolactone and breast cancer. The study you cited has a full discussion of the supposed risk, and concludes: “The data suggests that there is no definitive documented association between breast carcinoma and spironolactone ingestion after more than 30 years of spironolactone availability in the marketplace.”

    Taking any medication will affect your hormones, neurotransmitters, and overall body chemistry. We have to make calculated risks. People with severe cystic acne have higher levels of depression, less social integration, less career mobility, etc. Spironolactone is the only drug that works for many people. I believe there needs to be more evidence of serious harm before scaring potential users away from a relatively benign drug that might help them.

  13. I have been taking spiralatone for over a yr for my adult acne that I have suffered forever with after trying so many things this really works for me. But after no period for 6 months and stopped for 6 weeks to start trying for a baby I had a blood test that shows my estrodial levels were 2345 instead of between 15-350 ? Then had ultrasound done on ovaries which detected a cyst on left ovary. Is this all beacause of spiro or do I have pcos?? Please help

  14. My daughter has never had a regular period since starting at age 12. She ranges between 40-60 day cycles and it’s different every month. At age 17 they put her on lo-Loestrin fe and said it was totally safe but within 6 weeks started noticing hair falling abnormally while drying her hair. I immediate took her off and called the gynecologist who said no way it was caused from the pill and to just leave her on it longer and it would regulate. I read enough to know that wasn’t smart and took her off. I read only if you have a genetic susceptibility will this happen with high androgen pills which scares me. In 2 months of coming off the pill the shedding became horrible and she lost almost half her hair which the dermatologist said was Telogen Effluvium and give it 6 months and it will grow back. It slowly got a little better but recently picked back up again. She’s crying daily and her scalp looks thinner now and it’s harder to hide. She was tested for pcos but didn’t have the signs in ultrasound or endocrinology blood work. She does get some cystic acne on her chin monthly but it’s not horrible. I took her to a naturopath who put her on a strict diet eliminating gluten and dairy and sugar. She eats mostly vegetables, low glycemic fruit, fish, chicken, sweet potatoes and rice or quinoa. He’s convinced it’s her adrenals and she’s taking Ashwagandha and other supplements like viviscal and magnesium and zinc and vitamins but it really hasn’t helped. He said don’t try any other birth control it will just cause a worse hormonal imbalance. I’m a little scared of vitex because I don’t know exactly why her periods are irregular and don’t want to make anything happen like what happened with the pill by messing with her hormones. Her dermatologist finally saw our desperation and said we should try spironolactone for now to try to stop the shedding because she is going into her senior year in a state of depression. I know it’s not good long term but nothing natural was working and she’s only 17 and had long beautiful hair before all this. Do you think spironolactone will help temporarily while we still work on natural ways of getting her hormones in balance and promoting ovulation. I don’t want to make things worse but we tried only natural ways for 9 months and it’s not working. Please do you have any advice? Thank you!

    • I feel your and your daughter’s frustration and desperation- been there. Based on my experience, I would stay on the spirino if it is working and tolerable, but keep lowering the dose until you’ve found the lowest effective dose that works for her. I found that 1/14 the original prescribed dose worked for me. I would think any reasonable physician would work with you on this.

  15. Hi Dr Briden,

    I’ve read through Dr Prior’s website and her guidance on cyclic progesterone therapy + Spiro for high androgen symptoms: 300mg Prometrium cyclic therapy + 100mg Spiro. I’ve read your thoughts on Spiro and recommendations of dosing for Prometrium (50-100mg), and was just curious about the difference in viewpoints. Thank you!

    • Thanks for your question. Yes, I’ve asked Prof Prior about spironolactone and raised the issue that it can impair ovulation. I think her view is that it’s one of the few treatments that can really suppress androgens (which is true), but in the big picture, I prefer natural androgen blockers combined with progesterone (which is also an androgen blocker)

      • Hi – I’m dealing with androgenic alopecia (I believe trigged by hormonal BC pills) and have been prescribed Spiro by my dermatoligist but don’t like the side effects of it. I’m looking into my natural treatments. Do you recommend natural progesterone cream? How much and when? Thank you!

  16. Hi Lara,

    I was on 200mg of spiro for 4 years. The side effects of it began to persuade me that it was time to go off of it. About 4 months ago I began decreasing my dosage by 25mg every month to slowly wean myself off. However, I am now experiencing a lot of shedding that began a month ago. I knew that going off of this medication could cause this however I was wondering if you could tell me more about what might be happening.

    Will this shed continue for months as I continue to decrease the dosage or possibly even longer?
    Could this shedding possibly just be TE that will eventually grow back?
    Is this anything I can do to help any future shedding?
    Is there a better way to wean myself off of this drug?

    It is so hard to continuously watch it fall out as it is thin to begin with and I regret having gone on it. I would really appreciate any information you can provide to help me better understand.

    Thank you!

  17. Aldactone isn’t for everyone with hair loss, but it can help women whose hair loss is a result of a hormone imbalance. Learn how it works and who’s an ideal candidate for the treatment.

  18. Why does spironolactone stop periods? I had no periods (eventually over the years) but I also never experienced breast pain.

    Now that I am off of spiro I have breast pain and periods.

    If breast pain is a sign of not metabolizing estrogen properly wouldn’t that indicate that my estrogen was lower while on spironolactone if I had no breast pain while on the drug?

  19. Spironolactone worked wonders for my hair and skin. Lost half my hair got it all back on spironolactone with no side effects been on it for over ten years. I know of transgender people have used it at much higher doses for over 30 years with no issues. My hormones were already messed up. I had such oily skin and hair I was a mess. Severe painful and itchy seborrhea, from all the oil and I had excess body hair, yuck. All gone now …my hormones were already screwed up so bad no problem using a medication to fix that.

    • I just came off of spiro and will be going back on it. I must for me personally the benefits out way the risks. I cannot suffer with the symptoms of too much androgens. I wish there was a safer alternative but my quality of life matters and without it I’m certain I will have severe symptoms. I agree my hormones are already jacked up.

  20. I actually had miraculous reults with spironolactone and I was on the drug for 15 years for hirsutism and hair loss. I decided to go off of the drug bc my Mom was diagnosed with breast cancer and I feared the long term effects of this drug. Over the past 6 weeks (I stopped spiro 2 months ago) I lost half of my scalp hair volume and body hair is growing back.

    Is there a safe supplement that works as well as spiro? I know you mentioned zinc. I am at my wits end, feeling suicidal. I don’t know what is worse, taking the drugs with the risk of cancer and other things or losing my mind.

          • Thanks, I have your book and have been taking some of the supplements you recommend but without proper guidance from a health care person I don’t trust what I am doing. It feels like I am shooting in the dark and I don’t have access to anyone here who would understand your treatment m, they would look at me like I was nuts. I started taking DIM but then I recently read that it doesn’t allow androgens to turn to estrogen which equals more testosterone. So I am confused why you wrote that DIM is an anti androgen treatment.

          • DIM is an aromatase inhibitor, which means yes, it slows the conversion of testosterone to estrogen but that does not mean it causes excess testosterone. (DIM also promotes the healthy metabolism of detoxification of estrogen.)

            But DIM has another separate effect which is to block androgen receptors, which is why it’s helpful for acne and other symptoms of androgen excess.

  21. I have been on spiro for about 4.5 years now. 50 mg for hirsutism and PCOS. I have never really noticed much of a difference, but had been to scared to stop the medication because “what if my hirsutism gets worse?” However, the last few months I have noticed that I have been shedding way more than what has been normal for me. I have also noticed in the past few weeks that my body/facial hair is increasing. I was diagnosed with depression/anxiety when I was 16 (now 32) and also noticed that my moods are way off (irritability way up). I have changed my diet and lost 22 lbs. My husband and I have tried to get pregnant off and on for over a year. Reading this article has really opened up my eyes. I am 1) frustrated that my doctor put me on this spiro while it has a side effect of increased depression and anxiety and 2) that it can cause anovulation! I am coming off of it and switching to zinc, magnesium and progesterone. I do wonder, though, how should I wean myself off the medication? Thank you for this site, I have been reading so many of your posts and find them very informative. Naturopathic medicine is new to me and makes the most sense. Thank you thank you!

  22. Thank you for your post. I’ve been on Spiro for a year for adult acne, and have suffered a huge spike in my anxiety and depression. It too was marketed to me by my dermo as “the safe drug” and I blindly followed her advice. I got the Skyla IUD 6 months into starting Spiro and attributed my mood fluctuations to the IUD, never thinking it could have been the Spiro. I have since removed the IUD (too soon to tell if it has made a difference), but after reading the Period Repair Manual and doing some research, I’m now thinking the Spiro might not be as safe and could be part of the culprit in these terrible mood fluctuations.

    My question is: how do I safely come off of the Spiro? I want to do it ASAP, but also concerned that an abrupt cold turkey could have some adverse effects. Any advice?

    THANK YOU!!!!

  23. I’ve been on Spironolactone for several years now and really want to get off of it. After numerous testing, no one can determine the cause of my hair loss so I’m not sure what to address as a root cause. How do u recommend I get off of it and proceed?

    • I feel you Danyell, I’m pretty convinced that a lot of my hair loss and other hormonal problems have actually been caused or exacerbated by Spiro (I’ve been on it since I was 15 and I’m not 31). I wanted to go off of it but was scared all my hair would fall out. I’ve heard if you abruptly stop it, it can trigger telogen effluvium (aka a bunch of hair shedding) so it’s best to taper. But I can’t find anywhere how to do that best. I was on 100 mg so I just decided to cut down 25 mg every month. After about 3 weeks, I saw my doctor and she said that was pretty slow and I could probably go down 25 mg every 2 weeks. When I went down to 75mg I noticed no difference, last week I went down to 50 mg and I haven’t noticed a difference yet. If I do see more shedding, I’ll prob stay at 50 for an extra week or 2. Idk, hopefully that helps!

      • I too would like to know how to come off spiro. I was put on it for PCOS and hirsutism (sp?). However, I have recently noticed an increase in body/facial hair growth and the hair on my head has increased its shedding. I have suffered from anxiety and depression my whole life and am frustrated to now read that spiro can exacerbate my depression/anxiety and my doctor put me on it.

  24. I have an under active thyroid and PCOS, along with hair loss and thinning, thick facial hair, and I am overweight. I have been taking 75 MG of Levothyroxine for the past 4 years and have very recently been prescribed Spiro and birth control (both of which I have NOT started yet), for my hair loss. Based on the comments I am reading I am very reluctant to start this new “treatment” and would like to know what other effective treatment options I have for the hair loss, hair growth on my face and weight gain? I would really appreciate your advice.

  25. I spend countless hours every night trying to understand my hair loss and the hormonal/genetic causes. I have tried countless things, thousands of dollars later, I am in the deepest depression. Today I saw a Integrative Medicine physician specializing in hormones and reviewed my lab results. I’m happy to say, it is in line with everything I’ve read here. This site has had the most honest and straight forward information i have ever found. I am going to start bio identical progesterone and optimize my Thyroid, and hope for some success. I never understood that the progestin in OC’s is different from natural progesterone in it’s effects on the body. Thank you and I look forward to more information.

  26. Hello Lara I’m so happy to have finally found a blog like yours. I have been doing more research and I think I’m going to go off spiro. I take it for acne and hair loss but my hair still falls out so I’m realizing it may actually be contributing to it instead of helping the hair loss. It feels right intuitively and it’s nice to hear what you say about it too. I’ve been on 100 mg of spiro for about 15 years (omg!). How slowly should I taper it down to prevent a huge hair shed and breakouts? I’m 31 now and I started it when I was 16-17 after Accutane didn’t work for my acne. I was also on hormonal birth control from age 15 to 28.

