How Spironolactone Changed My Life (And My Self-Esteem)

Because it shouldn’t be a disappointment to look in the mirror every morning.

08.15.16
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When I got a little bitty goalie that secretes hormones delicately shoved into my uterus last October at an OBGYN practice with the name “Downtown Women,” I finally felt fully grown. Minutes later, however, a more acute feeling surfaced, one that can really only be described as the pain of a million little tiny cheapo earrings pricking my guts. When it hit, I was shopping on the second floor of a fast fashion chain near the gynecologist for a dress to wear to a wedding. I lay down in the dressing room, finally infertile, and almost ready to die.

The pain subsided. A day later, I felt free. A week later, I got sexually rejected by no less than 10 University of Michigan frat boys at that very wedding. A month later, I got my first IUD-related cystic pimple. Two months after that, I still had it. Then I got a bunch more.

It would be an enormous disservice to my greasy, bespotted, whiny younger self to say this was my first brush with acne. It wasn’t. I’d had all sorts of teen acne before, plus the lifestyle-based acne that arises when, for some reason, in your mandatory freshman year gym class, you are forced to participate in a swimming unit. I had plenty of acne! But never hard, painful cysts. As a woman in her mid-twenties, I refused to pick at it or burn it off with too-harsh benzoyl peroxide. So I did what all adult women do: consult British and Korean teens on the internet. They told me to try a spot of Buffering Lotion, or a cortisone shot (that insurance didn’t cover and I still haven’t paid for!! Please don’t tell Dr. Chien!), and some PRID Drawing Salve.

Nothing really helped. That is, until I resigned myself to the fact that no matter how much goo (brown goo, in the case of PRID) I put on my face, this problem was internal. Not in a spiritual way. (I work very hard on my mental health!) I mean, like, hormonally speaking. According to my legion of anonymous teens, there was one solution that could work, if I was patient. It was called spironolactone, and I couldn’t pronounce it.

(Turns out it’s pronounced Spir-o-no-lact-one, so uh, exactly like it’s spelled.)

Scientifically speaking, spironolactone is a diuretic that helps your kidneys expel water and salt. It’s like dandelion tea, but in pill form! Also, with more side effects! Initially, Spiro was developed to treat hyperaldosteronism, a condition that causes the body to produce too much of the hormone aldosterone, by restoring the body’s sodium and potassium level. Spiro also has been used as a hypertension drug. But one day, as I imagine it, a bunch of stodgy old physicians from near and far gathered around a body that was a medical oddity: a woman with perfect skin! Nurse, I’ll have 100 CCs of whatever pill she’s taking, stat!

So it probably definitely went like that, and now, off-label Spiro use is all the rage.

Endocrinologists and dermatologists now prescribe the pill for adult and cystic acne. Essentially, Spiro inhibits sebum in the sebaceous glands. Typically, women with an androgen excess have overactive sebaceous glands, which causes acne. I am woman with a lot of androgen, hear me roar! And yet, I am by no means woman with any amount of patience, so in the days and weeks immediately after I asked my endocrinologist to put me on Spiro, I felt duped.

(Unrelated: every woman should have her thyroid checked by her endocrinologist! It could be the reason why you’re so sad all the time!)

I expected to go to sleep and wake up with creamy, hyperpigmentation-free skin, fully inhibited sebaceous glands, and without hypertension, to boot.  Instead, for weeks, I woke up looking the same. It shouldn’t be a disappointment to look in the mirror every morning, particularly when you’re as young and as period-free as you’re ever gonna get. I tracked the progress of my skin on Spiro on my newsletter, dutifully. A few months went by; nothing changed. People emailed me telling me to stick with it! as if I was thinking about dropping out of medical school or an ill-advised improv class. Without them, I may not be here today. By here I mean the laundry room of my apartment building, typing for Man Repeller and listening to Britney’s latest ouevre.

Around three months in, I asked my endocrinologist if she could take me up off my starting dose of 50 mg, up to 100, and still, nothing happened. I developed a self-conscious tic in which I would hold my hand up to my face when I spoke. I’d seen Lindsay Lohan do this in interviews in the mid-aughts, and while I’ve always wanted a bad reputation (“The cocaine in the pants I was wearing on my body wasn’t mine.” –Lindsay in 2007, almost verbatim), I want a worry-free face more.

Then, about six months in, I woke up a changed woman. My long-suffering chin — which had, for months, been hard, lumpy, and painful — became smooth. My cheeks, which had, over the winter, begun to take on a rough, graveled texture, resurfaced themselves. Even the pimple above my lip that’s recurred every single month disappeared. (Though part of that may be because I no longer get my period with my IUD.) (Also worth noting: many women stop getting their periods after they go on Spiro, too).

