Effects of Spironolactone on Androgen Levels

Mechanism of Action and Hormonal Changes

• The American Academy of Dermatology recommends spironolactone as it significantly reduces total and free testosterone levels in women with hyperandrogenism, with observable decreases within the first weeks of treatment 1
• Spironolactone competitively blocks the binding of testosterone and dihydrotestosterone to androgen receptors in the skin, and may also inhibit 5-alpha-reductase and increase sex hormone-binding globulin (SHBG) 1
• The Academy of Dermatology suggests that anticonceptives orals (AOC) are first-line therapy, suppressing ovarian androgens and increasing SHBG 2

Important Considerations for Combination Therapy

• The American Academy of Dermatology notes that combining spironolactone with anticonceptives orals containing drospirenone does not significantly increase the risk of hyperkalemia in healthy young women 1
• However, it is recommended to avoid AOC with androgenic progestins, which can worsen hirsutism, and to monitor potassium levels in patients with compromised liver, adrenal, or renal function 2
• Concomitant use of anticonception is advised, as spironolactone is category C in pregnancy (feminization of male fetus) 1