    I’ve had hair loss since 2008 when I was diagnosed with hypothyroidism. I took levothyroxine until about a year ago when I started taking a compounded T4/T3 pill and it made a huge difference in my energy, weight etc. I was also scared to go off BC because I was afraid of painful periods and hair loss but I felts o much better when I went off. I’ve eaten mostly gluten free for the past several years and recently tried going dairy free for the first time. Quitting dairy was one of the best things I’ve ever done. I feel I’ve been slowly making these positive changes and getting off spiro is the last piece of the puzzle. Seeing others describe it as a prison really resonates and I’m super excited (yet scared) to break out of it as well. I just want to make sure I do it the right way. Also thinking of seeing an acupuncturist to help with the transition. Anything else you would recommend?

    • Your main goal is ovulatory cycles. It’s unlikely you’d be ovulating on 100 mg of spiro, but you could be, which would be a really good sign. In that case, it should just be a matter of weaning off over a few months.

      • hi i was on 50 mg of spiro last year for mild acne which i got coz i was stressed . After 6 minths i left it and had heavy hairfalll . I was put back on 100 mg of spiro . Took it for 8 months and my hair kept fhinning and falling . I also started getting period every 18 days . I was also veru depressed with extreme high libido . I felt emotionaly weak and sad and crying . My hair texture also changed from silky straight to flyway wispy . I have now weaned of spiro after loosing 60 percent of my volume . What could be weong with me . My test are normal except low vit d and high dht . Will mg hair recover . I am 42 year old . Need your advice pl

          • Hi Lara

            I have weaned off Spiro and though my shedding is a bit better my scalp has had rapid diffuse thinning…. I can see my scalp…. Will this hair grow back as right now i see mord and mord of my scalp eaxh day and it’s scaring me. I had mild acne for a month and was given Spiro. I had no hair issues before Spiro. I took 100 mg for 9 months and my hair kept shedding and texture changed to try tingly wispy. I am off Spiro since Jan 2017 but experiencing this rapid thinning since Feb. What should I do…. Wait it out or go back on Spiro… Pl advice.
            God bless

        • I had zero issues with hair until spiro. I’ve been off for 11 mos, and although better, still shedding abnormally

          • did u have any regrowth specially in the front scalp? I hate this drug…. Dont know what to do

          • The very front was how i first noticed. I do have regroeth there, but it’s still see through. If you’re on FB, join the telogen effluvium support group- a few of us suffering from spiro induced TE there.

            I hate it too- it was caused me anxiety and grief

  27. I am a 48 year old women struggling with hair loss, which began in my eyebrows about 4 years ago. I had been on the pill for over 20 years, and the shedding started slowly, but seems to correspond to getting off the pill and perimenopause. The eyebrows were the first I noticed, but now have some areas around the ears and the scalp that are thinning – especially the ears and temple. I have had thyroid checked by numerous doctors, all is normal. I had a scalp biopsy that showed slight miniaturization, and my testosterone is way below normal – almost non existent – and my SBHG was high. My gynecologist put me on progesterone and testosterone drops for about 5 months now, but my numbers have barely budged, so we are sneaking it up a bit. I am getting regular scalp/eyebrow injections from dermatologist, eat healthy and take good vitamins and supplements. My gut tells me this is a hormone related, which is how I found your blog post. And my dermatologist has suggested trying spironolactone. But after reading your blog, I am very hesitant. Plus, since my testosterone is so low, it seems odd to take something that is targeting that.

    I realize I have a complex and unusual pattern of hair loss, with the eyebrows being affected and the T levels so low. But curious if you have any thoughts?

    • Hair loss from eyebrows is a common sign of under-active thyroid. Has your thyroid been tested?
      Are you still on the Pill? That’s why your SHBG is high, and your testosterone low.

      • I have been off the pill for about 8 years, and my thyroid has been thoroughly tested by several doctors, including the test for antibodies, and found to be normal.

  28. I’m 28 and I’ve been so desperate to resolve my hair loss that I actually tried Spiro for a few days. It dropped my blood pressure so low that I would almost collapse just walking to lunch. It was terrifying.

    I liked the comment you made above, Dr. Lara about how hair loss requires “real detective work.” It’s a perfect description. I’ve spent all of my free time for over a year now scrounging through old forums and articles trying to find my answer. I was thinking about creating a resource, like a 1-stop checklist of all the tests to run and how they map to causes. Although you’d be much better equipped to do this. Maybe for your next blog post 🙂

    • A checklist would be great!!! It is very true detective work is necessary! After two years of hair loss, with new symptoms following afterwards, I found out the culprit was Crohn’s disease! My gastrointestinal symptoms were nearly the last to be noticed- and it was the cause all along! I used this website and had all sorts of hormonal tests, iron tests- thyroid tests. The tests were abnormal, but not enough to be diagnosed. The abnormalities were then explained by Crohn’s! Please do a checklist! It’s so crucial!

  29. I’ve been struggling with hair loss post pill for over a year.
    I’ve been taking magnesium and zinc supplements to help normalize, plus biotin.
    And of course Rogaine, which seems like the only thing dermatologists will offer.
    All I can say is that I’ve had minimal results, a lot of depression and hard to keep up hope my body will ever return to normal.

    Could you please write a blog post about what women like me can do to combat post pill hair loss? I don’t mean hair just falling out (telogen effluvium). I mean androgenic alopecia (and chronic telogen effluvium). My hormone levels are fine according to my doctor and blood tests but I just feel like the pill messed up my body, my hair and it will never return to normal.

    Is there anything else I can do? Sometimes I feel like giving up and saving for a wig.

  30. Hi Lara, your post helped me so much to decide whether taking spironolactone or not. I have hormonal hair loss, my estrogen is very low and I don’t know if it has to do with androgenic alopecia, because my doctor prescribed Spiro together with minoxidil. I am desperate as I loose more and more hair everyday. I would like to know what I should do in this case, if I should not take this drug…what do you suggest? Is there a natural healing for hormonal or androgenic alopecia?
    Thank you so much!

    • Hi Priscilla,

      I am not Lara, but my experience is that spironolactone also disrupts your estrogen metabolism. If you have low estrogen, this isn’t the best choice. It helps for people with high androgens. I went on it for acne some three years ago, and in order to avoid the gigantic shed and acne that occurs post taking, I have to wean off of it extremely slowly over 2 years. I do not suggest taking this. It usually causes more issues than helps: anxiety, insomnia, collagen loss, problems with menstrual cycle, hair THINNING (though its supposed to help it interferes with your hormones and cortisol levels)- if your only problem is low estrogen I would investigate why this is occurring. Were you on birth control, did you take antibiotics for an extended period OR a heavy dose of them? Do you have a diet high in wheat, sugar, processed foods? Do you diet, or are you low body weight? did you just stop the pill?
      If it is the foods or antibiotics (which is why my hair loss began)- correct your intestinal permeability, remove sugar, gluten and high carbs (besides potatoes, rice, yams) and your body will once again be able to produce enough estrogen. If it is dieting, this needs to be addressed- our bodies will not produce an adequate amount of hormones if we are not eating enough, as it causes stress on our bodies which then preserves our regular functions. Good luck figuring it out, but I would highly suggest not using spironolactone- it is a temporary fix that can just make things worse. Nevermind this drug messes with your electrolytes and blood pressure (which is the reason it is prescribed). I truly truly hope you find out whats going on with you~ it is such a traumatic experience losing hair, especially as a female.

      • Hi Theresa!
        Thank you so much for replying to my message and telling me about your experience with spironolactone and for all your advices, it is so nice of you! After reading it I am impressed and kind of scared too after knowing how damaging this drug can be! I definitely won’t take it!
        I am not sure whether it is only the low estrogen or if I also have high estrogens, but if I do, I think it is also not worth taking, as I know I may have all of those problems you told me you had. I have already removed gluten, dairy (most of it) and reduced sugar ingestion. I usually eat healthy food, don’t take antibiotics, neither the pill, but I am low body weight. I know I have to change a lot more, but you helped me a lot with your testimony to decide never taking spironolactone and to start working for my body healing naturally. I hope I can have my hair back again, it really is traumatic.
        Thank you so much for everything and for your wishes. I wish you all the best!

        • It is SO traumatic. I know body weight is huge, Lara Briden has touched on this in several of her blog posts. I unfortunately have been diagnosed with crohns from antibiotics, so its much harder to get my weight up. I only wish it was as easy as, just gain weight, but for women there is a lot of stigma with weight gain. Your welcome for helping you with my experience. I want to help anyone I can- we shouldn’t have to do this alone. She has many articles on how to embrace our bodies, and eat to nourish. Here’s one website. If you are low weight, are you having your cycle, regularly? if not, I like to use Stefani’s blog, paleo for women, as I have hypothalamic amenorrhea, and low body weight. Here’s specifically a post about hypothalamic amenorrhea https://paleoforwomen.com/overcoming-hypothalamic-amenorrhea/ But she has a lot of useful pointers. One thing I’d say, is don’t go drastic paleo AT ALL, esp if you are low weight. I made that mistake and it further complicated matters. Happy healing, Priscilla! I have hope for your hair, and mine:)

  31. Hey Lara! Your blog is just the best – it’s been so helpful to me for explaining things in layman’s terms throughout study a bachelor of health science in natural medicine.

    I understand why you would prefer to use other means in treating PCOS related hair loss, but what about andregenic alopecia/FPHL? I was diagnosed recently and it runs in my family too so I know what I’m up for without intervention 🙁 I am only in my mid-twenties and with an interest in natural health, being told my only hope was a lifetime taking a pharmaceutical drug has been very hard for me to come to terms with, quite traumatic actually. I haven’t started taking it yet (I’ve had it here staring at me for the last few nights but just can’t take it!!), but I have been prescribed 25mg of Spiro and topical minoxidil. I’m hoping you could please share your opinion on whether or not in this case, you would consider the use of Spiro, or what other alternatives you recommend? My blood results are all within ‘normal’ ranges. I’m absolutely desperate for any insight as I have researched this tirelessly day and night and can’t seem to find many credible natural alternatives for hair loss of this kind. Any help is much appreciated. Thank you!

    • By the way, I take an individualised herbal blend for hormonal regulation and liver function, 50mg zinc daily (pyroluria), an ACE + Selenium supplement, as well as activated B’s and iron daily as I am also a celiac and can struggle with absorption. I don’t consume gluten whatsoever, and will have VERY occasional dairy and sugar. My diet is actually quite good and I am not on medications and no birth control in over 5 years.

  32. I took Spiro lactone 50mg for acne in 2014 for 6 months .I am 42yrs now . My acne cleared but after 2 months of leaving Spiro my hair started shedding in clumps. I had long silky straight hair which changed texture Nd became flyway dry and wispy .I was put on.spiro again and 100mg and my hair are still falling after being a year on this medicine .by hair has also become super thin lifeless and dry and I.shed more before and during my period cycle.o have lost 60 percent of my volume and wanna know what to do .should I keep taking Spiro or leave it .I cant afford to loose more hair now .Pl help and advice .I live in.india . Also I have been extremely stressed before Nd during this hair loss .

  33. Hi, just discovered ur blog and saved my life! What do you think about flutamida to stop hair loss caused by an excess of androgens (specially androstendione) due to PCOS??? I heard is better than spiro cause it doesnt debalance your hormones…. (Sorry for my English in advance, it is not my mother toungue).

  34. I have an unrelated question. What supplements can help alleviate the menstrually related migraine on one side of the brain? Please advise. thanks!

    • Did you have colic as a baby? Do you have allergies to pollen, food allergies, or food intolerances? Do you get motion sickness or nosebleeds easily? IBS or GERD? If you answered yes to a few of those you may want to look into DAO (diamine oxidase enzyme). A study from Spain showed that 87% of migraine patients are deficient, which can be genetic or acquired. All those problems I listed are associated with elevated histamine. L-histidine is an amino acid in foods, more in protein sources, but still in plant based foods like strawberries and avocado and eggplant. Your body converts this to histamine. DAO is supposed to break down excess dietary sources of L-histadine, gating how much gets into the blood. Controlling the raw material your body can convert. If you have too little DAO, too much L-histadine circulates, and the enzyme HDT which converts to histamine does not saturate or stop converting. Take a few capsules before EVERY meal. And look at a low histamine diet. Avoid vinegars, fermented foods, wine, chocolate and other high histamine foods.

