Does Spironolactone Lower Sex Drive? What the Studies Actually Show

Spironolactone and sex drive come up together because the drug blocks androgen receptors, so a drop in desire is a plausible thing to expect. The honest answer is thinner than that. No randomized trial has measured desire as an outcome on spironolactone. What the trials counted was breast pain or breast growth in men, reported by 10 percent of men on 25 milligrams daily against 1 percent on placebo, and menstrual disturbance in women on acne doses, reported by 72 percent of the people in one 54-person survey. This page prints what was counted and names what was never counted.

Figures from Pitt et al. 1999 (PMID 10471456), Trinchieri et al. 2021 (PMID 34933535) and Hughes et al. 1988 (PMID 2969259).

Is it the spironolactone, or is it me?

Two people land on this page with the same question and very different ledgers. One is a woman taking spironolactone for acne, hair loss or unwanted hair. Her skin is better, her labs are fine, and her desire has gone quiet. The other is a man taking 25 milligrams a day for heart failure or blood pressure. His chest is tender. Both typed the same words into a search bar.

Doses in the published work run from 25 to 200 milligrams a day, most of them between 80 and 110, so those two readers are on very different doses of the same drug. This page goes one drug deep. It reports what each trial and review counted, and it says out loud when a number was never collected. Three other pages cover wider ground: our guide to blood pressure medication and sex drive, PCOS and low sex drive, and the finasteride page, on another drug that works on androgens.

Nothing here tells you to change your dose. Spironolactone is doing work you cannot feel while you read this, and stopping it is a decision for you and your prescriber.

What the drug does to hormones

The question gets asked because of the mechanism, and the mechanism is documented. A 1976 conference report in the Annals of Internal Medicine states that spironolactone therapy is often associated with estrogen-like side effects, including erection problems and breast growth in men and menstrual irregularity in women. The same report describes the drug affecting gonadal and adrenal steroid production, raising plasma gonadotrophin levels in children, and acting as an antiandrogen at the target tissue level. It has no sample, no counts and no measured outcome. It is a discussion.

Rose and colleagues (1977) put numbers on part of that picture. They studied 16 people with hypertension: 6 who took spironolactone and developed breast growth, plus 10 control subjects. Blood testosterone was 2.7 ng/ml in the spironolactone group against 4.4 ng/ml in controls (P less than 0.02). Blood estradiol was 30 pg/ml against 13 pg/ml (P less than 0.01). The shift came from a rise in the metabolic clearance rate of testosterone (P less than 0.02) and in the rate of peripheral conversion of testosterone into estradiol (P less than 0.001). The authors read the changed testosterone-to-estradiol ratio as a contributor to breast growth.

Six people on the drug, hormone measures only, and the dose is not printed in the abstract. Nothing in that study asked anybody how they felt.

Negretto and colleagues (2024) tested the obvious version of the reasoning. They looked at testosterone deficiency in hypertensive men and found it in 26.36%. It tracked with body mass index (p=0.0007), and total testosterone fell by 8.44 ng/dl for each one-unit rise in BMI. It did not track with use of spironolactone (p=0.3546), age (p=0.0520), diabetes (p=0.1112) or the number of blood-pressure drug classes (p=0.732). The work is cross-sectional, its screening tool is a questionnaire, and no desire measure sits inside it.

A hormone shift was measured in six people. Desire was measured in none of them.

What the men's trials counted

The biggest trial of this drug is the one everyone quotes, so look at what it counted. Pitt and colleagues (1999) ran a double-blind randomized trial in severe heart failure: 1,663 people with a left ventricular ejection fraction of no more than 35 percent, most already on a diuretic and digoxin. 822 took spironolactone 25 milligrams daily, 841 took placebo, and the trial stopped early after a mean of 24 months. Deaths fell from 386 on placebo (46 percent) to 284 on spironolactone (35 percent), a relative risk of 0.70 (95% CI 0.60 to 0.82), and hospitalization for worsening heart failure was 35 percent lower. Serious hyperkalemia was minimal in both groups.

The sexual-side-effect number that trial printed is about breast tissue. Breast pain or breast growth was reported by 10 percent of men on spironolactone and 1 percent of men on placebo (P below 0.001). There is no desire measure in the abstract, and women are not broken out.

