Spironolactone and acne. Ashley emailed me last week to ask about spironolactone’s effectiveness for acne.
“Hi there! Love your website and content – you have such great information about acne and skin health!
I’m curious to get more info on Spironolactone…I feel like I still don’t understand how it works to block androgens, and I’d like to learn more. Do you have any resources you can share with me?
Thanks so much!
Maybe like Ashely, you’ve been struggling with acne for years and you’re wondering – could Spironolactone be my magic fix?
Come dive in with me. This is the ultimate guide to Spironolactone for Acne Warriors – your 8-point checklist before determining if Spironolactone’s an effective acne treatment for you.
Today I’m revealing: how does Spironolactone work? Will spironolactone clear my acne? Does spironolactone fix hormonal imbalance? And more…
Are you excited? 🙂
1. Spironolactone & Acne: How does it work?
Let’s get Ashely an answer to her awesome questions first. How does Spironolactone work for acne?
It’s important to know how Spiro works for acne because then you can understand if Spironolactone could be an effective treatment for your acne.
For example, if you have a dry skin type, Spironolactone may not be for you.
Here’s a bird’s eye view of how Spironolactone works;
Psst AV = acne vulgaris (the clinical name for acne).
The rationale for using spironolactone in the treatment of AV is that it has been shown to inhibit sebaceous gland activity. As increased size of sebaceous glands and increased sebum secretion are essential components in the development of AV lesions, inhibition of sebaceous gland functions leads to reduced formation of acne lesions.J Clin Aesthet Dermatol. 2012 Mar; 5(3): 37–50.
Sounds pretty nifty eh.
Now here’s part 2: the science of how Spironolactone works;
Psst- don’t worry if this quote feels like science-gook, I’ve got your hand and I’m explaining everything for you after;
Spironolactone decreases 5-alpha reductase activity… In addition, it increases the level of steroid hormone binding globulin (SHBG), thus providing a sink that reduces circulating free testosterone as more is bound by the increased quantity of SHBG. The resultant effect of reducing free testosterone in circulation is an increased estrogenic state,… Spironolactone also acts locally by competing with dihydrotestosterone (DHT) for cutaneous androgen receptors, thereby inhibiting testosterone and DHT binding.J Clin Aesthet Dermatol. 2012 Mar; 5(3): 37–50.
Pwoar eh – 5-alpha reductase what?
Let’s rewind a super step.
5-alpha reductase is an enzyme in your skin – it’s a facilitator – kind of like a middleman. Or middle woman 😉
This middle woman takes testosterone – a cause of oily skin and acne – and turns this acne-causing hormone into DHT (dihydrotestosterone) – a hormone that’s 5-10x more potent than testosterone. Wowser eh.
Spironolactone helps block 5-alpha reductase – therefore turning down the volume of androgens in your skin.
But that’s not all Spiro does. Spiro also turns up the levels of steroid hormone-binding globulin (SHBG). SHBG hugs onto hormones like testosterone so your body can’t see them.
Another win for reducing androgen levels.
Plus, plus, Sprio itself competes with DHT in your body. Your body has what we scientists call receptor sites for reading chemicals like Spiro and DHT. Think of them like docking stations (a Star Trek docking station 😂). Only when chemicals are docked can they be ‘read’ and used by your body. Spironolactone’s like a bumper car at the fairground, pushing DHT away from your docking stations and therefore reducing androgenic signalling in your body and your skin.
Sounds pretty awesome right? Make sure to read points 5 & 6.
Bottom line: Spironolactone can help treat androgen-caused acne by reducing androgen levels in your skin.
2. Does Spironolactone work if my blood tests show ‘normal’ androgen levels?
You finally get your doctor to pay attention – they’ve ordered blood tests – you get an ‘all normal’ results and it feels heartbreaking.
But I have acne – everything’s obviously NOT normal.
Maybe like me – you then get told by your healthcare provider to just accept and live with it 😢 these words made me cry.
If you’ve been following me on Instagram or are an Honesty Insider on my newsletter – you know I’m not necessarily a fan of blood tests for guiding acne healing. Mostly because 90% of women with acne (estimated from my own experience of working with acne clients) – will have normal androgen levels by blood test.