  35. Hi Lara, thank you so much for sharing your knowledge and incredible work so freely. I hope younger generations will be informed about the horrors of bcp as a cure all for menstruation problems because of work such as yours.

    I’m trying to wean off spiro gradually, reducing every couple of weeks from 200 – 150-100, now 75. My skin was never perfect on it anyway. I’ve introduced berberine 500mg to try and avoid a cystic breakout that has happened every time I’ve come off it in the past, so I end up going back on it in desperation. Is it ok to introduce DiM while I’m still weaning off the spiro?
    I’m gluten free dairy free and sugar free (with the exception of an occasional binge, which I know doesn’t help!) and already take 75mg zinc picolinate, vitex, magnesium and fish oil. My testosterone levels (tested whilst not on spiro) are normal, so I must be androgen sensitive. I’m also on antibiotics for my acne, which I know is bad but I’m desperate and I figured it was better than spiro. I’m sure stress is playing a role which I’m trying to manage but need to get through a difficult few months.

  36. Dear Dr. Briden- Thank you for taking time to help women with hormonal issues, your education is invaluable. I have my own story that I’d like to share with you…I am a 40 year old woman and was on ortho tri-cyclen for 25 years. In 2010, I was put on 100 mg spironolactone for severe hirsutism, and it worked wonders for me. Last June, I came off the birth control pill after my husband had a vasectomy, thinking it was the right thing to do. I can not tell you how horribly my body responded. I continued the monotherapy of 100 mg of Spionolactone each day, which caused a host of other issues (including absent periods). In December, my midwife wanted to put me back on the pill, which I happily agreed to, thinking my hormones would ‘balance’ again. It almost had the opposite effect! I began retaining water, had severe panic attacks, insomnia and aggression to name a few of the issues. I went back off in February of this year to try spironolactone on it’s own again. This time, I began to have strange ‘periods’, light brown in color, accompanied by unresolved water retention. My physician tested my hormone levels and found I have no progesterone- (which of course I wouldn’t)!- and put me on 25 mg of bio-identical progesterone cream. Initially this helped to get rid of the excess estrogen in my system. I have been continuing with the cream, but am finding that it is no longer working as well, and almost seems better if I use less or none of it. HELP! Eventually, I would like to wean down the spiro amount, and perhaps stop completely. However, I tried to come off another time and my body reacted so poorly that I went back on with in a week. I know it is interfering with my ability to metabolize estrogen, and I am following mostly a gluten and dairy free plant based diet, with the exception of eggs and fatty fish. I also use DIM, magnesium and D3 to help my body rid itself of estrogen excess. I am loosing this battle, though! If I was your patient, what would you recommend for weaning off spiro? I can’t continue to spend all my time worried about how I may feel the next day….spiro truly is a prison.

    • Hi laura, I know you posted a couple years ago. I’ve been reading all the comments for help bc I don’t know if Lara will respond to my comment. But what did you do coming off spiro!!?? Currently in the battle of it… I’ve been off two months but it’s so hard. Any tips or advice? I experienced a lot of the same side effects as you did from spiro!! It’s truly horrible. They are lingering and I just want my life and skin back.

  37. Hi Lara,
    I started spiro 25mg for Pcos cystic acne and was on it for 3 months. I didn’t like the side effects (dizzy, fatigued, swollen and painful breasts) so I tappered to 1/2 a pill for a week and then stopped. I am having horrible anxiety daily with panick attacks thrown in just for fun. This has been going on since I stopped and it has been a month. It has to be related because I never have experienced this before. Dr put me on celexa 10mg, visteral 25mg and Ativan 1mg for the anxiety. I can’t take it. Have you ever heard anything like this and what would you recommend? I want my life back! Thanks

  38. Hi Lara. I have been on Spiro 25 mg for 1 1/2 month because of hursutisme but quite a month ago because of swollen and sore breasts and fatigue while running, and symptoms remain. My period has come back twice after 5 years, so maybe this is pms, just constant. I was a bit underweight 5 years ago when my period stopped, but normal weight know. Testosterone levels are normal. Do you know when I can expect symptoms to go away? And can you explain why they occur and what to do?

  39. Dr., i used spiro for 3 yrs for acne. worked great on acne. started losing hair after 2 yrs on it. went off spiro june 2015. still having hairloss. my estrogen & testosterone are still low. did the spiro reduce my “T” & im low on “T” & need more testosterone now? im using natural estrogen & progesterone creams but no dr’s have suggested testosterone. my ob, my endo or my derm. but my T is lowest number in acceptable range. please help

    • Jen, has your acne come back since stopping spiro in june?? If so is it worse than it was before you started the spiro?? And how are you treating it now?? Thanks!!!

  40. I was having issues with my parathyroid,…I had high calcium, high testosterone, ..was then diagnosed with pcos, even though I’m past menopause. I am no longer considered Insulin resistant.My calcium, has come down to normal range. I was given the lowest dose of SPIRONOLACTONE, to help reduce the testosterone,..the level has come down. The endocrinologist wants to double the dose to help bring it down more. I’d like to go off this because reading this terrifies me. But they say it is dangerous to stop taking.

  41. I’ve been struggling with androgenic hair loss for about a hair since coming off the pill. I’ve tried Rogaine and am working on reducing gluten and sugar in my diet. But my hair just hadn’t come back (I was only on the pill 9 months). I had 6 months of shedding, now it’s fine and limp. I see short hairs falling, too. My doctor recommends spiro to try next for a fix. If you don’t receommend it, what are other options? I feel like I’m running out of options and time. I’m 34

  42. Is there a way to taper off of this drug (spironolactone) and avoid excessive acne and hair loss? I tried going off and my hair was falling out in clumps, and my skin became super oily and covered in cystic acne. Is there any supplements to take to help support my hormones while tapering?

    Please please let me know, I feel trapped on this drug. I need help.

      • Thank you so much Lara, that helps so much to read. How slowly do you taper if I am on a dose of 50mg? and what natural treatments would you suggest? I am already on zinc and magnesium. Would either saw palmetto, inositol, or vitex help?

      • Hi Lara

        My name is Abby, i’m 23 and i’m from the UK i’d love some advice.
        I weaned myself very very slowly off of spironolactone ( i was on it for a year 200mg (very short space of time at the beginning) – 150 – 100 – 75 – 50 – 25 (25 longest) then id halve these etc. I came off of it sucessfully with little to no side affects about a year and a half ago, ( i was on it for Acne after i had onset acne from coming off the pill – Loestrin 20 – i was on it since i was 15 for so about 5/6 years).

        ANYWAY, my problems are now is that my libido is poor and my hair just isn’t as thick as it used to be. I even contemplated for a couple of weeks going back on Loestrin 20 for some stupid reason!! I came to my senses. I would love some help regarding supplements and foods, i do already take fish oils omega 3 and a health food shop supplement here for hair skin and nails to help maintain my skin that has wonderfully settled and of a normal complexion (not perfect, no but it’s not acne so i’m happy with it!).. however i’m pretty stuck on what to do about my libido it’s taking a toll on my relationship and very upsetting at times, my hair is always limp too with no product and seems to grow at a snail pace. What would you recommend in terms of supplements and food to help libido and hair? Thankyou so much! Abby xx

  43. What about spironolactone for acne? I need to get rid of my hormonal acne. It is either spiro or the pill as my options… i have high testosterone im sure and do not do well with progesterone only pills but my skin is better on combined oral contraceptive pill! Please advice?

  44. Lara,

    Not sure if you weren’t able to read my comment, but I’m definitely hanging by a thread health wise. It started back in June, and everything has gone progressively down hill since then. it began with hair loss and insomnia. I went off the pill, thinking it the culprit as I found out that Junel 1/20 is one of the higher androgenic pills. So I went off, and then started to go off spironolactone. My body FREAKED OUT. Mind you, I was taking 800 mg of magnesium, 50mg of zinc, and gentle iron bisglycinate. it didn’t help. For two and half months, I saw no calming of my skin, and I lost about 60 percent or more of my hair. I went back on spironolactone because at that time there was no doctor was willing to find an actual alternative treatment to get off the drug.

    Now I’m stuck with the side effects, AND possibly something else along the lines of autoimmunity is occurring in my body. Im unsure if the spironolactone can cause autoimmunity (high ana and crp), as well as elevated liver enzymes and fatty liver? I do know that the eye pain and jaw pain are most likely related to it, though. Since I stopped the pill, my hormones are out of control. My progesterone is to the point where I could be considered perimenopausal. Im 31. Please help.

    I finally found a holistic doctor who suggested I stop spironolactone slowly, and he will have me on progesterone compounded at the time I decrease my dose. I have very low progesterone, and low estrogen, and my dhea is mid range at 139. My lh and fsh both are very low, and I’ve not had a cycle since end of June, when I stopped and had a withdrawal bleed. Since June, I started a low glycemic diet with no gluten, refined sugars or dairy (though i have very rare occasional honey and maple syrup). I had greek yogurt, but stopped around september. Since september I’ve also tried no grains at all, just what would be called the AIP diet. But I stopped because it started making me feel worse. Introducing sweet potatoes, cassava, and starchy vegetables has considerably helped with the anxiety, but it still is bad. It has also helped me to actually eventually get sleepy at night, instead of being a total insomniac.
    I feel like I’ve tried everything, my mood and mind are becoming a spiraling ball of stress and obsessiveness to the point where Im terrified to try anything. I don’t want to start progesterone if it will further mess me up. Can you tell me if it would help while weaning off spironolactone? can it help me avoid the hair loss and cystic acne that follows upon withdrawing? or do you think i may also need estrogen?

    • Hi Theresa,
      One very important thing to keep in mind is the lag-time of hair loss, which is 2-6 months. So if you were having pill-induced hair loss, that would have continued until at least September-October, by which time you were low-carb, which causes hair loss. When did you go back on carbs? you probably can’t expect an improvement with your hair until 3 months after that.

      Generally, yes, progesterone is helpful for hair and skin, but too much could suppress ovulation and prevent you from regaining your periods–which is the very thing you need to do so you can make both estrogen and progesterone. Being back on carbs will help you to get a period. I recommend you read Chapter 7 of my book which discusses all the different reasons for lack of periods.

      • Thank you so much for your reply. Would 50mg be a low enough dose of progesterone? Also, I’m still on spironolactone. Once I get off, will bring on progesterone prevent the acne, hair loss of coming off?

          • Can spironolactone initiate Female Pattern Hair Loss? In other words, when I stopped spironolactone the first time, and was losing clumps and clumps of hair, was this telogen effluvium, or did being on spironolactone cause me to have androgentic alopecia. Im asking bc I know I need to get off of the spironolactone, but I don’t want to go bald. Is it like birth control in that it will take several months to slow down the hair loss after stopping? Or once I’ve been exposed to testosterone blocking, will my body permanently have worse acne and hair loss upon stopping? Thanks,


          • Stopping spironolactone can trigger temporarily worsened hair loss (like a telogen effluvium), which is why I usually try to wean it down. And then, Yes, there may be a rebound “androgen excess” for a few months, but most women do eventually go back to their baseline androgen levels (or hopefully better with natural treatment)

  45. I am 59, I was prescribed progesterone compounded in a pill form and have been on it for about three years. My hair was growing very fast. I went to another dr when I moved and he took me off it, claiming that it causes bone loss! My hair has been falling out rapidly, he suggested rograine, which I have been using but my hair is still shedding. I thought that it may be due to the changes in my antidepressants as I was regularly taking Xanax and busperone and was changed to Zoloft, klonopin and stayed on the bus par. Because of all of these changes in medications, I thought that it may have been the klonopin that was causing the hair loss, but I had been taking these changed medications for five months or so prior to the hair loss and the dr took me off the progesterone and about six weeks or more after that, my hair started falling out! Do you think that the lack of progesterone is the cause? Also, do you think that progesterone causes bone deficiency???
    Thank you.

