A precious few things are touted as a cure-all for hormonal acne, but spironolactone—a prescription-based medication—has been doing the rounds on social media for exactly that reason. But can anything really be a cure-all for something as complex as acne, and who exactly is it right for?
Originally developed to treat conditions such as high blood pressure and heart failure, spironolactone is now frequently prescribed by consultant dermatologists, like Dr Zainab Laftah, for hormonal acne and female pattern hair loss due to its anti-androgen effects.
“It’s most commonly prescribed for women with signs of androgen-driven conditions,” Dr Laftah explains. “This includes hormonal acne, particularly acne affecting the lower face and jawline, excessive hair growth (hirsutism), and female pattern hair loss. By blocking the effects of androgens, spironolactone helps reduce oil production, slow hair follicle miniaturisation, and improve unwanted hair growth.” She adds that it isn't routinely prescribed to men because of those same anti-androgen effects, which can lead to side effects including breast enlargement, reduced libido and sexual dysfunction.
It's gone viral online for a reason; it really does work. Partnerships Manager Molly Jappy, 27, tried everything to treat her hormonal acne, which was caused by Polycystic Ovary Syndrome (PCOS). “I spent 10 years trying every treatment and ointment, including Accutane, antibiotics, topical treatments, supplements and endless skincare products to no avail,” she tells Marie Claire UK. “I felt hopeless until I discovered spironolactone. I’ve had clear skin ever since. My confidence has just soared.”
Similarly, journalist and beauty expert Kristina Rudulfo found that her nodular, cystic acne wasn't responding to over-the-counter skincare. She eventually discovered spironolactone, which she took on and off over the next eight years. “Results typically show at the three-month mark and the difference was dramatic. I went from having anywhere from 15-20 painful, red cysts all across my jawline to having smooth, clear skin. Similar to the way people describe GLP-1 treatments as erasing "food noise", spironolactone erased the mental load of acne. I was no longer stressing and monitoring my diet for triggers, or combing over every single ingredient in my skincare and make-up.”
Kristina has since gone off the medication, however—citing side-effects from the anti-androgen properties that make it so effective. In combination with her contraceptive IUD, she found that spironolactone made her menstrual cycle irregular and, at times, caused it to disappear altogether. "Before planning for a family, I wanted to come off it and get my body's reproductive health and hormones back to baseline," she says. "But I do think I'll go back on it eventually because it was the most effective acne treatment I've ever tried."
It’s not a one-size-fits-all, despite what social media is saying
Dr Malvina Cunningham
While Consultant Dermatologist and Renew + Me ambassador, Dr Malvina Cunningham states that many people tolerate spironolactone well, she notes that Rudulfo's experience is not uncommon. “It’s not a one-size-fits-all, despite what social media is saying. Acne is a complex condition, and what works well for one person may not be suitable or effective for another.”
The most common side effects include increased urination (the medication is a diuretic), as well as breast tenderness, menstrual irregularities, headaches, dizziness and fatigue. However, there are also more serious side effects to consider.
Dr Christine Hall, a GP and aesthetic doctor who has taken spironolactone herself, stresses that the medication should only be used under appropriate medical supervision. "I have seen many hospital admissions, particularly in older people, where the cause has been this drug," she states. “In many cases, it is good practice to carry out blood tests before and during treatment. One of the key concerns with spironolactone is that it can affect and elevate blood potassium levels. Elevated potassium levels, known as hyperkalemia, must be monitored carefully because, if left unchecked, they can lead to serious complications, including abnormal heart rhythms and, in severe cases, death.”
Accordingly, it is generally not prescribed to people with certain underlying health conditions, including kidney disease, where the risk of elevated potassium levels is higher, or those with very low blood pressure. It is also not recommended during pregnancy, breastfeeding or while trying to conceive.
Interestingly, another less common side-effect that has been widely discussed on social media is breast enlargement. “It can happen because spironolactone’s anti-androgen effects alter the balance between androgens and oestrogen,” explains Dr Laftah. “In women, this may lead to a feeling of fullness or a modest increase in breast size, although this is not a universal side effect and is typically mild.” She adds that, in most cases, any breast enlargement associated with spironolactone improves or resolves once the medication is discontinued.
Out of the nine women I spoke to for this feature, only two reported mild side effects, including increased urination and occasional light-headedness. What may prove more prohibitive, however, is accessing the treatment itself.
Spironolactone is prescribed off-label for acne and is typically recommended by a dermatologist following an assessment. While it can be prescribed through the NHS, many people access it privately. All but one of the women I spoke to had received their prescription through a private dermatologist. The exception was Molly, who was eventually able to access it on the NHS following a PCOS diagnosis. Several cited NHS waiting times and administrative hurdles as reasons for going private.
"The biggest issue was actually getting hold of it," says 29-year-old writer Amber Rawlings. "There's so much red tape. I didn't even try going through the NHS because I'd heard it could take months, so I went straight to a private dermatologist. It was extremely expensive.”
While spironolactone itself is relatively inexpensive, the overall cost is driven by consultations, blood monitoring and follow-up appointments. Typically, an initial dermatology consultation can range from £200 to £350, while subsequent appointments may cost £100 to £250, depending on the clinic.
It was worth it for Amber, though: “I went from having skin that I was constantly fixating on to skin that I didn't have to think about at all. And honestly, that changes your whole existence. If you’re a suitable candidate for it, I’d recommend it in a heartbeat.”
But, of course, spironolactone is not the only solution for hormonal acne. As Dr Hall asserts, before even considering it, individuals should see a dermatologist and get an accurate diagnosis of the type of acne they have. “That’s really the key to finding the right treatment," she says. "In general, we like to start with the least invasive approach first. That means making sure someone is using the right over-the-counter skincare products and that their routine has been properly optimised. If that's not enough, we would usually consider adding topical prescription treatments. Oral medications are typically reserved for situations where they are genuinely needed.”
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