Spironolactone for Acne: Why It Helps—But Doesn’t Heal
First: We’re Not Anti-Medication
Let’s be clear: there is absolutely a time and place for acne medications. If your skin is flaring, your confidence is tanking, and you just need a win? Spironolactone might be that win. For some, it provides relief from painful, hormonal acne that just won’t quit. We’ve worked with many clients who’ve used it—some are still on it, others used it temporarily.
And there is no shame in that. It’s not an either-or situation. You can support your skin and your mental health while still planning to address the root cause underneath. We’re all about smart, strategic healing, not perfectionism.
That said, many of our clients come to us with the goal of eventually getting off medications like spironolactone, while also addressing the root causes of their acne. And we fully support that goal with science-based tools, testing, and a personalized plan to make that transition sustainable.
What Is Spironolactone?
Originally a high blood pressure medication, spironolactone was found to have an anti-androgenic effect—meaning it can reduce levels of hormones like testosterone and DHEA. These are often referred to as "male hormones," but let’s be real: women have them too, and they play an important role in female health. It’s only when they become elevated that they can contribute to problems like acne.
Here’s how spironolactone works:
It blocks androgen receptors in the skin, reducing the hormonal stimulation that leads to oil production.
It reduces sebum production, one of the main contributors to clogged pores and breakouts.
It lowers aldosterone, which indirectly reduces testosterone—especially through its role as a potassium-sparing diuretic.
Sounds like a dream, right?
Well, yes and no.
Spironolactone Suppresses Symptoms—It Doesn’t Solve the Problem
Here’s where things get real. Spironolactone might work beautifully in the short term. But it’s a suppressive therapy, not a curative one. It doesn’t ask: Why are your androgens elevated in the first place?
Common root causes of high androgens include:
Polycystic Ovarian Syndrome (PCOS)
Blood sugar dysregulation or insulin resistance
Chronic stress or poor adrenal function
Mineral imbalances (especially potassium, magnesium, sodium)
If those issues go unaddressed, your acne will likely return the moment you stop spironolactone. That’s the rebound effect so many people experience: their skin was clear on the drug, but flares right back up when they come off. Because the root imbalance is still there.
What If Spironolactone Works for You?
Great news—that tells us something valuable!
If spironolactone helps clear your skin, it's a strong sign that androgens are playing a significant role in your acne. And with that insight, we can get curious and start digging into why your androgens are elevated.
It tells us:
Your acne is likely androgen-driven
You may have underlying blood sugar or stress-related hormone imbalances
You might benefit from potassium repletion (many spironolactone users have low potassium after stopping)
This is where a mineral panel, blood sugar labs, hormone testing, and stress assessment come in. If you’re on spironolactone and want off someday, these labs can help you transition with a plan that doesn’t leave your skin hanging.
The Potassium Piece (It’s Big)
Spironolactone is a potassium-sparing diuretic. That means it helps your body hold onto potassium, which in turn suppresses aldosterone and downstream testosterone. When you stop spironolactone, potassium often drops—and the hormone cascade resumes.
Clinically, we’ve seen that many former spironolactone users have low potassium levels. Supporting potassium through food and minerals post-medication can make a huge difference in how the skin responds.
But PSA: if you’re currently on spironolactone, don’t just start chugging mineral mocktails. Too much potassium on top of the medication can lead to hyperkalemia. Work with a practitioner who knows your labs.
If Spironolactone Didn’t Work for You
That’s also helpful data. It could mean:
Your acne isn’t primarily androgen-related
Other hormone imbalances (like estrogen, progesterone, thyroid) are at play
You may have non-hormonal drivers: gut infections, inflammation, immune dysfunction, or poor skin barrier health
Root cause testing can guide you to what is causing your acne, and help you stop wasting time on the wrong treatments.
What Now?
Spironolactone for acne has its place. But it’s not a forever fix, and it’s not a healing plan. If you want clear skin for the long haul, you need to investigate why your skin is breaking out, not just suppress it.
Our take?
Use it if you need to. But work on root causes at the same time. And when you’re ready, taper off with support, not panic.
Want help figuring it out?
Apply to work with us and we’ll show you how to uncover your acne story—and finally rewrite it.
Your skin isn’t just screaming for medication. It’s asking you to listen deeper.
Let’s do that together.