  46. My girlfriend is on Aldactone 100mg. She is in menopause and noticed her hair falling out. Her doctor prescribed it for her. Has noticed her hair grow back. I was talking to her about my son loosing his hair. He is 24 and is taking Protein enhances to build his muscles as he workouts in the gym for about now 4yrs. My girlfriend recommended this Medication Aldactone. But after reading this I am not convinced.

    • Male hair loss is a completely different situation, as hair loss is normal for men. I’m pretty confident he doesn’t want to use a testosterone-suppressing drug.

  47. Hi! I started taking spironolactone for PCOS in my 30’s. I am now 53 and post menopause but still taking spironolactone. I am also taking bioidentical hormones and my hair is thinning more than ever. Plus I have rosecea and get flushed easily. I also have pretty severe tingling in my feet and hands. I was in a serious car accident in 2002, so always atributed the tingling to nerve pain. Now I’m wondering if it’s because I’m still taking this drug? Any help you can provide would be greatly appreciated.

    Kathy E

  48. My dermatologist said that theirs would help ! But dang!! I already take a thyroid pill and I’m in my prime of menopause !! He wanted me to take it for hormonal acne and a hair loss! What other things can I take for the both??

    • Hello Mona,

      You said you’re in menopause. I know hormone replacement therapy is great for women in their menopausal years. You can find a holistic or naturopathic doctor who will test your hormones, then prescribe either a bioidentical cream or bioidentical pill for use. I know many women who have had luck with it. I would check out Lara’s post on both acne and hair loss- I’m unsure if she mentions hair loss for menopause or acne, but most likely she does. I would NOT take spironolactone or start if you haven’t. I went on it and feel uncomfortably, irrevocably trapped on it bc now without it my hair comes out in clumps and my face becomes one big oily cyst. Derms are overprescribing the crap out of it- don’t do it. I wish Lara would let us know a way to taper off of spiro, bc I think it may be the root of my myriad of health issues that started 8 months ago. Good luck-


      • Theresa….. is your acne worse when you stop the spiro than it was before you started it??? Or your acne just goes back to what it was before severity wise when coming off of it???

        • Hello Amber,

          after getting off of the spironolactone my acne was worse than before I started. I would get a cyst on occasion while avoiding dairy. I went off spironolactone and had been gluten, sugar and dairy free for months, and my acne was horrible. The cysts were continuous, and two or three on top of each other. I went back on and it got better, but still isn’t as good as it had been before. I hope this helps. I wouldnt suggest ANYONE going on spironolactone after what I’ve gone through. If I’d known there were better ways to treat acne I wouldn’t have tried pharmaceuticals.

          • Are you still on the spiro now then?? I worry about starting it and the acne getting worse when i go off of it…. what other ways are you talking about to treat acne?? I have to find something besides oral antibiotics :/ and topicals dont seem to do much!!!

          • I’m on a Paleo diet (no sugar, grains, and NO absolutely NO dairy (that means no cheese, butter, milk, yogurt or other dairy derived products). However If you read Lara’s post she explains other supplements to take on top of that. The number one that works is magnesium (I take glycinate). Yes I’m still on the spiro, and still hate it, but going off also caused HAIR LOSS and acne. I’m stuck in a rock and hard place, do not go on this drug. Change your diet, be diligent, don’t cheat and wait patiently.

          • Did you try the full paleo diet before the spiro and wuch and it didnt work??? So your skin is clear on spiro but once you tried getting off it got terrible worse than beforehand? I think im going to give the paleo approach a good try. I have autoimmune thyroid disease as well… and im pregnant. Think my thyroid meds r causing more acne… what do you think of berberine?? Im going to try taking berberine, lactoferrin, vitamin b5, saw palmetto and magnesium after baby for the acne… sounds like a lot but ive got to get rid of this acne without antibiotics anymore and it causes me a deep depression having acne.

  49. Hello,
    I took 100 mg of Spiro for about 4 and a half months this fall and stopped about 2-3 weeks ago, because I couldn’t bear my hair loss anymore. I took this medication for acne, and although it gave me great results, I can’t substitute good skin for being bald. Every derm I consult with says there’s no way that Spiro would have caused the hair loss. It is really upsetting, because I read others’ stories on the web, and it DOES happen. What can I do? My hair loss has not slowed down yet. Please help.
    Thank you.

    • Same boat! Hope you get an answer. I was taking 200 mg though, and my derm has since apologized as it is a super high dose for mild acne.

    • Hi ladies, I also took 100mg from this time last year and noticed hair shedfing a few months later. I’ve now lost 35% of my hair. The derm denied it, but I had no hair issues prior. I’ve been off it 3 mos now and it did increase shed. Have you all recovered? Most of my loss is at top, crown, sides, and temples.

  50. Hi everyone,

    Please read. I’m a real mum, who had PCOS and PMS so bad I thought about suicide to escape it all but I have found out that our answer like the Dr of this thread has said is NOT in more pills but is bio-identical progesterone. Don’t wast your time and health on anything but this. You will thank me I promise.

    It works for all PCOS AND PMS issues. It works because the reason you (and me) are having these issues (weight problems, anxiety, depression, period pain, sore breasts, migraines, no period or irregular period, or bleeding for longer times than normal, sleep problems, skin problems, facial hair, on and on and on…) is because our bodies are not making enough natural progesterone from our ovaries to balance out the crazy amounts of eostrogen we produce AND ABSORB FROM OUR MODERN SOCIETY. Too much eostrogen is literally making us the most miserable that women have ever been in the history of forever! (In my opinion).

    If you look up ‘eostrogen doninance symptoms’ and ‘lack of progesterone’ etc it will click for you like it did for me. Look up natural/bio-identical progesterone therapy and you will be flabbergasted that this therapy has been helping women for over thirty years BUT because big pharma companies can not patent it the Drs have not been educated on how this can be used to help women like us to actually get better, for real, with no chemicals that fit poorly onto our bodies and make us worse.

    I had bad PMS and PCOS with crazy stuff (think fat, depressed, anxiety attacks, no period for three years followed by a month long period with very bad pains AND growing a beard) for almost twenty years and finally I found out about this more natural therapy with no side effects.

    I have been on bio-identical progesterone cream (alone, nothing else) for seven months and EVERY SYMPTOM HAS EITHER GONE COMPLETLY or is on it’s way. No period pain, no depression, a regular bleed, more energy, I feel like ‘me’ again after a very long time down a dark dank hole.

    There are lost of things to learn about it, how much to use for your specific needs and when to use it, (always rub it in twice a day, it works for only 13 hours and you want it to be constant not up and down) so look up sites and read up. In the US you can buy this cream at any drug store, look for reputabke ones like Natpro so the amount of progesterone in wach tube is consistant. In Australia you need a script from a Dr who knows about this cream (very bloomin’ hard to find).

    I promise this is worth your thoughts, your time and energy to look into. I was desperate and this cream therapy has helped me so much.

    Authors and Drs to look up are:
    •Jenny Birdsey
    •Dr. michael E Platt book called ‘the miracle of bio-identical hormones’
    •Sandra Cabot book called ‘hormones don’t let them ruin your life’
    •The natural progesterone therapy website (it’s all green and looks old and bodgy but has incredible amount of wonderful information and studies about this).

    I can only complain that my ‘beard’ isn’t going away fast enough. So my Dr put me on Spironolactone to help it along and I hate it ☹ it made my periods disappear and sore breasts again, which is why I found this thread. ? I’m getting off it ASAP and will just wait for the natural progesterone to slowely work it’s magic.

    Email me if you need me to tell you more from my personal experience. I want other women to feel better again too [email protected]

    Renae xxx

  51. Thank you for your post. I have been on Spironolactone for almost a year. (150mg) I love it and hate it. I love the clear skin, but hate the libido issues and weakness. It cleared my acne after about 6 months, but I want to get off of it and my bc pills to try for a baby as soon as I can. I’m scared of the inevitable breakout, however. I started taking DIM 200 mg almost a month ago and was hoping to wean off the spiro then the bc. I feel a little rushed because of my age also, I’m 34. Any tips on weaning to balance hormones? I take Magnesium and probiotics also. Thank you in advance 🙂

    • Hi justine… did you go off the spiro and the pill? Did spiro clear your skin? Im wanting to go on it after i have my baby…

  52. Hi Lara, just came across your blog researching Spiratin, I am at a loss at what to do. Im 27, have been on many contraceptives, mainly the pill since I was 15 (due to period pains) and came off Brenda (Dianne) last May 2014, my periods came back pretty quick and normal with no pains, had little bit of acne until about December 2014 when it got really bad around mouth and cheeks and jawline, been vegan since January 2015, skin got worse even though diet is pretty healthy (sugar would be worst thing but even done full detoxes and doesnt help), went to a skin doctor who said I have excess male hormones (must be androgens I think) as i break out often after periods not before and he suggested Spiractin, even though I was trying to not go down the medication route as I am all about being natural etc I had just gotten so over my acne and was constantly picking my face and there fore creating scars I felt i had no choice, took 2-3 months and skin became clear, only on50mg per day but I dont want to me on this forever, it goes against the reason why i came off the pill and against my values and beliefs, I am going travelling long term next year and want to be clear for that but also think maybe i wont have as much stress it might be a good time to ween off spiro, now i have been down to 25 mg a day for the past week as I am running out of pills so halved my dose as next appoinment is in 3 days and got a massive breakout 2 days ago, makes me think i need to try something else before I go away, should I a) do laser treatment? b) accupuncture c) chinese herbalist? Im not sure where to go can you please help, Im in Perth. Thanks, Yolanda

  53. I know this is an older post, but I have to tell you what a relief it is to have found this. I was diagnosed with PCOS in 2008 and miraculously became pregnant the same year. I delivered a healthy baby boy, who is now 7. During the past 7 years I suffered 2 miscarriages and also had my daughter via fertility. I am a classic PCOS patient… Anovulation, hirituisim, weight issues, anxiety, but surprisingly no male pattern balding (PTL). Anyhow, I wasn’t seeking “treatment” for my PCOS because I have either been pregnant or nursing since diagnosed. I decided to visit my endocrinologist again who put me on metformin and YAZ. Not really wanting to go on the pill, but not wanting to become pregnant again I decided to give it a whirl. Boy oh boy did I get whirl… A whirlwind of horrible horrible anxiety, and suicidal thoughts. I am a happy person, despite having anxiety in the past, I have never been a depressed person. It took me almost an entire pack of YAZ to figure out that IT was causing me to go crazy, literally. Thankfully I knew these thoughts were irrationally but it was soooo scary! It makes me sympathize for people who feel hopeless, but I have so much to live for, and be thankful for! Anyhow, fast forward a couple months and doctor put me on Spinolactone in combination with metformin (I dropped the pill completly). I took ONE pill, ONE and the anxiousness and suicidal thought came tumbling back. I immediately stopped and started googling Spinolactone, which is when I came across this post. YAZ and Spino are the same?!?! What?!?! How could this happen- the doctor knew my feelings about YAz, yet she prescribed me the same exact thing! Reading this post made me burst into tears! I am not crazy! These drugs- THEY are crazy! I immediately bought your book from amazon and can not wait to start reading it. Thank you for your insight into such a troubling disorder. I am so thankful for people like you. God bless you!

  54. hi Dr.
    after 3 yrs on 100mg/day of spiro (for acne) im now 45. with major hairloss. i stopped bc jan 1st this yr. stopped spiro in june. now endo wants to treat tsh of 3.6 with high antibodies with synthroid. could this all be from spiro? how long after stopping spiro (took for 3 yrs) will it take for my body to re-regulate? can levothroxine cause more hairloss? do i need it? i just started taking great multi with iron, zinc, selenium and i take magnesium too. im scared. main complaint is hairloss (i think from spiro)
    help please 🙁

    • Thyroxine will help your hair. As for whether your autoimmune thyroid condition was worsened by spiro, it’s possible but you’ve probably had it for a long time.