Trinchieri and colleagues (2021) pooled randomized trials of drug-induced breast growth, 32 trials in the final review. Across the 14 trials that included both men and women, 3,745 participants, breast growth was far more common on spironolactone than in the control groups: an odds ratio of 8.39 (95% CI 5.03 to 13.99). Breast tissue is the outcome there, and no trial in that pool measured desire.

Liu and colleagues (2022) pooled 15 randomized trials in people on dialysis, 1,258 participants, and found breast growth more common on spironolactone, a relative risk of 4.36 (P=0.0005). No confidence interval is printed for that figure, the pooled trials are small, and desire was not an outcome.

Elshahat and colleagues (2024) compared eplerenone with spironolactone across 10 studies and 21,930 people. Eplerenone came with less breast growth (RR 0.07, 95% CI 0.02 to 0.31), lower all-cause mortality (HR 0.78, 95% CI 0.64 to 0.94) and fewer withdrawals (RR 0.69, 95% CI 0.62 to 0.78). Read the breast figure as spironolactone measured against eplerenone; no desire outcome appears anywhere in the review.

A low dose flips the breast result. Lee and colleagues (2025) randomized 118 people with resistant hypertension, median age 55 years and 70% male, to spironolactone 12.5 milligrams daily or amiloride 5 milligrams daily. Blood pressure fell about the same in both groups at week 12, and no breast-growth case appeared in either one. The trial is open-label, it ran 12 weeks, several authors report industry disclosures, and desire was not measured.

What the women's studies counted

The acne and hirsutism clinics followed the most women, and their records are detailed. Hughes and colleagues (1988) surveyed 54 people taking spironolactone for hirsutism or acne in Leeds, aged 21 to 51, on 200 milligrams a day. Side effects occurred in 91%, and in 80% of them the side effect was tied to the drug's anti-androgenic mechanism: menstrual disturbances, breast enlargement and tenderness. Menstrual disturbances were reported by 72% and dry skin by 39%. Seven people (13%) stopped, and eight more kept disease control on a cut to between 125 and 175 milligrams daily. Two developed chloasma, a face pigmentation disorder. There is no control group, the list is what that clinic recorded, and desire is not on it.

Layton and colleagues (2017) reviewed oral spironolactone for acne in adult females: 10 randomized controlled trials and 21 case series. Every trial was rated at high risk of bias, and the evidence was low or very low for all outcomes. One crossover trial found a 200 milligram daily dose statistically superior to placebo for inflamed lesions; the others did not establish that lower doses beat active comparators or placebo. Period problems were more common at 200 milligrams a day than at lower doses, and pooling serum potassium supported the recommendation that routine monitoring is not needed. Desire appears in none of it.

Ershadi and Barbieri (2025), writing for daily practice, recommend a starting dose of 100 milligrams a day, say most people tolerate it, and call it more effective than lower doses. They flag lightheadedness and period irregularity as the usual complaints, with headaches too. Period problems tend to track the dose, and combined oral contraceptives can prevent or treat them. Sexual side effects are not among the effects they list, and they rate potassium monitoring of low usefulness in young healthy women.

Two older reports read as good tolerance. Cumming and colleagues (1982) gave 39 people with hirsutism 200 milligrams a day and found no discernible side effects over the year beyond diuresis in the first few days. Tremblay (1986) reported over 450 cases across five years and adverse side effects in under 5%. Single clinics, no control groups, no desire count in either.

Put together what those clinics recorded across hundreds of women on the acne dose: periods, breasts, potassium, dizziness. A desire number appears in none of them. The combined pill runs alongside spironolactone in these records, in Hughes's survey and in Ershadi and Barbieri's advice, so if your pill changed too you have two variables to sort out, and the birth-control page covers the second one.

Where the "lowers libido" line comes from

The sentence you searched for has a paper trail, and it is short. Giraldi and Victor (2002) wrote a review in Danish of sexual problems as an adverse effect of medicines, and its own framing is that existing knowledge of how medication influences female sexual function is very sparse. Inside that, it says spironolactone may cause lowered desire and impaired wetness. The word is "may". The abstract carries no sample, no dose, no count and no scale.

