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Q:  I was reading the site regarding Androgenic Alopecia. I have been on 150mg of Spiro for almost six months. I get conflicting messages on weather it is safe or not. My endocrinologist said no way to me using Spiro until he seen in person how this was effecting me emotionally. I was wondering if in your experience treating women with Spironolactone, if you have seen them develop any health problems from this medication or would you say that it is a fairly safe drug to use?

A: All medications, even nonprescription ones, have possible side effects so it can never be said that anything is absolutely safe. And safety also depends on individual sensitivity, other medications someone is on, and other factors. Spironolactone is not FDA approved for androgenic disorders but is widely used for these conditions. Based on my experience with several thousand women over 20 years, I do think spironolactone is quite safe for most women. Main side effects are:

1) Slight dehydration from the diuretic effect. Dehydration can cause lethargy and so affect mood. This can be prevented by increasing water intake. Some think spironolactone can sometimes help PMS.

2) Irregular menstrual bleeding. Not everyone who takes spironolactone has changes in her cycle. They can usually be prevented by oral contraceptives or other methods.

3) Women on spironolactone should use effective contraception. There is theoretical concern that spironolactone, because it blocks testosterone, could interfere with development of a male fetus. This has not been reported but no one should take a chance with the health of an unborn baby. Once spironolactone is stopped, it will not affect a future pregnancy.

4) Spironolactone can raise potassium, especially in combination with certain other medications. For people with healthy kidneys, this should not be a problem. However this is one of the reasons spiro should never be taken unless prescribed by a physician who knows your health situation.

If you think spironolactone is having a particular adverse effect, you should discuss this with your physician. Whether or not caused by medication, any symptoms which concern you should be checked out.

Hope this is helpful.

Geoffrey Redmond, MD

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