  55. Hi Lara,
    I find it’s interesting about certain percriptions drugs that can cause horrible effects on hormones and other functions of the body. I had to learn the hard way about Birth Control pills. I am a licensed Aesthetician and have been kind of my own guinea pig for “hormone harmony”. I found “weaning” off Birth Control pills helped to avoid the terrible side effects…I DO beleive also “natural suppliments” is the best method if at all possible. I have read upon as much as I can about Spironolactone and am ready to ” wean” myself once and for all on this. Can you please explain what exactly Spiro does to the hormones and how it affects the balance of one hormone to the other? My DHEA is normal, however my Progesterone is low and so is my Testosterone and Free Testosterone. Wondering if it affects ovulation and has shorten the monthly cycles.

    • Spironolactone can impair ovulation (and therefore progesterone production), but it depends on the dose.
      You say you have low testosterone…. Was that tested while you were one spironolactone or the Pill? (because testosterone would then have been artificially suppressed). You can read more about spironolactone in Chapter 7 of my book.

  56. Hello. I am 51 yrs old and went into menopause at 50. I was on bioidentical hormone therapy for about 6 months for only hot flashes, and then asked my OB/GYN to add progesterone to the estrogen, thinking better for my skin, from sebaceous hyperplasia, and he did. I have hot flashes, but not too bad, the reason for bioidentical hormone therapy. I wish I had never started those. hot flashes really not too bad, and not worth symptoms also that happened i have had terrible side effects, for about 3 months. I started HRT in April. Other effects too.
    I am now starting severe hair loss! Always thick hair, now changing. I am devastated and want to end this terrible effect,l I stopped HRT last week,, then called my doc and told him. He said stop it. I did not keep HRT bo0ttle, in case you asked me dosage. Never had hormone levels checked. I have sebaceous hyperplasia, and he put me on spironolactone. Wondering if i should stop this cuz of hair loss, fromresearch. I am scared and worried about my hair, Will ending spironolactone 50 mg help ending hair loss, as I read? Trying to help one thing, devastating another. Please help with ideas. Hair loss for about 3 weeks from this date, Oct. 4. Thank you so much!

    • You can ask the pharmacist what was in your formula. Find out if it contained an androgen such as DHEA or testosterone. In that case, the hair loss is probably just a temporary effect of the androgen, and it should improve on its own–without spironolactone.

  57. Hi Lara,

    Your blog is absolutely wonderful by the way.

    I read a research paper that Liquorice increases DHEAS and so now I’m confused whether to use it or not? I don’t have high testosterone, I have very regular periods and a good normal oestrogen level but I have very very high DHEAS and therefore suffering from excess androgens. I simply need to find a way to lower my DHEAS would Liquorice work or make it worse? Is there anything else you would suggest specifically for DHEAS.

    Best Wishes,


  58. I am a 43 year old woman with low hormones. I am taking progesterone cream to help but for about the past year my testosterone levels have been very high.
    Do you think it is because of the progesterone cream? I have been feeling very angry and have acne like I’m a teenager. I also had a high liver enzyme test result for the first time so I am just wondering if I should get off the cream and just deal with the abnormal periods and the other things associated with the low levels of hormones.

    • The right dose of progesterone has an anti-testosterone effect (because it blocks androgen receptors). Too much progesterone converts to testosterone. I would say the problem is the dose. Also, blood test is the only way to assess testosterone. Saliva test is not reliable for testosterone (it is reliable for cortisol, estrogen, and progesterone).

      • Wow! Thank you for the reply. No one has told me that before but it just seemed like when my progesterone went up so did my testroterone. My blood tests keep showing that my progesterone level is low so my doctor just raised it again. Estrogen is ok. Maybe I should just stop taking it for a while and see what happens. Let it just naturally do whatever it is going to do instead of messing with it all so much. I think I am making things worse instead of better. Thank you for the time!!

  59. Hi Lara!
    I always had fine but thick hair. I noticed several months ago that my hair seemed thinner than normal so I went to a derm. He prescribed spiro 50mgx day. The first two weeks starting this I noticed a huge change in the shedding of my hair -for the worse!!! Clumps were coming out. He said that this was from something months ago and that I should continue spiro. I did some of my own research I thought the mirena could be the cause of my hair loss (which my derm disagreed with). I had it removed anyways. My hair continues to shed. Do you think I should stop taking spiro? All other blood tests are negative. Derm said cause for hair loss was “just hormones”. Now my scalp is visible everywhere through my hair. Please help

    • Hair loss requires serious detective work, counting back 3-4 months before it started (and the months leading up to that). Yes, it could have been Mirena because it contains the progestin levonorgestrel, which is androgenic, and renowned for causing hair loss. It could also have been triggered by illness, thyroid, or any number of things (which hopefully the doctor screened for on the blood test). Normally, I would look to your periods for some clues, but that might not be possible because Mirena suppresses menstrual flow.

  60. Lara,

    Thank you for this post, I appreciate you expertise and guidance. You have no idea how much women need this blog, and your book (which I just purchased today). I have a question I need answering, and Im hoping you will be able to answer, as I have not had any help from doctors regarding hair loss at all. I had been on spironolactone for nearly 2 years. I am finally off (have been for two weeks now). Ever since I stopped spironolactone my hair has been shedding like Im on chemo, its everywhere, and even the slightest touch causes large amounts of hair to come out, with the root attached. This goes for my eyebrows and eyelashes as well. This was slightly a problem before stopping spiro, and now its gotten extreme. I was also on the pill (junel) for 3 years, and stopped in May (with no cycle yet). My acne has also returned worse than ever before, and in places I never had it, like all over my forehead, whereas before it was strictly chin and nose.

    Is there anything I can take to stop this shed, and the side effects, as you have suggested with birth control? Will my hair return?
    I have read that DHT is the culprit. If I have an answer, or plan, I may feel some sense of hope on the path, and accept the shedding cycle as natural. Right now I feel I am just wading further into problems. I have seen nearly every doctor under the sun with answers such as, drink more water, take antibiotics, exercise more, eat better. I am on a wheat free, dairy free, sugar free, soy free diet and have been since May. I am so desperate, and feeling overwhelmingly depressed because this issue has become progressively worse and I’m unsure what to do. My hormones were checked and they all seemed to be significantly low, including FSH and LH (premenopausal levels). Please help. I am supplementing Magnesium, Zinc (copper, too), and Maca. What else would be suggested. I appreciate it.

  61. Have been on spiro for 9 weeks now for androgenetic alopecia. Started at 50mg for about 2 weeks and then began taking 100mg since (as of 6/13/2015). I am noticing more hair loss these past few days while showering and styling my hair. Would it be safe to go back to taking 50mg? I’m afraid this is the “dread shed” that many have mentioned while taking this drug. I kind of wish I had never taken this drug! Please…I would love to hear your advice on cutting back my dosage.

    • I was in the same boat as you a few months ago. They had me on 100 on spiro and then 200 so at one point I was taking 200 MG of spiro and still on birth control (which is the cause of all these hair issues) so I decided to get off birth control and 6 months later I got of spiro. I feel better being off everything and now just waiting for my body to regulate itself and hopefully some new hair growth (not expecting much). I was really scared getting off the spiro because my doctor told me that spiro was the only thing holding my hair to my head. I got off it and started rogain a month later and that I’d when the shedding started. I don’t have that much to loose so I stopped rogain after 4 weeks. I haven’t noticed any major shedding since and it’s been a month no rogain and maybe 3 off spiro. But it takes awhile for your hair to react to getting of medication so I’m praying I keep the hair I have. I am now only taking biotin, zinc and saw palmetto. Fingers crossed this helps!

  62. I am just wondering if you know anything about Hair Loss in young men. My son is 26 and is showing signs of balding and hair thinning. His Father and grandfather are bald so I suppose you could say it is genetic. Still, are there any hormonal or other remedies which can reverse it or slow it down etc. I read somewhere about Indole-3-Carbinol. I would appreciate if you could refer me to information if you have it. Thank you and all the best, Maura

    • Great question. Generally, I would say that balding is normal in a man. However, there has been some talk about a “Male PCOS” (https://www.ncbi.nlm.nih.gov/pubmed/16752800). I hope that future research might enlighten us. At this stage, I would consider whether he has any underlying hormonal conditions such as insulin resistance, and then treat that. I am not aware of any nutritional supplements that can slow normal male balding.

      • Thank you Lara for going to the trouble of replying and looking up information to post for me. Much appreciated, I wish you all the best. Regards Maura

  63. I have been on spiro for about 2 to 3 years to treat hair loss from using Yaz birth control but I feel as though my hair has gotten worse and would like to get off. I went from 200 mg to 100 mg for the past week but my bottle is almost gone and I want to stop cold turkey. would it be okay to stop taking them or should it do it over a span of a few weeks or months?

  64. In my experience as a woman with PCOS, this rings false. Spironolactone helped me regrow my hair when it was balding and I don’t feel depressed. I know with any hormonal treatment, it’s a balance for each person to find what works, but it’s wrong to discourage women from a very effective treatment for hair loss (and hormonal acne).

    • Thanks for your comment. I’m glad to hear from someone for whom spironolactone actually worked.
      Can you please share with my readers whether you were ever able to come off it again? Or have you had to use it long term? (My experience with patients is that coming off will often trigger hair loss.)

  65. Thank you for your hair loss posts. I am 37 years old and have been struggling with hair loss for about 2 years. I am not on the pill, do not have PCOS and was told I have female pattern baldness. I have been prescribed spiro but am reluctant to take it as my testosterone levels are on the low side of normal. My hair loss is quite bad, I have lost over 50% of my hair in the past 2 years, my skin is clear, I don’t eat gluten or any refined sugar. Any ideas? It feels a little hopeless

  66. Hi Lara! I am 36 years old and have been struggling with hair loss for about three years now off and on after the birth of my daughter. I’ve had several stressors in my life including the death of my dad. Recently I had a scalp biopsy that was difficult to diagnose, however the two pathologists that examined it both felt it was genetic hair loss. My dad did lose his hair in his 40s to 50s but I will be the only woman on both sides of my family to suffer hair loss in my 30s. The others were in their late 60s to early 70s. I was recently told that I possibly have hashimoto’s. My mother was 19 when diagnosed with it so it’s been on the radar for many years. Also my periods have gotten shorter (from about 7 – 8 days to about 4 days) a little further apart and lighter. I had a test for hormones but it was on day ten of my cycle. Both progeaterone and estrogen were on the low side of normal. No doctor will listen to me because my blood tests, including thyroid all fall in the normal ranges, though on the outskirts. Do you have any advice on where to go from here? I am using rogaine and viviscal on the recommendation of my dermatologist.

  67. Hi Lara!

    From your experience what is the effect of going on a no sugar/dairy diet and taking supplements (Peony, licorice, berberine etc.) on hirsuitism? Do most people experience an improvement?

    Thank you so much for all the info on your website, I’ve just ordered your book as well 🙂

    • Hi Lydia, Generally speaking, those treatment should be helpful if your hirsutism is due to PCOS. But remember, it can take a long time to see results (6 months or more).

