Spironolactone for acne?

Perhaps you thought acne would be something you would be to leave behind in high school like your senior physics class or braces.  Unfortunately hormonal acne, which normally appears along the chin, jawline and cheek, can persist into early adult hood and even emerge during menopause.  If you see a dermatologist for hormonal acne, one medication they will most likely prescribe is spironolactone (Aldactone).  Originally developed as a potassium-sparing diuretic for the treatment of blood pressure, in the late 1950s, it was accidentally shown to have anti-androgen (aka male hormone) properties.  Basically when women with polycystic ovarian syndrome (PCOS) took the medication to lower their blood pressure many of their symptoms of androgen dominance such as acne, hirsutism and hair loss, improved.   As a result, dermatologists now prescribe spironolactone to treat their female patients with hormonal acne.

How it works?

Spironolactone attacks hormonal acne in two ways.  First, it increases the clearance of testosterone through the liver so you have less testosterone circulating and causing problems.  Excess testosterone can readily convert to its more potent form dihydrotestosterone (DHT) via the alpha-reductase enzyme.   DHT is responsible for hormonal acne by binding to specific receptors in your sebaceous glands leading to increase sebum production and inflammation.  There are also receptors on your scalp, hair follicles and your endogenous zones.  The binding of DHT at these sites can cause hair follicles to shrink leading to hair loss also known as androgenic alopecia.  The second way spironolactone keeps hormonal acne at bay is actually binding at these receptors so that DHT can’t.

What’s the problem?

Loss of your period! In my years of naturopathic practice, I have seen a number of women come through my New York City office that have struggle to get their periods either after stopping birth control or a simple mysterious disappearance. One common feature for these women was they were taking spironolactone for hormonal acne.  Once they stopped the spironolactone, amazingly their periods returned within a few months.  But isn’t too much testosterone the cause of loss of period and ovulation especially with women who suffer from PCOS?  Yes and No.  Testosterone is an essential building block for another hormone estrogen.  Women need to have enough estrogen to initiate ovulation, support pregnancy and have a menstrual cycle as well as support bone health. Often hormonal acne is less of an issue of increased testosterone production and more of an issue of poor conversion to estrogen.  If you have been on spironolactone and your period has stopped, you most likely have an estrogen conversion issue. Though many women would benefit from stopping spironolactone, women with conditions like congenital hyperplasia patients might need to continue.

So what you should do instead?

Acne no matter the form is always best treated from the inside out.  As a naturopath, I have found that a combination of key nutrients such as zinc, chromium, n-acetyl cysteine, fish oil and vitamin A along with a diet that eliminates highly inflammatory foods and keeps blood sugars in check serves the basis of most of my acne treatment protocols.   Hormonal acne adds another layer of complexity as we need to determine and address the cause of the androgen excess.  Androgen excess is usually due to either increased adrenal androgens, ovarian androgens, low testosterone to estrogen conversion or any combination of the three.  When we are over stressed our adrenal glands kick into overdrive increasing production of DHEA-S a precursor of testosterone. To calm the adrenals, I often recommend adrenal supportive herbs called, adaptogens, and mind-body relaxation techniques such as meditation, yoga and breathe work.  Ovarian androgen excess is closely related to insulin resistance and blood sugar regulation dysfunction commonly found in PCOS.  Poor conversion is also often linked to stress or not enough body fat. Another big focus in dealing with hormonal acne is preventing the conversion of testosterone to DHT both by improving estrogen production and using natural alpha-reductase inhibitors such as green tea, reishi mushroom, and nettles root.

Ready for clear skin naturally without the pill? Then schedule a naturopathic appointment with Dr Ivy.