Female Hair Loss

Does Spironolactone Cause Weight Gain?

Person standing on scale measuring weight gain due to spironolactone.

You might have heard of spironolactone being used to treat various health conditions, ranging from heart failure to hair loss in women, as a result of a condition like polycystic ovary syndrome (PCOS). It is a useful drug but like most medications, it may come with side effects. Common side effects include drowsiness, dizziness and nausea. Some people have even reported weight gain even though it is not formally acknowledged as a side effect.

Does spironolactone cause weight gain? We aim to answer this question below and explore the possible factors that could contribute to this link.

What is spironolactone?

Spironolactone is an FDA and Health Canada approved medication for treating high blood pressure and heart failure. It can alter the salt and water balance in the body by blocking the effects of a hormone called aldosterone. This causes the kidneys to increase the amount of water removed through urine, which can help to reduce fluid build-up in the body and reduce the strain on the heart.

Whilst it is only formally approved for these two conditions, it can be a very useful medication for a variety of other conditions and it’s often prescribed off-label to help treat the following (Pantibandla et al, 2023):

  • Polycystic ovary syndrome (PCOS)
  • Hair loss in women
  • Acne
  • Hirsutism (excess hair growth on the face and body)

It can also be an important drug involved in transitioning for transgender women. A combination of spironolactone and estrogen is often implemented as feminizing hormone therapy for transgender women transitioning. 

Our spironolactone tablets are available now with a prescription via our telehealth doctor's consult

If you are experiencing hair loss and are worried about weight gain or other side effects from spironolactone, consult with one of our doctors


Secondary uses of spironolactone
Whilst spironolactone is a diuretic, it also belongs to a family of drugs known as anti-androgens. They block the effects of male sex steroid hormones, such as testosterone and dihydrotestosterone (DHT), both of which play a major role in conditions such as PCOS and hair loss in women. DHT is the primary hormone involved for male pattern hair loss and it may play a smaller role in female pattern hair loss. The hormone can act very differently depending on the gender and area of the body having its effect. For example, in women DHT can cause excess hair growth on the face and other parts of the body.

In women with PCOS, the ovaries produce higher levels of androgen hormones, which can contribute to acne, increased facial and body hair and sometimes hair loss at the scalp. Spironolactone’s androgen blocking effects can help reduce symptoms and improve the quality of life for these patients.

Can spironolactone cause weight gain?

It’s unlikely that spironolactone will directly cause weight gain. If a patient experiences weight gain whilst taking spironolactone, it may be due to the health condition they are treating, rather than the effects of the drug. We will explore this concept further and attempt to explain the association between spironolactone and weight gain in different conditions.

Weight changes with spironolactone in cardiac conditions
Spironolactone is unlikely to be associated with weight gain when being used to treat cardiac conditions, because it works to remove excess fluid in the body. In this sense, some patients may actually experience a degree of weight-loss.
Weight gain while taking spironolactone for PCOS
There are close links between PCOS and obesity, with weight gain both contributing to the development of PCOS and being a consequence of it (Barber et al, 2019). When it comes to weight gain or difficulty losing weight with PCOS, there is no simple explanation, and many different factors are interconnected. Both insulin resistance and having higher levels of testosterone than normal are implicated in weight challenges in these patients. Some women may be predisposed to a high testosterone level and can later develop a resistance to insulin with PCOS, whilst others may experience increased androgen production because of insulin resistance (Navarro et al, 2015).

We know that insulin resistance is likely the reason that weight gain or difficulty losing weight is so often observed in women with PCOS. 50-90% of women with PCOS have a resistance to insulin (Venkatsean et al, 2001) and the body will compensate for this by increasing insulin production. High levels of insulin can increase hunger, promote fat storage and stop the breakdown of stored fat. This can all contribute to weight gain.

For women experiencing weight gain whilst taking spironolactone, it may be a result of the mechanisms of PCOS, rather than the medication. Much more research is needed in this field, but for now this could lend an explanation for the link between weight gain and spironolactone.

Weight gain while taking spironolactone hormone therapy
Spironolactone and estrogen can be prescribed for feminizing hormone therapy in transgender women.

This therapy can cause many physical changes, including a redistribution of body fat. This can typically result in fat collecting around the hips and thighs, as well as a decrease in muscle mass. In some cases, this may impact someone's lifestyle and may make it more difficult to exercise. A change in body weight might be observed as a result of these factors and one study found that 21% of transfeminine individuals undergoing hormone therapy gained 5kg or more (Kyinn et al, 2021).

To put it simply, transgender women undergoing feminizing hormone therapy may experience weight gain, but it is important to note that this is a result of the biological processes involved in transitioning, rather than the medication.

Spironolactone and weight gain: takeaway

In short, it is unlikely that weight gain is a direct side effect of taking spironolactone. Those suffering from conditions that may benefit from spironolactone, such as PCOS and associated hair loss in women, are likely to have other underlying causes for weight gain and this may have led to an association between the two.

If you are concerned about weight gain with spironolactone, we recommend consulting with a medical professional to ensure any underlying conditions are being treated.

References List
Barber, T.M., Hanson, P., Weickert, M., Franks, S. (2019). Obesity and polyscystic ovary syndrome: Implications for pathogenesis and novel management strategies. Clinical Management Insights: Reproductive Health, 13. 10.1177/1179558119874042

Kyinn, M., Banks, K., Leemaqz, S.Y., Sarkodie, E., Goldstien, D., Irwig, M.S. (2021). Weight gain and obesity rates in transgender and gender-diverse adults before and during hormone therapy. International Journal of Obesity, 45, 2562-2569. https://doi.org/10.1038/s41366-021-00935-x

Navarro, G., Allard, C., Xu, W., Mauvais-Jarvis, F. (2015). The role of androgens in metabolism, obesity, and diabetes in males and females. Obesity, 23(4), 713-719. https://onlinelibrary.wiley.com/doi/10.1002/oby.21033

Pantibandla, S., Heaton, J., Kyaw, H. (2023). Spironolactone. StatPearls. Treasure Island (FL): StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK554421/ (Accessed May 8th 2024.

Venkatsean, A.M., Dunaif, A., Corbould, A. (2001). Insulin resistance in polycystic ovary syndrome: progress and paradoxes. Recent Progress in Hormone Research, 56, 295-308. https://doi.org/10.1210/rp.56.1.295

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