  68. I have been on Spiro for over a year. My hair has gotten extremely thin, to the point everyone is making comments about it. Yesterday, I was researching causes and the only thing I could come up with was this medication. If it is used for people loosing hair can it really cause hair loss? Reading side effects I realized that my irregular menstrual cycles, fatigue, dizziness, and bloating could all be linked to this medication. I just stopped taking it because I cant deal with my hair loss. so can the Spiro be what is causing the hair loss and will my hair start to grow once off this medication? Please help

  69. Never written to an online doctor before, but I don’t know what to do. I’m 65 and continue to lose my hair to the point I can’t cover up the bald spots anymore. I I’ve been on bio-identical hormones since 2010. Then, we added spiro, first 50mg, then 75mg, now l00mg. A few weeks ago, I repeated the saliva testing & my results came back in normal ranges except for a low DHEA at 1.6ng/mL and a high Pg/E2 ratio at 609. The compounding pharmacy suggested to add 2mg of DHEA and decrease my progesterone to 40mg and my estriol to .25 and my doctor wrote the order to cover that recommendation. I’m concerned that adding DHEA will increase my testosterone level causing increase hair loss. I saw dermatologist last week and was told to try the bio-identical hormone changes plus 100 mg spiro for 3 months and see what happens. The dermatologist was also experiencing hair loss! She said they are doing wonders with hair transplants and said she would send me some suggestions. She told me to check out Dr. Lam’s website on adrenal fatigue. I am so very frustrated. I bought gluten free bread and pasta yesterday and thought I would try to avoid wheat products and see if that helps. I need to reorder my bio-identical creams, but are they doing any good? Is spiro causing hair loss? Would appreciate your opinion.

    • Hi Karen, Unfortunately, I can give only fairly generalised advice online. As much as I’d like to, I cannot give individualised advice about what exactly you should do. I will point out that Spironolactone suppresses DHEA, so a low DHEA is exactly what we would expect to see with that drug. Also, it’s not just DHEA that converts to testosterone. Progesterone can also convert to testosterone, which is why I’m pretty careful with the dose. I think there is a discussion about this in the comments thread of my first hair loss post.

  70. 30 year old female here with acne, oily skin, oily hair, major hair loss on the head (male pattern), facial hair and the only thing that came back was HIGH testosterone, both free and total.

    What can i do if hormonal imbalance and testosterone are to blame? my derm wants me to try spiro. I don’t know what other options i have so I will want to try it also.

    • If you have high testosterone, then it is likely that you have a condition called PCOS. Did your doctor say anything about that? The best treatment is to treat the underlying cause of PCOS (usually insulin). I discuss PCOS causes and treatments in my 4 Types of PCOS post.

  71. I feel like I am stuck between a brick and a hard wall here. I am a natural gal, but I just got my prescription for Spiro as Im desperately wanting to stop my hair loss. Dr. Briden, I have lost 50% of my hair in 3 months. Is this normal? Or is this hair loss something other than PCOS?

    I am a PCOS gal. Ive got high androgens (free and total Testosterone) and DHEA-S. Vitamin D deficient. Conventional doctor did partial thyroid panel..TSH 2.4 uIU/mL (this is always fluctuating), T4 5.8 ug/dL, T3 Uptake 33%, Free T4 1.9 ug/dL, TPO 8 IU/mL, TGO low positive. Is this Hashimoto’s, and if so what treatment should I follow? I want optimal health. I want to reclaim my femininity that PCOS has stripped me from. I have been taking peony and licorice for almost a month; it has not reduced PCOS symptoms, but my recent LH:FSH looked outstanding (1:1).

    Side note: Been going wheat and dairy free after being tested for gluten sensitivity and lactose intolerance. Had an endoscopy recently; images showed I have mild esophagitis and mild gastritis. Suffered from gut issues since childhood..antibiotics must’ve messed me up down the road.

    I hope this helps. Please let me know of any suggestions/approaches. Thank you

    • Have you ruled out insulin resistance? As I discussed in the PCOS post, an insulin problem is that most common reason for high androgens. But in your case, you also have inflammation (as shown by the positive TPO antibodies). Yes, ultimately, both the thyroid and insulin problem may stem from inflammation starting at your gut. Wheat-free, dairy-free is a good start, but please understand that it will take months (6-12) for that to help your hair.
      In the shorter term, the main thing to watch for are healthy, regular periods (ovulations).

  72. Hi Laura
    I have been taking spiro for about 4 or 5 years now. I was given it by a cardiologist to try to bring my blood pressure down. I had been on 25mg per day, but my BP is very high again and it has been doubled to 50 mg per day. I have noticed my hair thinning out quite considerably since the increase. I had a hysterectomy abt 9 years ago and have never been right since but perhaps this drug makes me depressed and anxious as this is how I feel all the time and never have energy. I don’t think my skin is great on it but since the hysterectomy it never has been good. I keep getting offered prozac, but don’t want to go down that route. Would you connect any of the negs to this drug
    Huge thanks

  73. Lara, do you know anything about spiro being linked to anxiety? I’ve been on it for 4 months for mild acne (25 mg/day) and I’ve been experiencing anxiety for the first time in my life. And not stress-related anxiety — it’s anxiety that seems to be have no real cause. Curious if you were aware of a connection. Thanks!

      • I suspected as much — but it’s a real relief to hear that from someone who knows what they’re talking about. I’ve been off for a week and so far my skin is good but the anxiety has not faded. Any suggestions for going off of it smoothly and minimizing the chance of breaking out? Thanks so much, Lara.

    • Hi Melanie,
      Thank you for bringing this up. Yes, menopause requires a different approach. I recommend: 1) maintain healthy adrenal function (HPA axis) because adrenal glands make hormones (including estrogen and progesterone), 2) consider taking low dose bioidentical estradiol and/or progesterone.

      Also, of course, maintain healthy thyroid function, and keep inflammation and insulin as low as possible (to keep androgens down).

  74. I am 44 female. Had horrible adult female hormonal acne around age 42 (while on birth control called zovia) my derm added 100 mg spiro, cleared up acne 100%. But after a year on spiro, I lost tons of hair. At part & in front at forehead line. I do use minoxidil now, but after a year of that, still not seeing much regrowth. Should I try stopping spiro or increase to 200mg a day? Controversial internet research shows some reports of LOSING hair after spiro? Please help. [email protected]

    • Jen, you can see from my post that I am not a fan of Spiro. In most cases, I encourage patients to get off the Pill, and off Spiro, and to reestablish a normal ovulation. That way, you can have the benefit of your own estrogen and progesterone for hair.

      That said, any hormonal change can temporarily worsen hair loss. (That includes stopping the Pill and stopping Spiro). What I do with patients: 1) correct any other possible reasons for hair loss (such as gluten, thyroid, or iron deficiency) for three months, and then 2) Reduce the dose of Spiro slowly over a couple of months, and 3) stop, and work to promote ovulation and natural periods.

  75. Forgot to also say that my testosterone and dhea tested low also.. Im am thin, so i know i dont make much estrogen, its hard for me to put weight on and keep weight on which bothers me. As my testosterone isnt high, i feel its more of a sensitivity and because my progesterone and estrogen fall low they androgens affect me more, would you agree with this? i have been taking zinc citrate now once a day, i think its 30mg, i saw you recommended this for androgen sensitivity, what dosage do you reccomend? im also stil on rhodiola, saw palmetto, liver support nac, iron, vit c, vitamin d3, b complex, omega 3 and evening primrose oil, and a probiotic. Came off vitex about a month ago so im considering starting the progestrone cream again but just a small amount during luteal phase. To keep my estrogen balanced i take flax seed daily, and have just started dong quai, just one cap in the morning. Any advice would be really appreciated. Like all the other women on here i feel i have lost my life to all of this, its already cost me a relationship with the best guy ever because i dnt want to hold him back with all this anymore. I NEED to sort this out.

    • Hi Lysney, you didn’t say (or maybe I missed it) what your periods are doing. You say that your estrogen is low, but if you have periods, then your estrogen must be fairly high around mid-cycle (ovulation). If you ovulate, then your progesterone must be high at least for a little while.

      Estrogen and progesterone are the best hormones for hair. Please figure out if you are ovulating regularly, and if not, then please work to promote ovulation as your #1 treatment. Please see my ovulation post.

  76. sorry for the spelling errors, i just read it back, i meant to say im now on pescription iron and my cortisol is still out of whack.

  77. Hi Lara, I went on spiro for acne which it cleared greatly and made my hair super soft and thick.. 2 years after coming off it and trying natural remedies im still a mess. Low ferritin, it was at 12.. then i supplemented a high quality heme iron supplement for 4 months and only got it up to 15. Im not on the pescription iron which is even higher. Hairloss really bad, got progressivly worse after coming off spiro. The spiro also gave me melasma, which has continued to get worse even 2 years off it. My Cortisol pattern is still way out of way, I got it tested in the mrning and it was low, i get an afternoon lull around 2-5.. and find it hard to either fall asleep or wake up in the middle of the night wide awake. I have been taking rhodiola as per request of my naturopath for about 6 months, but still getting these symptoms. I try to turn my brain off but im constantly stressed by there issues which i know doesnt help. My acne i have not been able to control since coming off spiro.. I was on progesterone cream for a while, aswell as saw palmetto, and i found that these helped but i stopped the progesterone cream as my naturopath tested me and i had gone to high… with low estradiol. She then put me on vitex instead, which has i presume lowered my estrogen even more?! so now i have worse hairloss, acne is all over my back and jawline, very painful and cystic. I feel i need to get my estrogen at a good level, yet everything i read for melasma says its caused by estrogen, i dont have high estrogen! i need more! so wot do i do?! im desperate.

  78. I started progesterone and testosterone and then experienced scary, crazy, I am going to be bald in a month if this keeps up hair loss. Scared to death I quit the progesterone and testosterone. My other doctor thinks the hair loss was created from to much testosterone so she gave me spiro. In this situation, do you think it will help with the hair loss until all the testosterone is out of system? I have only been taking it for 10 days but I am not sure if I should continue. I have been off the hormones for 3 weeks. I hear it can take 4-6 weeks to get out of your system. Thank you for any advise you can give me…

    • I don’t like the idea of a woman taking testosterone. I don’t think it’s safe (although I know that a number of doctors give it).

      I’m sorry to say this, but I think that you’re going to have to ride it out. The hormone will be out of your system pretty quickly, but your hair follicles are still responding to the levels you had months ago (were you on it that long?). I don’t think Spiro will help.

      It should all be temporary, and you will start to regrow your hair starting about three months after you stopped the testosterone.

  79. Do you have any recommendations for getting off spiro? My dr has prescribed it to me (200 mg a day) for hair loss and slight hirsutism. I’ve been on it for about 6 months and haven’t seen much of a difference but I am terrified that stopping it suddenly will make things worse

    • I came off spiro fine. I have been off of it since August, but my doctor insisted I go back on it because the acne and the hirsutism have returned. In fact they returned almost immediately (but not worse), but I was unwilling to go back on the medication based on my previous experience. I was terrified because of what the 50 mg dose did to me. My doctor suggested a 25 mg dose. I went one step further, and I am cutting each 25 mg in half for a 12.5 mg dose each day. My problem does not require such a huge dose of this very powerful medicine. Also, as my doctor pointed out, I know what to look for in the way of side effects, and I am much more prepared to take this very powerful medication. Keep us posted on what happens when you come off the medication.

      • Thank you for the reply! I don’t really feel any side effects of the 200 mg at all. I’m more concerned that if I get off my hair will shed a lot more. I will definitely keep you posted on my experience with that.

        • Your hair will likely go back to shedding. It was my experience that it did not shed anymore than it did before I had taken it. I just went from shedding without the meds to less shedding with the meds then back to shedding without the meds. It feels like more shedding because you haven’t been shedding as much. I feel a lot better on a lower dose because I think that Lara is right about how dangerous this drug is.

  80. Hi Lara,
    Just discovered this blog after years of frustration with illness. I was overweight about 4-5 years ago, at the young age of 19. I was feeling ill quite often, and had, in years prior, dealt with heavy, abnormal periods that caused vomiting and migraines. I had lost and regained weight a few times in high school, as well. At the age of 20, I had some blood work done and was told my DHEA levels were 3x the normal amount, and that because of my history of abnormal periods (though they were normal at that point), I needed to go on some medicine. I went to see an endocrinologist and she put me on metformin and spironolactone. I did spiro consistently, but was scared of metformin because of scary things I read online. I wasn’t diabetic, anyway, and really, only 30-40 lbs overweight. Over the past 4 years, I’ve been on spiro, and off and on again metformin a couple of times. I tried birth control pills for a month or two, once or twice in my life, and again, was scared off by what I knew they could do to my body.
    Finally, through a lot of work, I have lost all the weight I need to lose. I’m a vegetarian and I am at my BMI, I don’t have any acne, but my hair growth on my chin is still out of control, even after all these years (I’ve been getting electrolysis done on it for about 9 months now).
    I am still getting sick, though. This past summer, I have had random instances of vomiting and headaches. I am so tired of being sick like this 2-3 times a month since the summer. I did go on BCP in September, but like I said, I’ve been getting sick like this since July. I am having blood work done and seeing my doctor, but finding your website has inspired me to go off my BCP and spironolactone. If I am going to be sick anyway, I might as well be sick “naturally.” I also think I may have dealt with my high DHEA levels through weight loss versus spironolactone. Do you have any thoughts regarding this theory? What do you think of my quitting my meds cold turkey?

