Spironolactone (Aldactone) for the treatment of PCOS

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by Jesse

DID YOU KNOW? PCOS is a disorder of hormone (dis)regulation. Insulin and male hormones are often seen in much higher levels in women with PCOS than without the disease. The medicinal one-two-punch for this is typically a cocktail of Metformin and Spironolactone. Metformin helps to keep insulin low by limited blood sugar creation in the liver and sensitizing your body to sugars in the blood. Spironolactone, on the other hand, limits the creation of male hormones (androgens) so fewer of them are circulating in your system.

Do you have PCOS? This means you may have hair growth in funny places, painful acne, oily skin (seborrhea), androgenetic alopecia, obesity and, less frequently, acanthosis nigricans (an area of thickened skin, typically behind the neck, that is darkened in appearance and fuzzy soft to the touch).

Spironolactone is the androgen blocking powerhouse pill that can lessen these masculinizing issues for women with PCOS and excessive blood androgen levels.

DID YOU KNOW? Benign cysts that form in the ovaries – often referred to as the PCOS “sting of pearls”- are capable of affecting the production of hormones, such as the androgens Spironolactone is designed to suppress.

Cystic Acne
As if unwanted facial hair wasn’t hard enough to deal with, Mother Nature often throws PCOS patients the potentially disfiguring complication called cystic acne. This isn’t the same as annoying adolescent pimples or outbreaks. Proactiv won’t do anything to get rid of it. This is something much more irritating (literally).

Cystic acne is much more likely to leave scars because the infection often occurs many layers below the skin surface. This is also why topical cleansers and treatments do so little to ease the condition. Treatment has to start below the skin, not on top of it.

Heather from CysterWigs has experienced this symptom her entire adult life. It requires diligence to keeping your skin clean, exfoliated, and well moisturized. In her case, it also required the use of Spironolactone to decrease the hormones responsible for her break outs. She considers this pill her not-so-secret weapon for keeping the dreaded “beard of acne” away!

Androgenic Alopecia
We need to be very specific and state up front that Spironolactone is not a miracle cure for hair loss. It will not make hair grow back if that follicle is already dead. However, this pill can slow or even stop excessive hair shedding in women with high androgen levels. We will discuss testosterone and its role in female hair loss in a later, more detailed installation of this blog series.


DID YOU KNOW? Hirsutism is defined as the excessive growth of body hair in women. It is classified as mild, moderate and severe and is measured by a chart very similar to this one.

The symptoms of hirsutism include excessive growth of hair on the face of a woman or unwanted growth all around the body, especially in the chest and in the back. The hair is usually dark and thick as opposed to the “peach fuzz” one might expect.

Polycystic ovarian syndrome (PCOS) is known to be a frequent cause of hirsutism. According to American Family Physician, PCOS is responsible for three out of four cases of hirsutism.

Spironolactone treatment
What exactly is this pill we’re talking about? It’s another classic example of a medical oops turning into a medical win.

Since its discovery in the 1950s, Spironolactone has demonstrated that it has a curious side effect: it lowers testosterone levels in the people who take it.

DID YOU KNOW? Spironolactone is one of the most common medications prescribed for trans women when they first begin their transitioning process. Spironolactone is either prescribed in combination with estrogen therapy or as a way to suppress androgens before adding more hormones to the mix.

Spironolactone (Aldactone) is actually a diuretic (water pill), normally prescribed to people who have high blood pressure or those who experience swelling due to excess fluids in some areas of their bodies (edema). Most women who this medication to suppress androgen production will get positive results, although it may take up to 6 months to see an improvement in symptoms.

How does Spironolactone work?
Androgens, such as testosterone, are responsible for the growth of hair on the face, chest and stomach that occurs in some women who have PCOS. Spironolactone, when taken, does a great job in decreasing androgen levels in the body, which in turn neutralizes the effect of androgen on the skin, while also improving acne.

Possible side effects may include:

  • Increased urine frequency (remember this is a diuretic)
  • Weight loss (mostly water weight)
  • Nausea (this generally goes away after a while)
  • Clear skin and easing of other androgen-related issues

Important things to note:

  • In case of liver or kidney problems, inform your doctor before you start taking Spironolactone.
  • Do not take it if you are pregnant or you could get pregnant
  • Spironolactone is best taken along with oral contraceptive pills
  • VERY IMPORTANT: Avoid taking potassium supplements while using Spironolactone! This medication can cause of build-up of potassium in the liver, which can damage the liver over time

Stay tuned for next week’s installment: Birth Control Pills and PCOS

Legal Disclaimer

This article contains general information about medical conditions and treatments.  The information is not medical advice and should not be used to replace the advice of a trained physician. If you have any suspicion that the information in this article may apply to you, be sure to contact your doctor for more details!


You can see all of Jesse’s posts here.


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