The 1976 conference report is the older source. It lists erection problems and breast growth in men and menstrual irregularity in women among estrogen-like effects, and it measured nothing.

Two reviews then place spironolactone among the drugs definitely associated with breast growth. Deepinder and Braunstein (2012) estimate that drugs cause about 10% to 25% of all cases, and say most reported associations rest on poor-quality evidence. Bowman and colleagues (2012) put drugs at about 20% of cases in men, with spironolactone among the less common causes. Yang and colleagues (2024) mined the FDA Adverse Event Reporting System and found spironolactone with a reporting odds ratio of 15.8 (95% CI 13.99 to 17.83) across 30,265 reported cases of breast growth. Spontaneous reports have no denominator, so that number says the signal is loud and says nothing about how many people take the drug.

Lower desire follows from the mechanism, and reviews keep repeating it. Nobody has counted it against a placebo. If your blood pressure is controlled, your labs are fine and you still feel flat, that gap deserves its own conversation: numbers fine, still flat.

Five decades of what was counted

Spironolactone has been prescribed for high blood pressure for over sixty years, and used in dermatology clinics for most of that time, so there is a long paper trail to read. The useful way to read it is by what each decade bothered to measure. The hormone story arrived first, in six people. The menstrual numbers came next, in a clinic survey. The biggest trial of all counted breast tissue in men. Across the decades since, desire shows up as a word in reviews and never as a number in a trial. Seven studies carry most of what is known, here in order. Read each one for its outcome, since that is where the gaps live.

Spironolactone in the studies: who, what dose, and what was counted

Study	Design	Who	Dose	What was counted
Pitt 1999	Double-blind randomized trial	1,663 people with severe heart failure	25 milligrams daily	Breast pain or growth in men, 10% against 1%
Hughes 1988	Survey, no control group	54 women with hirsutism or acne	200 milligrams a day	Menstrual disturbances 72%, 13% stopped
Layton 2017	Review of 10 randomized trials and 21 case series	Adult women with acne	Up to 200 milligrams	Low or very low quality, menstrual side effects more common at 200 milligrams, no desire outcome
Trinchieri 2021	Meta-analysis of 14 trials, 3,745 participants	Mixed gender	Dose not printed	Odds of breast growth 8.39, 95% CI 5.03 to 13.99
Lee 2025	Open-label randomized trial	118 people with resistant hypertension	12.5 to 25 milligrams	No breast-growth case in either group, no desire measure
Rose 1977	Metabolic study	16 people with hypertension	Dose not printed	Testosterone 2.7 against 4.4 ng/ml, estradiol 30 against 13 pg/ml

What actually helps, graded honestly

No trial has tested a fix for desire in people taking spironolactone, so there is no graded answer for desire itself. Three levers have something behind them in these sources, and each one is your prescriber's call.

The dose comes first, and it has the most behind it. In Hughes's 1988 survey of women on 200 milligrams a day, cutting to between 125 and 175 milligrams daily kept skin and hair under control while easing side effects in eight people. Layton's 2017 review found menstrual side effects significantly more common at the 200 milligram dose, and Ershadi and Barbieri (2025) call the common adverse effects dose dependent. That is one survey, one low-quality review and one expert practice piece.

The second lever is the combined oral contraceptive. Ershadi and Barbieri say the menstrual irregularities that come with spironolactone can be prevented or treated with a combined pill, and Layton's review shows those effects tracking the dose. It addresses the periods and says nothing about desire.

The third lever belongs to men taking the drug for their heart, and it is a swap a cardiologist can weigh. Elshahat and colleagues (2024) compared eplerenone with spironolactone across 10 studies and 21,930 people and found breast growth far less common on eplerenone (RR 0.07, 95% CI 0.02 to 0.31). Lee and colleagues (2025) randomized 118 people with resistant hypertension to spironolactone or amiloride and recorded no breast-growth case in either arm at 12 weeks. Neither study measured desire.

The hormone question is the tempting one, since Rose found low testosterone in six people and Negretto (2024) found no link between spironolactone and low testosterone in hypertensive men. That gap deserves a morning blood draw, and whether testosterone fixes low libido covers it. For women on acne doses, low libido in women covers the wider ground.