  81. I just wanted to say that I did take spironolactone for acne and it worked wonders, it was a beauty pill for sure and to add to that it stopped all the dark hair growth on my face and even body hair became less and when I would shave no more razor burn or very little, it was great!!!! And wow, my skin glowed, it was the best skin I’ve had since my childhood. But after 7 or 8 months I noticed my hair falling out and as time went on more and more hair was coming out of my head and so I went back to my dermatologist, a really good one who I trust and still do trust, she took a pull test on my hair, said I was good and maybe it was stress and that the spironolactone would not cause hair loss on my head. I have no history of hair loss in my family, none. So I continued on… and it got worse and worse until I was showering every three days because the more I showered the more hair fell out. On top of that I would get so angry, and it was very unusual for me. Finally I was convinced it had to be the medication, I gave up, went off the spironolactone….and my hair kept falling out… but about two months later it slowed. Today my hair is a dry, brittle, and growing back, thank goodness…. it’s growing back. However the facial hair that I had always had on my face that was noticeable to probably only me that went away during my spironolactone use… o it’s back it’s back big time, it’s double what it use to be, dark, fast growing and twice as much as it was before I used the spironolactone. Anyway I just wanted to pass it along, that it does feel like a gorgeous beauty pill but in some cases… mine anyway… it went from gorgeous to crying in the shower.

    • yes!. And along with this I lost my eyelashes, and other body hair. I didn’t like not having to shave my legs after a while. Depressing. Crying after every shower. AWFUL. Soooo good to know it gross back. UGH. This drug is a joke.

  82. As a long time sufferer of PCOS, I was desperate to do something about the hirsuitism. I was also an avid gym nut. I went everyday the doors were open. I started taking spiro at the very lowest dose, and at first there were no side effects. The hair went down, and I was feeling great. I took spiro for 6 months before my gym performance started lagging. I just couldn’t do what was once so easy. My trainer pushed me harder. I got sicker. I gained weight. My urinary tract was on fire!! At this point I had been on it so long I never could have imagined it was the cause of the urinary symptoms. A great deal of pain and many tests later. I put two and two together. I was totally and completely dehydrated for a year. It was causing extreme pain in my urinary tract. Everyone please watch out for this medicine. I saw at least 10 doctors. None of them put it together. It just isn’t a “normal” side effect. Nothing about PCOS meets a standard protocol for care. When are they going to figure that out? We are all different! Anyway, I just had an “aha!” moment one day. I stopped taking it, and within 3 days I was back to feeling better. 3 days!!! Best of luck to all PCOS sufferers out there!

    • Well said, Regan: “Nothing about PCOS meets a standard protocol for care. When are they going to figure that out? We are all different!”

      I agree wholeheartedly. PCOS is not one thing. It is not one disease. Which is why I wrote my Types of PCOS post. You might be interested to see that, if you haven’t already.

  83. Hey Dr Lara I was realy glad to know about your blog and i realy appreciate your concern for PCOS sufferers. Every doctor that i have been to just tells me to continue the pill i live in pakistan and overhere they give Diane35 for PCOS i have been taking it since i was 14 for last five years.i had a very sever acne and it realy cleared it up but i am still experiancing a very sever haifall i stopped the pill for 3 months but i had to start again because my periods stopped coming and i had a very bad acne breakout.

  84. I would love for someone like you to help with androgen alopecia. It is heart breaking and the only answers ever provided has been spiro. My naturopath thinks it is all liver related and i am taking god knows what to help. Feels like a losing battle.

  85. Help ..my hair has been falling out for 2 years. .. doctors check thyroid level say they look fine… now its possible l may have PCOS but waiting for next doctors appointment which is in 2 months 🙁
    How do we get our levels back to normal…

  86. Hi Lara,

    I stumbled across you site today.
    Ive been on aldactone (and metformin) for 8-10 years. In 2011 I lost al my weight (over 50kgs) by entering a bodybuilding completion and dropping to minimal body fat.
    Since then my weight has gone up and down around my on and off season.
    3 years in a row I have attempted to get off it, and wasn’t losing any weight so I went straight back on it.
    This year I have attempted to get off it again, ive been off it for almost 3 months now. I train 2 hours a day and am on a high protein diet that would definitely work if I were on Aldactone.
    Can you tell me what the hell could be going on with my body? What can I do to start losing weight without getting on aldactone?

  87. Hello Lara,

    I just stumbled upon your blog/site late tonight trying to research the treatment options offered to my daughter ( 17 years) today by Derm. Am so glad I did!
    My beautiful girl had lovely long and thick hair which started to fall ( I noticed it mostly) about a year ago now. Her normally clear skin ( for a teenager) has also stated to show more break outs than normal and her hair is now very greasy and needs washing frequently when it was really normal for years and years. She escaped the teenage acne etc phase lightly even though menstruation started around 11.5 years. She has had many big exams and under a lot of stress with huge schoolwork load too. I realise that lack of sleep and stress are probably playing havoc with her physiology but overall she is very happy, calm and takes life in her stride. ( I’m usually the one who is stressed and worried about everyone and everything!)
    Today’s visit with the Dermatologist was the final result of pestering our GP to runs blood tests ( not all done as they could see no reason) and further tests done by the consultant too. In short, most of the blood panel is normal but ferritin is a little lower than ideal for good hair growth ( 76 ng/mL); serum Vit D2 + D3 is 69nmol/L and the DHEASulph is at the upper end if the norm @ 7.2umol/L ( upper limit is 7.7). All other hormones were within normal. The Zn test is not back yet and no test was done for Mg.
    So, the Dermatologist has prescribed Yasmin pill plus Spiro plus minoxidil.
    Only a short course but I am now worried about the side effects of these powerful drugs on a young body and the fact that they may themselves, totally disrupt her hormones.
    I am desperate to do the right thing and she, naturally, is keen to do the quick thing! My husband wants to trust the advice of the doctors but I am not keen to take internally medications which have major physiological effects, even for a short duration.

    Please could you give some advice? I am in a dilemma and very worried, though trying to keep these concerns to myself.

    Thank you and warm regards,

    • I know that it is difficult to go against a doctor’s advice, but I believe unequivocally that the Pill is never the right solution for hair loss.

  88. Hi Lara,

    Thanks so much for all of your helpful notes here.

    I was on OBC for my high school and early college years and then got off the pill. After that, I started developing acne on my back, which I’d never had. I went back on OBC and started Spiro last fall because I was having terrible outbreaks on my face and back, the worst I’ve had. I’m 24 so this just doesn’t seem normal.

    The combination worked very well and my skin looked the best it had in years. However, shortly after starting the Spiro, I developed an autoimmune disease (monoarticular inflammatory arthritis) and immediately stopped both drugs because I was frightened of putting artificial hormones in my body in the face of a serious health issue.

    My skin has been steadily getting worse since – an outbreak started on my shoulders and now covers my whole back. I feel incredibly insecure about it and am considering going back on the Spiro but am caught between alleviating this issue and it’s possible interference with healing my autoimmune disease.

    Can you over any advice on potential holistic approaches? I’m now on a prescription drug for the autoimmune disease (may need to add another stronger one) and would love to avoid adding another prescription (Spiro) on top of it.

    Thank you so much for your help!


  89. I just stopped taking aldactone after several hellish months. Yes, my hair has never looked better and I had clear skin (but weird texture). I, also, had awful feelings of rage and constant irritability. It took a long time to figure out that it was this pill causing these feelings. It took 2 weeks to get out if my system and I’m calm again. I have 3 young children and thank God I didn’t hurt them.

    • Hi Michelle.
      Yup. The rage, and also insomnia! I also realized it was messing with my adrenals. However, this pill did a number on my hair, as well as birth control. I am losing my eyelashes and eyebrows from it! Ive been tapering for a few weeks, and already getting sleepy at night (plus off the birth control). Its so sad what dermatologists shrug their shoulders at when I share. I told them I ceased dairy and no longer have cystic acne, and they said yup, that “sometimes does it.” Ever since Ive changed my diet, the cysts have been barely a worry. If Id known refined sugar and dairy were the problem I would have preached this to my brother who went on accutane and is now spiraling down into depression. Its maddening. Our guts have their own brain, how could it not affect our entire system.

  90. I use spirolactone. Originally it was prescribed for my hair to no avail. It does nothing for my hair. In fact I am wondering if the spirolactone is the reason my hair is worse. It has been great for my high blood pressure. I am 65 years old. Please give me some advice.

  91. hi Lara
    have you written anything on idiopathic hirsuitism before? I follow your blog religiously but cant find anything..do you do skype consults as I am in melb?
    with so much thanks

    • Hi Geraldine, ‘Idiopathic’ just means that your doctors cannot explain why the hair loss is occurring (but there must be a reason). If they have said idiopathic, then you must have tests to show: normal androgens, normal thyroid and iron, and negative for gluten-sensitivity.
      I have seen a number of patients with this unexplained ‘androgen-hypersensitivity’ hair loss. ie. Normal androgens on blood test, but still displaying symptoms of androgen excess. What generally improves things is zinc and also repair of the intestinal flora (correction of intestinal dysbiosis). I’d love to discuss it with you in more detail. Can you get to my Sydney rooms for an initial consult? we can then follow-up by phone.

  92. I want to offer another comment here. I’ve had lots of messages from people saying: “I tried a natural treatment for a few months, but hair loss got worse, so I stopped.” Here is something to remember: Hair has a LAG-TIME of at least 3 months. The shedding that you notice NOW is a the direct result of what you were doing or taking 3-4 months PRIOR. Not what you are doing now. SO, please think carefully before you abandon a natural treatment.

    • Hi Lara,
      With all due respect, the 3-4 month lag time does not apply to my experiences with hair loss. If I take any anti-fungal, hormone, or the wrong herb, my hair loss explodes about 2-3 days later. If I cease taking whatever sparked the reaction, the shedding reduces significantly within a day or two. I’ve been trying (again) to tackle candida. I began the anti-fungal on Monday. The initial response was dizziness, fatigue, and irritability. By day three, my face and scalp began to burn (a precursor to hair loss). That night I lost handfuls of hair in the shower. I did not take the antifungal the next day and the hair loss decreased by more than half ( I count them). The same thing happened when I tried estrogen, progesterone, thyroid hormone, and DHEA. I once tried persisting through the burning and hair loss. I finally gave up after a week and a half when I was loosing 300+ hairs in the shower. The loss dropped to 20 within three days. I’ve found that very few health professionals understand hair loss. Through my experience and from talking with many others, I believe that there are far more triggers for hair loss than what the medical community recognizes. I wish you could provide some insight into this phenomenon. I have had positive autoimmune tests but no diagnosis and the hair loss is diffuse. The burning is real, significant; triggered by a change in supplement and definitely leads to profuse shedding.

