Spironolactone for Hirsutism
Verdict: Published with Warning
Across 6 PubMed studies, the evidence for Spironolactone in Hirsutism grades Tier B — preliminary evidence. Effective, but with safety or population caveats.
B 🟡 B Preliminary Evidence Published with Warning
Why this grade7-layer evidence engine
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Scoring transparency
All scores computed by a 7-layer evidence engine — fully auditableRaw score 0.68
D
C
B
A
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Final grade
B · Published with Warning
Confidence
89%
Highly consistent evidence
Evidence level
E1
Cochrane high-quality SR/MA
▸View the full decision path (audit trail)
- compute_raw_score — 加權公式: L2×0.30 + L3×0.25 + L5×0.25 + L11×0.10 + L1×0.10 = 0.677
- tier_from_score — 依分數區間映射至 tier letter
- apply_hec_rules — 高品質 SR/MA 顯示 positive (5 篇 > 0 negative)
- tier_strict_requirement_check — Tier 條件達標，未降階
- detect_disputes — 偵測到 0 個 hard + 1 個 soft dispute
- decide_status — 依 tier + dispute 結果決定 status
PubMed studies (6)L2 · primary research & systematic reviews
Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne
Finding: Spironolactone 100 mg/day significantly improved subjective hair growth versus placebo (OR 7.18, 95% CI 1.96 to 26.28) and lowered Ferriman-Gallwey score (WMD -7.20, 95% CI -10.98 to -3.42), but no benefit was shown for acne.
View on PubMed Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis
Finding: Antiandrogens as a class (flutamide, finasteride, spironolactone) were superior to placebo with a standardized mean reduction of -1.29 (95% CI -1.80 to -0.79), and the three antiandrogens were similar to each other in efficacy.
View on PubMed Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials
Finding: Antiandrogens reduced Ferriman-Gallwey scores by only 3.9 points vs placebo (95% CI 2.3 to 5.4, I2 = 0%) and the authors graded this as weak evidence that antiandrogens are mildly effective; spironolactone beat metformin by just 1.3 points (95% CI 0.03 to 2.6).
View on PubMed Do Pleiotropic Effects of Spironolactone in Women with PCOS Make it More than an Anti-androgen? Evidence from a Systematic Review and Meta-analysis
Finding: Spironolactone improved hirsutism versus active comparators (vs finasteride MD -2.43, 95% CI -3.29 to -1.57; vs cyproterone acetate MD -1.18, 95% CI -2.10 to -0.26) but had NO effect on FSH, LH, menstrual cyclicity, BMI or HOMA-IR, i.e. its benefit is anti-androgenic, not metabolic.
View on PubMed Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne
Finding: Spironolactone 100 mg/day for 6 months produced a statistically significant subjective improvement in hair growth versus placebo, but all trials were small and acne data were too limited to draw conclusions (original Cochrane review, superseded by the 2009 update PMID 19370553).
View on PubMed Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial
Finding: Over 6 months spironolactone 100 mg/day significantly reduced the Ferriman-Gallwey score (mean change -41.0 +/- 5.5%) and hair shaft diameter (-11.7 +/- 5.6%) versus placebo (no significant change), and was statistically indistinguishable from flutamide and finasteride.
View on PubMed Regulatory & authoritative positionsL4/L5 · FDA / EMA / NIH ODS / Cochrane / Mayo …
L4a US FDA
Supportive
Spironolactone has been shown to be a tumorigen in chronic toxicity studies in rats. Spironolactone should be used only in those conditions described under INDICATIONS AND USAGE. Unnecessary use of this drug should be avoided. ALDACTONE is indicated for: Treatment of NYHA Class III-IV heart failure and reduced ejection fraction to increase survival, manage edema, and to reduce the need for hosp… source↗
L4b EU EFSA
Supportive
Qaialdo received marketing authorization on 26 May 2023. It is authorized to manage refractory oedema associated with congestive heart failure; hepatic cirrhosis with ascites and oedema, malignant ascites, nephrotic syndrome, and for diagnosis and treatment of primary aldosteronism and essential hypertension. The medicine can only be obtained with a prescription, and children should only be tre… source↗
L4c UK NHS
Supportive
It's used to treat: swelling, in the ankles, feet and other parts of the body, caused by fluid build-up (oedema), heart failure, high blood pressure (hypertension) if other medicines have not worked. It's only available with a prescription. Spironolactone is not usually recommended during pregnancy. This is because it can potentially affect a baby's development. [Serious side effects include] h… source↗
L4d TW TFDA / 衛福部
Supportive
安達通錠25 毫克 Aldactone Tablets 25 mg 衛署藥輸字第022610號 本藥須由醫師處方使用。適應症：利尿、高血壓、原發性醛類脂醇過多症。孕婦用藥分級：D 級。高血鉀症徵象(有高達26%病人發生，即使與Thiazide 利尿劑合用亦如此)。 source↗
L4e WHO
Supportive
Spironolactone is an aldosterone receptor antagonist used to treat edema, hypertension, heart failure, and aldosteronism. More specifically, its antimineralocorticoid activity is responsible for its therapeutic efficacy in the treatment of edema, high blood pressure, heart failure, hyperaldosteronism, and ascites due to cirrhosis. Additionally, spironolactone reduces the rate of testosterone pr… source↗
L5a NIH Office of Dietary Supplements
Supportive
Spironolactone tablets are indicated for: (1) the treatment of NYHA Class III-IV heart failure and reduced ejection fraction to increase survival, manage edema, and to reduce the need for hospitalization for heart failure, and (2) use as an add-on therapy for the treatment of hypertension, to lower blood pressure. Additionally, spironolactone is indicated for the management of edema in adult pa… source↗
L5b Mayo Clinic
Cautious
The most commonly used anti-androgen for hirsutism treatment is spironolactone (Aldactone, CaroSpir). The results are modest and take at least six months to be seen. Side effects can include irregular periods. These medicines also can cause birth defects, so it's important to use birth control while you take them. source↗
L5c Cleveland Clinic
Supportive
These medications, including spironolactone (Aldactone®), finasteride (Proscar®) and flutamide (Eulexin®), can effectively treat mild cases of hirsutism by lowering the amount of androgens your body produces. source↗
L5d Harvard Health
Supportive
The most commonly used medicine is spironolactone (Aldactone), although others are available. It is unsafe to take anti-androgen medicines during pregnancy. source↗
L5e Specialty Society (condition-mapped)
Cautious
For most women with hirsutism, we suggest against antiandrogen monotherapy as initial therapy (because of the teratogenic potential of these medications) unless these women use adequate contraception. Spironolactone 100-200 mg/d given in divided doses (twice daily). We do not suggest one antiandrogen over another. source↗