Does it wear off on its own?

Honest answer: no study has followed desire over time in anyone taking spironolactone, so nobody can tell you whether a drop lifts, stays or worsens. What was timed is the good the drug does. Hughes found acne improving within 3 months and hirsutism responding only after 4. Cumming and colleagues (1982) tracked hair changes in 39 people on 200 milligrams a day: noticeable within two months, maximal at six, holding at twelve. The breast and menstrual effects were counted once, at the end of follow-up, as a yes or a no. The tenderness and the period changes people report can arrive months apart. Desire was asked about at no time point in any of these studies. If you want a timeline of your own, write down your start date, every dose change, and when the change in desire showed up.

What to bring to your prescriber

Everything above lands in one place: a prescriber who knows what you have noticed. Bring dates, numbers and the label, and skip the summary. A visit built on specifics ends with a plan. A visit built on I feel flat lately usually ends with a shrug.

1. The timeline: when your skin, hair, blood pressure or heart numbers changed, when desire changed, every dose you have been on, and the reason you take the drug.
2. The side effects the trials actually counted, so the conversation gets specific. Breast tenderness or growth for men. Period changes for women. Say what you noticed and in which month.
3. The dose question. Menstrual effects tracked the dose in Layton's review, and eight women in Hughes's survey stayed controlled on 125 to 175 milligrams.
4. Whether a combined pill is already part of the plan, since Ershadi and Barbieri list it as the way to prevent or treat the period problems.
5. For men taking it for the heart, the eplerenone question (breast growth RR 0.07 against spironolactone) and, for resistant hypertension, amiloride, which showed no breast-growth case in either arm.
6. The supplement question with the label in hand, because spironolactone is a blood-pressure medication and the NUUD label tells people on blood-pressure medication to avoid it.

The everyday levers, and where a botanical fits

Start with the sentence that settles most of this page. The NUUD label says to avoid use if you are on blood pressure medication, have cardiovascular, renal, or pulmonary conditions, or if you are sensitive to any of the ingredients. Spironolactone is a blood-pressure medication whatever reason you take it for: acne, hair loss, hirsutism, heart failure. So for nearly everyone reading this, the label says no, unless your prescriber reads that sentence and tells you otherwise. That warning is the product's own.

With that said, the levers that move desire are ordinary ones, and none of them need a prescription.

• Sleep, in quantity and quality. Exhaustion flattens wanting before any drug touches a receptor, and sleep, libido and testosterone covers how those two feed each other.
• Movement you can keep up. Exercise and libido covers what is realistic.
• Time with a partner, unhurried, with nothing expected at the end.
• Treating what the drug is for as the first lever. Clearer skin, steadier hair, a heart that is protected. Safety there comes before any supplement on top.
• A botanical, the smallest lever on this list, and only with your prescriber's word.

NUUD is a botanical supplement built around desire in general. It does nothing for acne, hair loss, hirsutism, blood pressure, heart failure, or the side effects of spironolactone or any medication, and it has no role in managing any medical condition. The formula is anchored by the NUUD Mushroom Complex™, with Muira Puama, Boiled Rehmannia Root, Tribulus Terrestris, and Piper Nigrum for absorption, on a timeline of roughly 30 to 60 minutes. If you take blood-pressure medication, and spironolactone is one, or have a heart, kidney or lung condition, the label says no, and your prescriber decides the rest. If your prescriber has read that label and has no objection, that is what our women's libido gummies are for. There is a men's version.

Nothing is wrong with you

Two answers meet you at the door of this question, and both are useless. One is the shrug: everyone is tired, desire fades, get on with it. The other is the confident post insisting that spironolactone kills your libido, written by someone who never read a trial. Neither one leaves you anywhere.

The numbers say something quieter. Ten men in a hundred reported breast tenderness or growth against one on placebo. Seventy two percent of women on the acne dose reported period changes. Desire was counted by nobody, in any of these studies, at any dose, in either sex.

So the honest shape is this. The drug shifts hormones in ways that were measured in a handful of people. The acne, the hair loss, the blood pressure and the heart all flatten wanting on their own. So does a year of being tired, and the stress of a body under repair. Your desire dropping while you take this drug is possible, and it is the kind of thing with five causes at once.