      • Lara te puedo escribir en español? Yo creo, que la mejor manera de regresar tu “balance hormonal” es como tu lo afirmas, de eso no tengo duda. Pero la caida de pelo, es una pesadilla, llevo 7 meses perdiendo arriba de 300 cabellos dia a dia, he tomado muchos suplementos naturales, estoy haciendo paleo al 99% sin embargo mis valores de DHEA y Testosterona siguen altos. Entiendo que la sanacion natural es un proceso largo pero seguro. Sin embargo siento que no puedo mas con la caida de pelo. Mi pregunta es: Si acepto la pildora solo por un “pequeño tiempo”, nunca para largos terminos, quizas solo unos par de meses y trabajo muy duro en mi estilo de vida, reduciendo inflamacion y siguiendo con paleo, hay posibilidades que pueda dejar la pildora con mas facilidad? Se que esto no esta bien, tampoco lo quiero hacer, pero tengo miedo de perder todo mi pelo por completo. No sabes como me encantaria una consulta contigo por skype, lastima que vivas en otro continente. Gracias por todo, por ser tan buena y linda con nosotros.

        • Me gustaría ayudarte, de verdad. Estas haciendo muchas de las cosas correctas, y yo estoy seguro de que vas a ver resultados, pero necesitas más tiempo. Para usar la píldora “un poquito” no va a funcionar porque suprime la ovulación y evita que la progesterona. Por favor me envíe un mensaje privado. (Y perdone mi Español pero me gusta practicar. 🙂 )

          And in English for my readers: It does not work to use the Pill just a short time to recover hair, because it just prolongs the problem. It suppresses ovulation and prevents progesterone. And then there will still be a hormonal shift to endure when the Pill is eventually stopped.

  93. Hi, I am terrified of getting off Spironolactone. When I’m on it my skin is perfect. If I miss a day I get cystic acne! ( I have been on Accutane 4 times with no help) I love Spironolactone. The only problem is I bleed constantly on Spironolactone so I have to take the pill (loestrin FE) to stop the bleeding. But now the birth control is causing hair loss. On it for 4 years now. My sjin has never been clearer and my hair has never been thinner. Should I just add estrogen (like estroven) or progesterone supplements? Or switch birth control? I know this is against everything you preach. But I have NEVER had clear skin like I do now.
    Thanks in advance!

    • Marie! Paleo can improve you skin 90% trust me. I found my skin is beautiful since I’m on paleo, my main symptom right now is hair loss, and I think that takes more time. If you don’t addresses the root of this, once you left spiro and birth control things would be much worse. Is not easy, require discipline but I want my hair, life and health back, I’m going to fight hard. Good luck

      • Hi Marie, I agree with Laura. A paleo-type diet does wonders for skin. No wheat, no A1-dairy, no concentrated fructose/sugar. Also supplemental zinc and panthothenic acid. Also herbal anti-microbials. I find that acne is the ‘easy’ thing to treat in clinic. (Hair loss is the hard thing.)

        As for the Roacutane (accutane, isotretinoin), it is horrible beyond words. I could never even write a post about the drug because it would make me too sad. It damages the gut, and there is now emerging evidence that it interferes with DNA expression and damages our hormonal system.

        • Dr. Lara, my teen daughter took 7 months of accutane for cystic acne. The acne is very improved. Her labs during treatment were OK (they were tested monthly). She continues to take a low dose of oral contraceptive. In terms of the accutane, I must admit I was nervous about it but the derm assured us it was safe. From your expertise, what should I watch for in the future if she were to have any future issues? Also, she likes the oral contraceptive, any advice on how to help her understand how it could be unhealthy for her? I greatly appreciate any input. My child’s health is so very important to me – knowing what’s best and who to trust is so hard.

      • Dim detox, I am constantly touting this stuff cause it worked wonders for my skin. Cutting dairy helped too though, as did primrose oil.

  94. Hello Lara ,

    I’d already written on your blog last automn, we talked about the fact that it was so difficult to get the special blend of poeny and licorice in Europe because traditionnal herbalists or pharmacy don’t have them in their office…
    they have Licorice but not the Poeny one.

    So I had an intensive look on internet and find an on line pharmacy in New Zeland that sells that blend of herbs in tablets and ordered them; they were shipping in Belgium (very good idea !)
    So I took Polyfem , 3 times a day now , as it is mentionned on the label, but I was wondering how long does it take to notice some results, 3 months ? (like the pill or spiro did, in general ) or does it take any longer with herbs?
    I have in general a very low blood pressure (never more than 11) so my Homeopath here don’t bother with the side effect of licorice on blood pressure.

    But it is a fact, that alternative practionners here don’t know this association of herbs for Pcos.They prescribe Lady Mantle, Chaste Berry Trea (agnus castus) and Gromwell (lithospermum officinale), which were not efficient enough for me to lower the nasty effects of androgens, on my hair and sKin…I hope my hair and skin ar going to be better far soon !
    that’s my ultimate help ….
    (in addition, I’m taking specific vitamins, Mg, zinc supplements, watch my diet, exercise …)
    At nearly fourty years old, I’m still feeling so low and self conscious like so many women who struggle with pcos.

    Best regards From Europe,


    • If you have been on it 3 months, your skin should have improved by now, assuming that you are ovulating regularly (and have a good progesterone reading). You might want to check on a blood test that it has lowered your LH and testosterone.
      Yes, I know the Mediherb Polyfem. It’s an Australian product. I prescribe 2 first thing in the morning, and not the full 3 tablets/day, but please check with your herbalist about what is right for you. I also recommend that you stop them for 5 days with every period.
      Your hair may take longer to improve. So much depends on what is actually happening with your hormones and your body. I wish that I could have a detailed conversation with each and every one of you, to try to get to the bottom of your individual case.

      • Good Morning,

        Well if you notice some results with your patients with 2 tablets per day, I’m going to stick with that dose, because there’s only 60 tablets in a bottle.My tablets are so precious!

        This Australian lab should consider to sell this product more easily here, I think there would be a lot of demands from PCOS sufferers !
        I’m going to begin my 3rd months of treatement so, can’t wait to be already in june to notice all the results !
        thank you for the tip to stop the tablets during my period, my cycle are still a bit long but far better than before ! i’m also taking lady mantle and gromwell herbs on liquid extract formula to support progesterone (second phase of the cycle) and DIM as you advice it in your article, on line.

        I would check my level of progesterone (so low) and LH before summer because last october the ratio level with FSH was so high, that the big trouble with me, my androgens level is just slightly raised.
        I like the fact that you pointed it out that there was two types of PCOS, because I am lean like many others girls with (unknown ) PCOS, and it took so many years to have a proper diagnosis.

        Have a nice day, (though I should check the jet lag with Australia)


  95. Thanks Lara! What is so strange is I did not have this problem until I lost weight. Now I am of normal weight and have been for 6 years 130lb 5’6. I have had GGT and all is normal. I do ovulate every month (at least my body temp goes up .6 degree and stays there for about 14 days), Seems I have lower than normal estrogen based on some tests. Only took the BC pill for a couple of months 18 years ago. It caused enough problems for me then to know it was bad news. I am 36 and frustrated. I appreciate the info that you share. It helps to know someone out there is trying to help, without causing more harm. I wish you were in the US, or even better, that I was in Australia.

    • I can see why you are frustrated. You are not insulin resistant and sounds like you are ovulating regularly.
      I assume that you have looked at thyroid and gluten? Antibiotic-damage to intestinal bacteria? Zinc status?

      • Thyroid is normal. The only other hormone imbalances are that my estradial is low or low normal most of the time. I only have 1-2 day periods, very light. I was wondering if DHEA can go higher when the body uses it to make estrogen? I don’t know, just an idea. I did not have any issues with facial hair or hair loss until I lost 45lbs a few years ago. I have to believe there is a connection there. My androstenedione is elevated off and on. I have not had zinc checked yet.

        Do you do consults by phone or email for people in the US? Or do you know of any good recommendations here. I really appreciate you taking the time to answer some of our questions. I know you can’t diagnose or treat us, but it at least leads us in the right direction. Thanks again. 🙂

  96. Hi Lara, Love your blog, thanks for sharing your info with all of us. 🙂 My DHEA is very elevated and DHEA-S is at high end of normal. I have male pattern hairloss and hirsuitism. I am 36.The docs want me to take spiro and the BC pill. I do not want to do this. I am more interested in why my DHEA is so high to begin with. Obviously the DHEA is what is causing my symptoms. Do you know what can cause DHEA to elevate like this for years? Also how can a person lower it naturally? I cannot get any answers on these questions from doctors. Thanks for any help.

    • Some of the DHEA is coming from your adrenal glands, but your ovaries release 20% of DHEA (and 50% of androstenedione).
      Insulin resistance and leptin resistance are major drivers for over-production of androgens (by both ovaries and adrenal glands). Anything that interferes with normal ovulation will cause the ovary to make more androgen than estrogen. This could be thyroid issue, chronic inflammation, gluten sensitivity, zinc deficiency. Also, a history of Pill use, and – very worrying – environmental toxins. A paper just came out called: Industrial endocrine disruptors and polycystic ovary syndrome. I would be very grateful if anyone out there can access the full-text paper and share it with me. Environmental toxins ALSO interfere with adrenal feedback mechanisms (therefore causing abnormal elevation of adrenal androgens DHEA and DHEAS).

      As I described in my PCOS post, the ovaries are the victims. 🙁

      All of that said, the herbal formula peony and licorice (1:1 ratio) does lower LH and androgens. I get very good success with it in my Sydney clinic. I know that it’s not easily available out there in the rest of the world. I’ll try to blog about it soon.

      • Hi Lara,

        Your blog is absolutely wonderful by the way.

        I read a research paper that Liquorice increases DHEAS and so know I’m confused whether to use it or not? I don’t have high testosterone, I have very regular periods and a good normal oestrogen level but I have very very high DHEAS and therefore suffering from excess androgens. I simply need to find a way to lower my DHEAS would Liquorice work or make it worse?



  97. hi there, what about using it for hirsuitism? do you have any treatments that have worked for hirsuitism? thanks so much. i love you blog

    • The same concerns apply for Spiro’s use with hirsutism. It has a lot of side effects AND – more importantly – the drug interferes with ovulation and normal hormone balance. Which means that it perpetuates the underlying hormone imbalance that causes hirsutism and other androgen symptoms.

      • Hi Lara, Thank you for addressing hormonal hair loss issues, PCOS, and Spiro. A dermatologist put me on spiro. 200 mg. even though my tests showed low free testosterone and DHEA. The spiro., which I stayed on for over a year, caused more hair loss, two periods a month, high potassium levels, fatigue, depression, etc. I finally stopped cold turkey about 7 months ago. Unfortunately, even with almost 6000 mg of myo-inositol a day and a perfect diet, I’ve only ovulated once in those 7 months. My scalp has become increasingly oily, I’m breaking out again, have hair growing on my face (worse than ever), and I’ve lost most of my hair. Progesterone cream made my hair loss worse. I’ve tried estrogen, also which was a disaster. I’ve tried, unsuccessfully, finding a licorice and peony supplement online. I’m at my wits end. I know that the spiro. really messed up my body. Is there any hope (at 43) of restoring my hormones to balance? I gave indole 3 carbinol a try along with 750 mg. of NAC – I don’t know if it was the I3C or the Nac, but I had a major hair shed, so I stopped. I’m desperate for advice.

      • Hi Lara,
        I am 59 years old and was diagnosed with PCOS in my early twenties. I took spiro and metformin for years, stopped the metformin on my own, and continued taking low dose Spiro (50 mg) daily for many, many years. I suffer with thin hair and loss. If I do not take the Spiro, my skin breaks out with cystic acne and is very oily. The problem is, I recently received lab results that are in the category of adrenal fatigue; cortisol is depressed and my pooled DHEA value (DHEA + DHEA-S) is low. What should I do? Could the Spiro be the cause of this? Or can the stressors in life (diet, emotional, work, physical stressors) be the causes alone? Please advise……………………

        Thank you,

          • Lara what do you suggest to treat hormonal acne if not spironolactone??? Topicals dont help me and i cant be on oral antibiotics any longer… ive been looking into berberine… but idk what also to use!

  98. Lara you have no idea how much appreciate your work, since doctors offer nothing really interesting for us. We really need you. Thank you so much. I can’t wait to read the natural treatments options

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