Spironolactone

Spironolactone is a prescription medication traditionally used as a potassium-sparing diuretic to treat conditions like high blood pressure, heart failure, and fluid retention. In dermatology and hair-loss contexts, it is frequently prescribed—especially for women—for acne, hirsutism, and androgen-related hair loss because of its strong anti-androgenic properties. Beyond blocking aldosterone, spironolactone antagonizes the androgen receptor and can reduce the effects of testosterone and DHT at target tissues, which is why it’s effective for androgen-driven skin and hair conditions.

That same anti-androgen mechanism makes spironolactone a high-risk medication for individuals with or vulnerable to PFS/PSSD/PAS-type syndromes. Many of the symptoms reported with spironolactone—such as sexual dysfunction, reduced libido, emotional blunting, fatigue, and mood changes—overlap closely with androgen-disruption syndromes. Even though it’s often described as “reversible” or “safe when stopped,” some people report persistent effects, particularly when baseline hormone or neurosteroid systems are already fragile. For this reason, spironolactone is commonly avoided in PFS/PSSD/PAS communities, as the potential risk of worsening or destabilizing the condition may outweigh its cosmetic benefits.

Crash Anecdotes:

https://www.reddit.com/r/PSSD/comments/12ixa25/a_reminder_to_women_about_spironolactone_and_pssd/

https://www.reddit.com/r/PSSD/comments/wywb91/spironolactone/

My Personal Risk Ranking:

High Risk of Permanent Worsening (for PFS/PSSD/PAS):
If you currently have PFS/PSSD/PAS, this substance may carry a high risk of worsening symptoms—potentially in a lasting way—and is best avoided.