Spironolactone
Spironolactone is a prescription medication traditionally used as a potassium-sparing diuretic to treat conditions such as high blood pressure, heart failure, and fluid retention. In dermatology and hair-loss contexts, it is frequently prescribed—especially for women—for acne, hirsutism, and androgen-related hair loss. Its usefulness in these settings comes from its anti-androgenic properties, including antagonism of the androgen receptor and reduction of androgen signaling at target tissues.
In PFS/PSSD/PAS communities, spironolactone is generally approached with significant caution due to its known anti-androgen mechanism. Many symptoms reported during or after spironolactone use—such as sexual dysfunction, reduced libido, emotional blunting, fatigue, and mood changes—overlap closely with androgen-disruption syndromes. While spironolactone is often described clinically as “reversible” after discontinuation, some individuals report persistent or prolonged symptoms, particularly when baseline hormone or neurosteroid systems may already be unstable. Because of this overlap and the drug’s direct androgen-blocking action, many in these communities choose to avoid spironolactone when the indication is non-essential (e.g., cosmetic use).
Crash Anecdotes (Community Reports):
https://www.reddit.com/r/PSSD/comments/12ixa25/a_reminder_to_women_about_spironolactone_and_pssd/
https://www.reddit.com/r/PSSD/comments/wywb91/spironolactone/
How to Interpret This Page
This page summarizes anecdotal reports and community observations, not medical evidence. “Risk” here refers to how frequently severe or prolonged symptom worsening is reported, not to proven causation or population-wide probability. Individual responses vary widely, and absence of issues in some users does not rule out significant reactions in others.
Risk Signal Based on User Reports
Reports of Severe and Sometimes Lasting Worsening (for PFS/PSSD/PAS):
Among individuals who already have PFS/PSSD/PAS, spironolactone is frequently cited in community reports as preceding symptom worsening, sometimes described as prolonged. Given its direct anti-androgen action and the overlap between reported effects and PFS/PSSD/PAS symptoms, many in the community consider avoidance a more conservative choice, particularly when alternative treatments are available.
For individuals without these conditions, spironolactone is widely prescribed and tolerated by many, but there are still reports of sexual, emotional, and energy-related side effects during use. In susceptible individuals, especially those with prior adverse reactions to androgen-modulating drugs, careful consideration and medical supervision are often advised.
Evidence basis: Anecdotal reports (online forums, self-reports); established pharmacology as an anti-androgen; no controlled studies examining PFS/PSSD/PAS outcomes.