View this post on Instagram
Peek at this science quote. You’re going to feel overwhelmed with relief and hope when you read it 😀
Studies have shown that women with hormonal pattern AV who have normal circulating androgen levels exhibit increased levels of the tissue-derived androgens, 3-alpha-androstanediol glucuronide and androsterone glucuronide, both of which appear to act locally on target tissues to promote the development of AV in female patients.J Clin Aesthet Dermatol. 2012 Mar; 5(3): 37–50.
Did you see that? Even if you have ‘normal’ androgen levels your skin can be excessively producing androgens locally. These androgens aren’t getting picked up on your blood testing.
Psst, certain foods can cause your skin to develop an androgen excess that causes acne – download your free copy of my acne diet cheatsheet here to get a head start on healing. Fun fact: an effective acne diet can heal acne faster than Spironolactone.
Bottom line: Spironolactone can be a treatment option for acne when androgen levels are ‘normal’.
3. How long does Spironolactone take to work?
😀 I bet you’re wondering this question after I just dropped the bomb about an effective acne diet working quicker than Spironolactone.
Here are the facts from that 10-year Mayo study looking at 395 patients taking Spiro – by the way, that’s a major sample size (meaning it’s telling us reliable results).
Median times to initial response and maximum response were 3 months and 5 monthsJ Eur Acad Dermatol Venereol. 2020 Sep;34(9):2106-2110
Translation: Spironolactone starts working after about 3 months, with best effects kicking in at month 5.
This also means if you take Spiro and see no improvements in your acne by month 5 – you should discontinue treatment. Spiro is not ‘the one’ for you.
Bottom line: Spironolactone starts working (for most women) from month 3, with the best treatment results at month 5.
Psst, an effective acne diet can show complete healing of active acne in 2-3 months. Get your free acne diet cheatsheet here.
4. Will spironolactone clear my acne?
This bit’s important to know: Spironolactone shows varying results. For some women Spiro can (temporarily – for as long as you’re taking the medication – and a little while after) show a complete healing of acne. For other women, Spironolactone isn’t effective.
The efficacy of spironolactone has been established by several studies showing improvement, with lesion reductions ranging from 50 to 100 percent in women treated for AV.Am J Clin Dermatol. 2017 Apr;18(2):169-191
For women who respond to Spironolactone, you can expect to see between a 50-100% reduction in acne.
Studies seem to indicate a 50% reduction in acne is the most common i.e. as an average of all women taking Spironolactone.
I work with many women who have taken Spironolactone in the past – if it worked for them, acne has returned after stopping treatment. It’s important to know this: when we take medication to ‘cure’ acne, it’s often and most of the time only working to temporarily fix hormonal imbalances. As soon as you remove the medication those hormonal imbalances return quickly.
Bottom line: Spironolactone can clear acne in some women. For women who respond to Spiro treatment a 50% reduction in acne is average.
5. Does spironolactone fix hormonal imbalance?
This is such an interesting question. Spironolactone is affecting your hormonal balance. You now know Spiro does this by reducing the volume of androgens in your skin.
It’s amazing you know this. Yay. Go you.
Therefore technically Spironolactone can help heal an androgen excess. However, in my scientific opinion, hormonal imbalances are only fixed when we understand the trigger causes of those hormonal imbalances.
For most women, the trigger cause of their acne isn’t a genetic or biological ‘malfunction’.
Instead, the trigger cause of acne is diet and lifestyle-based – this is what I show you how to heal inside Acne Warrior.
It’s a bit like the difference between type one and type two diabetes. Type one is genetic: a patient cannot make insulin themselves. Type two is caused by diet and lifestyle and is completely reversible without medication.
Isn’t this amazing news 😀 Many women don’t have to rely on medication to heal their acne – Corrin’s 6-year journey is proof.
Bottom line: Spironolactone can help to prevent androgen excess, however, the hormone balancing effect is only present when taking the medication – be sure to read point #6.