If you want to want it again, and you want to feel normal again, say both out loud at your next visit. That sentence is the beginning of an answer.

Keep reading

• Blood pressure medication and sex drive
• PCOS and low sex drive
• Does finasteride affect sex drive?
• Birth control and the libido drop
• Low libido in women
• Why is my libido so low?

Frequently asked questions

Does spironolactone lower sex drive?
Not proven, and that is the honest answer. The mechanism makes it plausible: the drug blocks androgen receptors, and reports from 1976 to 2002 repeat that it may lower desire. No randomized trial tested that against a placebo. What the trials counted was breast pain and breast growth in men, plus menstrual disturbance in women on acne doses. So a drop in desire is possible, worth raising with your prescriber, and unmeasured in the studies that would settle it.

Does spironolactone lower testosterone?
In six people, yes, and in a larger study there was no link at all. Rose and colleagues (1977) measured blood testosterone of 2.7 ng/ml in 6 people taking spironolactone against 4.4 ng/ml in controls, with estradiol rising from 13 to 30 pg/ml. Negretto and colleagues (2024) studied testosterone deficiency in hypertensive men and found no association with spironolactone use (p=0.3546). Six people is a signal worth following up, and it is not an answer.

Does spironolactone cause sexual side effects in men?
The counted ones are about breast tissue, and they are real. In the 1999 heart-failure trial, breast pain or growth was reported by 10 percent of men on spironolactone against 1 percent on placebo. Pooled across 14 randomized trials, spironolactone carried odds of breast growth of 8.39 against controls. Erection problems are named in the 1976 conference report and counted by nobody. Eplerenone came with far less breast tissue in a 2024 comparison.

Does spironolactone for acne affect libido?
No study measured it. The acne literature counted periods. In a 1988 survey of women on 200 milligrams a day, 72 percent reported menstrual disturbance, and Layton's 2017 review found those effects more common at that dose across trials rated low or very low quality. Ershadi and Barbieri (2025) list lightheadedness, headache and menstrual irregularity as the common adverse effects, and sexual effects appear nowhere on that list.

Can I take a botanical supplement with spironolactone?
Ask your prescriber first, and expect the answer to be no. The NUUD label says to avoid use if you are on blood pressure medication, and spironolactone is one whatever reason you take it for. No interaction studies exist for this formula with spironolactone or anything else. NUUD does nothing for acne, hair loss, blood pressure, heart failure, or the side effects of spironolactone. It is a botanical supplement built around desire in general, and this is not a call to make alone.

