Spironolactone, commonly referred to as 'spiro', is one of the less common medical treatments for acne in women.

Spironolactone is not specifically a medication for acne, but is sometimes prescribed as an 'off-label' treatment. And for some women with certain types of acne, it can be effective. 

Primarily spironolactone is used to treat fluid build-up in the body. It is also used to treat high blood pressure, early puberty in boys, and as a transgender hormone therapy in transfeminine people.

For acne in women, spironolactone works at a hormonal level as an anti-androgen. This makes it an effective treatment option for women whose acne is caused by excess androgens (male-sex hormones), who also want to follow a pharmaceutical route.

How spironolactone clears acne

One of the leading causes of acne in women is excess androgens, which is sometimes referred to as hyperandrogenism. In particular, the androgens testosterone and dihydrotestosterone (DHT) in excess are most commonly connected to the skin condition.

Women whose acne is caused predominantly by excess androgens will often experience hirsutism too, which is thick dark hair growth on the face, neck, chest, stomach, lower back, buttocks or thighs.

Spironolactone is a steroidal anti-androgen, which means that it blocks the effects of testosterone and DHT on the body and skin. It does this by decreasing androgen production from the ovaries and adrenal glands.

It is due to its anti-androgenic activity that spironolactone is an effective pharmaceutical treatment for women with acne due to excess androgens. And it has a relatively high success rate of 50-100% when taken in high doses.

However, it is important to note here that as soon as a woman who is treating her acne with spironolactone comes off the pharmaceutical her acne will likely return. So, she will need to be on it for the long-term. Spironolactone can also cause the following side effects:

What causes excess androgens?

Excess androgens can have a few underlying causes, however the most likely is a diet high in sugars (specifically simple carbohydrates) or insulin resistance.

Medications can also cause excess androgens, such as hormone-releasing birth control. Some hormone-releasing birth control methods can worsen acne, while others can clear it. Progestin-only pills for instance can raise the levels of circulating androgens in the body making acne worse. If a woman's acne is caused by androgen excess from a progestin-only pill, then she has the option to switch to an ethinyl estradiol alternative which is an anti-androgen. It is important to note here however that the synthetic estrogen in these types of pill can contribute to estrogen dominance, which is another cause of acne.

Spironolactone must always be taken with an effective form of birth control, as there is a risk of feminization of the male foetus if a woman was to conceive while on the medication.

Polycystic ovary syndrome (PCOS) is also one of the more common causes of excess androgens in women. PCOS is not a disease, but rather a cluster of symptoms. It is an endocrine and metabolic disorder that can cause delayed or irregular menstrual cycles, excess bodily hair growth, alopecia, infertility, obesity and acne. The exact cause of PCOS is not known. However, because the disorder runs in families, it is thought that the root cause may be due to a mutation of one or more genes. 

In conclusion

Spironolactone can be an effective pharmaceutical option for the ongoing treatment of acne in women. However it always needs to be taken with an effective method of birth control, and with its discontinued use the acne will likely return.

A natural alternative to spironolactone is Clear Skin Complex, which along with diet changes can clear acne long term.