Expert: Peter J. Panagotacos, <B>M.D.</B> - 9/5/2007

Question
QUESTION: Hi Dr. Penagotacos,

I have been on spironolactone 50 mg/day for about 6 years for Acne/PCOS.  I never had a problem with hair loss.  About 18 months ago I got a generic brand that gave me horrible side effects so I reduced my dose to practically nothing.  Within weeks I was losing all my hair.  I went back on ever-increasing dosages first 50, then 100, 150, now 200 mg/day on the advise of a reproductive endocrinologist.  I am still going bald.  

Can stopping the drug cause a reverse effect?  What should I do now?  I'm afraid to go off of it in case the shedding becomes even worse.  In 18 months I have lost 1/3 - 1/2 of the hair on my head and sprouted new hairs over 100% of my body, including my face.

I am desperate.

Thanks,

Pam



ANSWER: You are sprouting hair because your testosterone level is too high giving you a high DHT. In order to prevent this taking 200mg of spironolactone is a standard dose. but in some patients it may not be enough. You have not mentioned what oral contraceptive pill you are on. I would suggest Ortho Tri Cyclen. If you are on a mini pill that could be the problem. Lastly why not ask your endocrinologist if you could take Avodart- Dutasteride. It is not usually given to women since it is meant to treat Prostate problems in men but it is the only medicine out there that will block 5-alpha reductase Type I which is in the skin and hair of men and women. This blocks production of DHT so that even if you have an elevated testosterone you will have fewer hairs to growing on your body and less baldness because the DHT that causes that.

---------- FOLLOW-UP ----------

QUESTION: I am not on birth control because I have had my tubes tied.  I am 46 years old.  I just had all my bloodwork done and I am not in menopause.

What about Proscar?

Answer
Tying  your tubes does not stop your ovaries from producing hormones you do not need or want. That is the reason for the Ortho Tri Cyclen.
Propecia works well if you have a prostate gland which is why it was not suggested for you. It works on the enzyme found in the prostate 5 alpha reducatase Type II-- Type I is in the skin and hair of both men and women and Dutasteride- Avodart- is the only medicine which blocks it.
In my last answer I wrote:
 I would suggest Ortho Tri Cyclen. If you are on a mini pill that could be the problem. Lastly why not ask your endocrinologist if you could take Avodart- Dutasteride. It is not usually given to women since it is meant to treat Prostate problems in men but it is the only medicine out there that will block 5-alpha reductase Type I which is in the skin and hair of men and women. This blocks production of DHT so that even if you have an elevated testosterone you will have fewer hairs to growing on your body and less baldness because the DHT that causes that.