References

1. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. The New England journal of medicine. 1999;341(10):709-17. https://pubmed.ncbi.nlm.nih.gov/10471456/
2. Trinchieri A, Perletti G, Magri V, Stamatiou K, Trinchieri M, Montanari E. Drug-induced gynecomastia: A systematic review and meta-analysis of randomized clinical trials. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica. 2021;93(4):489-496. https://pubmed.ncbi.nlm.nih.gov/34933535/
3. Yang X, Zheng X, Zhang M, Huang J, Huang P, Wang J. Drug-Induced Gynecomastia: Data Mining and Analysis of the FDA Adverse Event Reporting System Database. Clinical epidemiology. 2024;16:617-630. https://pubmed.ncbi.nlm.nih.gov/39280118/
4. Spironolactone and endocrine dysfunction. Annals of internal medicine. 1976;85(5):630-6. https://pubmed.ncbi.nlm.nih.gov/984618/
5. Rose LI, Underwood RH, Newmark SR, Kisch ES, Williams GH. Pathophysiology of spironolactone-induced gynecomastia. Annals of internal medicine. 1977;87(4):398-403. https://pubmed.ncbi.nlm.nih.gov/907238/
6. Hughes BR, Cunliffe WJ. Tolerance of spironolactone. The British journal of dermatology. 1988;118(5):687-91. https://pubmed.ncbi.nlm.nih.gov/2969259/
7. Layton AM, Eady EA, Whitehouse H, Del Rosso JQ, Fedorowicz Z, van Zuuren EJ. Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. American journal of clinical dermatology. 2017;18(2):169-191. https://pubmed.ncbi.nlm.nih.gov/28155090/
8. Spironolactone for acne in women. Drug and therapeutics bulletin. 2023;61(9):132. https://pubmed.ncbi.nlm.nih.gov/37468231/
9. Dhurat R, Shukla D, Lim RK, Wambier CG, Goren A. Spironolactone in adolescent acne vulgaris. Dermatologic therapy. 2021;34(1):e14680. https://pubmed.ncbi.nlm.nih.gov/33326148/
10. Wang C, Du Y, Bi L, Lin X, Zhao M, Fan W. The Efficacy and Safety of Oral and Topical Spironolactone in Androgenetic Alopecia Treatment: A Systematic Review. Clinical, cosmetic and investigational dermatology. 2023;16:603-612. https://pubmed.ncbi.nlm.nih.gov/36923692/
11. Cumming DC, Yang JC, Rebar RW, Yen SS. Treatment of hirsutism with spironolactone. JAMA. 1982;247(9):1295-8. https://pubmed.ncbi.nlm.nih.gov/7199587/
12. Tremblay RR. Treatment of hirsutism with spironolactone. Clinics in endocrinology and metabolism. 1986;15(2):363-71. https://pubmed.ncbi.nlm.nih.gov/2941190/
13. Giraldi AG, Victor J. [Female sexual dysfunction as adverse effect of pharmacological treatment]. Ugeskrift for laeger. 2002;164(41):4757-60. https://pubmed.ncbi.nlm.nih.gov/12407875/
14. Deepinder F, Braunstein GD. Drug-induced gynecomastia: an evidence-based review. Expert opinion on drug safety. 2012;11(5):779-95. https://pubmed.ncbi.nlm.nih.gov/22862307/
15. Bowman JD, Kim H, Bustamante JJ. Drug-induced gynecomastia. Pharmacotherapy. 2012;32(12):1123-40. https://pubmed.ncbi.nlm.nih.gov/23165798/
16. Lee CJ, Ihm SH, Shin DH, et al. Spironolactone vs Amiloride for Resistant Hypertension: A Randomized Clinical Trial. JAMA. 2025;333(23):2073-2082. https://pubmed.ncbi.nlm.nih.gov/40366680/
17. Liu J, Jia W, Yu C. Safety and Efficacy of Spironolactone in Dialysis-Dependent Patients: Meta-Analysis of Randomized Controlled Trials. Frontiers in medicine. 2022;9:828189. https://pubmed.ncbi.nlm.nih.gov/35372414/
18. Elshahat A, Mansour A, Ellabban M, et al. Comparative effectiveness and safety of eplerenone and spironolactone in patients with heart failure: a systematic review and meta-analysis. BMC cardiovascular disorders. 2024;24(1):489. https://pubmed.ncbi.nlm.nih.gov/39271992/
19. Negretto LAF, Rassi N, Soares LR, et al. Testosterone Deficiency in Hypertensive Men: Prevalence and Associated Factors. Arquivos brasileiros de cardiologia. 2024;121(3):e20230138. https://pubmed.ncbi.nlm.nih.gov/38597552/
20. Ershadi S, Barbieri JS. Spironolactone for Acne: Practical Strategies for Optimal Clinical Outcomes. Cutis. 2025;116(1):26-31. https://pubmed.ncbi.nlm.nih.gov/40875941/
21. Searle TN, Al-Niaimi F, Ali FR. Spironolactone in dermatology: uses in acne and beyond. Clinical and experimental dermatology. 2020;45(8):986-993. https://pubmed.ncbi.nlm.nih.gov/32844462/
22. Aguilar Medina DA, Cazarín J, Magaña M. Spironolactone in dermatology. Dermatologic therapy. 2022;35(5):e15321. https://pubmed.ncbi.nlm.nih.gov/35038224/

This article is for general education and is not medical advice. Acne, hirsutism, hair loss, high blood pressure and heart failure are medical conditions that only a licensed clinician can diagnose and manage, and spironolactone (Aldactone) is a prescription medicine. NUUD is a botanical supplement and has no role in diagnosing, treating, curing, or preventing any of those conditions, the side effects of any medication, or any other disease, and these statements have not been evaluated by the Food and Drug Administration. Talk with your doctor before starting any new supplement, and do not stop or change your medication without your doctor.