6. Can Spironolactone mess up your periods?
I had a client who initially came to me when she was taking Spironolactone – it had messed up her periods, they were completely irregular. It’s a common side effect of Spironolactone.
She told me her dermatologist had offered her oral contraceptives to help regulate her menstrual cycle.
It might seem amazing at first, but there are important facts you should be made aware of before deciding to take oral birth control to regulate your periods;
- Birth control switches off natural hormone production
- The ‘period’ you have on oral contraceptives isn’t a ‘period’ it’s a withdrawal bleed
So yes, seemingly The Pill can help regulate your menstrual cycle – however, the period we have on oral contraceptives is an artificial bleed. When scientists developed the pill they thought it would be nice if The Pill mimicked a natural cycle. So they engineered an ‘off week’ from the medication to give the appearance of a period.
And that’s because Spironolactone interacts with two other hormones which are super important for regulating your menstrual cycle and your period health – they go by these names;
- Luteinizing hormone (helps regulate your cycle, stimulates ovulation)
- Follicle-stimulating hormone (causes an egg to mature)
Bottom line: Spironolactone can cause irregular periods (a side effect of Spiro provoking ‘side hustle’ hormonal imbalances).
7. Does Spironolactone have side effects?
I’m so glad you’re asking this question. It’s a super important question when debating a new medication for acne. As with all medications – Spironolactone has potential side effects.
That awesome published paper which collected the data from 395 patients taking Spiro at the Mayo Clinic between 2007 and 2017 – a 10 year period, tells us all about the most common side effects of Spironolactone treatment;
Adverse effects developed for 41 patients (10.4%). The most common adverse effects were dizziness, irregular menstrual bleeding, and fatigue.J Eur Acad Dermatol Venereol. 2020 Sep;34(9):2106-2110.s
This means there’s about a 1 in 10 chance you may experience noticeable side effects from taking Spironolactone tablets.
And if you’re asking why? Why would I get dizzy or why would I feel tired all the time or why would my periods become irregular? Here’s the extra science savvy…
Spironolactone wasn’t developed to treat acne – Spiro was originally (and still is) a medication to treat fluid retention. For this reason, sometimes Spiro goes by the nickname of ‘water tablets’ – they make you pee more – they’re a diuretic – they get rid of water.
Water tablets impact your electrolyte balance and electrolytes aka salts in your body are the reason why your heart pumps – they also help your blood pressure be happy.
Psst – water tablets often get used as a treatment for high blood pressure because high blood pressure can be caused by constricted blood vessels – and fluid retention can cause constricted blood vessels.
For this reason, Spiro may cause low blood pressure which makes you feel dizzy like you just came off a tea-cup ride at the fair. Low blood pressure and imbalances in electrolytes can also leave you feeling groggy – the feeling of just waking up in the morning but instead of this feeling passing – you feel like you just rolled out of bed all day.
See question: 6. Can Spironolactone mess up your periods? for the download on Spironolactone and irregular periods.
8. Is Spironolactone a cure for acne?
What happens when I stop taking Spironolactone? You’re an absolute skincare savvy to be asking me this question.
I bet you already know the answer too.
Spironolactone works to block androgen signalling in your body. As Sprinonolatone focuses on androgens rather than the trigger causes of your androgen excess, the effects of Spironolactone last for as long as you continue the medication.
Symptoms return in months (2-5 months for most women) after discontinuing treatment.
Bottom line: Spironolactone is a plaster cure for acne – when discontinuing Sprio symptoms in most cases return.
Psst, if before you decide to take Spironolactone, you would love to get a head start on healing the root causes of your acne – and trial a natural way to heal your hormonal imbalances – download your free copy of my acne diet cheatsheet here. I can’t wait to guide you on the path to natural acne healing.
Cheryl Woodman is a scientist, skin health expert & award-winning skincare formulator who’s more friend next door than bow tie wearing professor. Through her 1-2-1 services and video courses she’s here helping you get healthier, happier skin you feel comfortable, confident and like the freakin’ awesomesauce you are in. Select the option which best describes your skin health here to see and hear the amazing transformations you could be getting.