Health and wellness touch each of us differently. This is one person’s story.
While waiting in a new dermatologist’s office two years ago, I told myself that this was the last doctor I’d ever consult about my acne. I was tired of the disappointment — and expense.
The most severe form of my breakouts erupted from the tender years of middle school through college, but at age 30 I was still experiencing the effects of hormonal acne.
Every time I glanced in the mirror and saw a new cluster of swollen pimples on my face or back, I felt a tinge of the same humiliation and self-loathing that defined my teenage years.
Although I was now an editor at a magazine in downtown Manhattan, I wanted to crawl back under the covers like I did in college after waking up to yet another round of painful cystic acne.
It’s not as if I didn’t try to treat my chronic moderate-to-severe acne. Throughout my young life, I’d visited several dermatologists who prescribed me everything from topical retinoids and acids to daily doses of oral antibiotics.
Yet even after months of use, these medications failed to remedy my monthly onslaught of red, painful bumps. Oftentimes, the medications only left me with peeling skin and less money in my wallet to spend on concealer.
Instead, he asked me if I’d ever heard of spironolactone. I hadn’t, but was willing to try anything.
After briefly discussing how spironolactone works and its potential side effects, he sent me off with a prescription for the oral drug.
Why haven’t you heard of spironolactone for acne?
While dermatologists are increasingly scratching “spironolactone” onto their Rx pads, many acne sufferers still haven’t heard of it — no matter how many times they’ve typed “acne” and “help!” into Google’s search bar.
Although doctors have known of its skin-clearing effects for the last few decades, the medication is only now gaining recognition as an effective treatment for hormonal acne in women.
The reason spironolactone is still fairly unheard of by acne sufferers is likely due to its main use: treating high blood pressure and heart failure.
While I’d taken the birth control pill since I was a teenager in an effort to combat period-induced breakouts, spironolactone works a bit more aggressively. It blocks androgens (aka male sex hormones).
By inhibiting the production of these hormones, like testosterone, the medication reduces oil production and thus lowers the frequency of clogged pores.
Furthermore, the treatment isn’t just targeted for women whose acne flares up around the time of their menstrual cycles. Spironolactone can also help post-menopausal women experiencing a sudden influx of skin issues.
In fact, females with high hormone levels and acne at any age may see improvement with the drug. Men are rarely prescribed spironolactone for acne as it causes feminization, including a loss of libido and breast tissue growth.
So, did it work for me?
Like most medications for acne, spironolactone also doesn’t work immediately. I noticed a decrease in the number and size of spots I had after six weeks, but I’d still get some spots during my period.
Around the three-month mark, I stopped by my local drugstore to pick up more blemish concealer in preparation for the typical monthly breakout around my period. Yet, it proved to be an unnecessary purchase: I literally had two spots that week, instead of around 20.
Three months after starting spironolactone, my acne had vanished. All that remained were a few scars.
Since my mid-20s, my biggest breakout area had been my upper back and shoulders, which disappeared within three months.
But after four months of spironolactone, I also no longer had to fret about pimples emerging on my chin and cheeks every month when the cramps came.
My skin was smooth, significantly less oily, and even free from the blackheads that used to decorate the pores on my nose.
I even triumphantly stashed my charcoal and mud masks under the bathroom sink, as I no longer woke up to red or blotchy skin.
Having clear skin for the first time in my adult life quickly altered my self-perception. I stopped attacking my every flaw and held my head a little higher while walking down the street.
As my back was no longer inflamed, I started wearing clothing that I avoided before, like backless dresses and tank tops.
I’d had acne for so long that I never realized just how much time I’d wasted being embarrassed and frustrated about it — not to mention how many hours I’d spent trying to treat and cover it.
Although everyone should strive for this self-confidence and acceptance with or without clear skin, spironolactone allowed me to come to terms with all those years of being ashamed of my acne — as if it were my fault — and then, finally, move on.
Other pros and cons of taking spironolactone
Still, despite its capacity to treat acne, spironolactone isn’t free from potential side effects.
As reported in a 2017 research study new users may experience dizziness, headaches, nausea, and vomiting.
On rare occasions, the drug has also been shown to spike potassium levels. Due to the low dose with which it’s prescribed for acne, it’s extremely unlikely that users need to swear off bananas or other potassium-rich foods.
Yet, as high potassium can lead to weakness, heart palpitations, and even death, I still get a blood test done once every year just to be safe.
On a less risky note, spironolactone is known to cause breast tenderness and, in some women, breast enlargement. By two months into taking spironolactone, my breasts had blown up by almost a full cup size.
While I welcomed this side effect with a dance party in the mirror, the downside is that my breasts still feel more sore and swollen than usual around my period.
Spironolactone is also known to reduce the amount and thickness of body hair, particularly on the face. Inversely — as if it’s aware of many women’s beauty goals — it also increases the thickness of hair on the head.
I never noticed either side effect as my body hair is minimal, and my hair was already unruly enough to clog every shower drain I’ve ever encountered.
Yet, transgender women have long touted the drug as helpful in reducing or eliminating facial hair growth. Doctors also prescribe it for those facing female pattern hair loss.
I’ve been taking spironolactone for two years now.
To be clear, it’s no magic cure for acne: I still experience occasional tiny breakouts here and there, usually tied to stressful events. Yet, the important element is that my acne is in control.
While things could always change — I’ll have to stop taking the drug if I get pregnant, for instance — spironolactone has given me the chance to raise my self-esteem and embrace my skin, scars and all.
Paige Towers earned her BA from the University of Iowa and her MFA from Emerson College. She currently lives in Milwaukee and is working on a book of essays about sound. Her writing has appeared in The Harvard Review, McSweeney's, The Baltimore Review, Midwestern Gothic, Prime Number, and many other publications.