We often talk about acne as it relates to “self esteem” (the latter is some growing-up-in-the-nineties concept that I still don’t understand), but not enough as a condition that affects mental health. Years later, my mind still has a tendency to delineate full semesters of high school of college as “good” or “bad” based on what my skin looked like for those months. I’ve spent most of my life trying to find quick fixes –– practically bleaching my face off with Proactiv or some generic Walgreens knockoff, dousing it with apple cider vinegar, hoarding my family pantry’s collection of hydrocolloid bandages, overexfoliating until my skin was the dry, thin consistency of crepey string lights. It took me an entire adolescence to discover that those fixes weren’t quick, and perhaps not fixes at all.

Spiro isn’t quick, either, but it fixed me for now. An added bonus is that somehow the Spiro impelled my scalp follicles to quickly regrow the baby hairs that I’d previously destroyed with both heat and fingers in my quest of looking low-maintenance-tousled — and spent several hundred dollars trying to repair. Turns out a lot of women take Spiro when they lose hair due to stress. It does stress me out thinking about whether or not I’m going to be on Spiro and a whole handful of other pills for the rest of my life, but I’m trying to take it one day at a time. You should too. (Also: ask your doctor! That’s what they’re there for.)

The other Real Talk downside of Spironolactone, besides the reality that it can take over six months to become effective, is that it messes with potassium levels. That means regular blood withdrawal to make sure you don’t have dangerously high potassium levels, and, if you are me, regular time spent pretending to be brave in front of a hunky phlebotomist. Just this week, I’ve gone down half a dose because I’ve been feeling lightheaded when I stand up. If you’re a rational-headed person, you might argue that having better skin is not worth feeling nauseous several times a day. I might argue right back that having skin that doesn’t require a Pyrex cup worth of primer and foundation it is worth literally everything I have to my name, which are, in order of importance to me: my AM/PM pill towers, my Pyrex 2-cup measuring cup, and that dress I wore to that wedding.

Claire Carusillo is a freelance and fiction writer in New York. She writes a weekly beauty newsletter offering off-label product usage advice.

Photographed by Krista Anna Lewis; creative direction by Emily Zirimis. 

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  • Leslie

    Just a warning to all the ladies reading this: I was prescribed Spiro at age 24 for mild but persistent hormonal acne. I was later informed that if you become pregnant while taking it, your child can be born with hermaphroditic sex organs (genitalia of both sexes.) Despite being on birth control pills, I stopped taking Spiro immediately and actually did get pregnant accidentally 2 years later (married by then and very pleased, but just saying.) Please be smart.

    • CLAIRE CARUSILLO

      Spiro has required more medical monitoring for me than my thyroid disorder, mental health, etc.! Be smart!

    • Greer Clarke

      I think the problem here is that you were “later informed”. Before I went on a drug very similar to Spiro, I had to sign a contract saying I would use two methods of contraception (usually pill and condom) during every sexual encounter. That or abstinence.

    • Jill

      Hi Leslie, I was just browsing the comments for this discussion exactly! I was just told the same thing by my doctor… How did coming off Spiro work for you? Did you switch to something else? I’m thinking about getting off, but am so sad since it’s been a life-saver for my skin.

      • Olivia

        I stopped taking Spiro last year and I haven’t had the cystic acne that I had before taking it since I stopped…which is weird because I’m definitely more stressed out now than I was when I was on it. I haven’t been taking anything for my skin since but I’m also not on birth control, so that may have something to do with it.

  • Marie-Claude

    I recently had to change birth control for health reasons. The one I take now has less estrogen which has prompted my skin to turn back time to 8th grade where I had acne like you wouldn’t believe.

    It’s so discouraging! I have spent so much money on products since then, trying to get back my 25 year old acne free face! But, so far to no avail! Might have to ask my doctor for some of that if it works!

    • CLAIRE CARUSILLO

      <3 <3 <3 good luck

  • Liz

    Love Spiro, but be careful if you already have low blood pressure. I have POTS, but my doctor still prescribed it, and I fainted at a concert a month after starting it. I’m now on a lower dose and just have to be careful about standing up too fast.

    • CLAIRE CARUSILLO

      Same here!!

      • estheresther

        Claire what kind of IUD did you get? The copper one or the hormonal one?

        • CLAIRE CARUSILLO

          i’m on the mirena, which is hormonal! it’s not perfect (obviously, see 2,000 words on cystic acne), but it’s effective & painless!!

  • earlyholo_scene

    If you have acne, please consider a change of diet before going onto harsh medication. I had constant, intense acne starting in my teens and lasting through my late 20’s. I tried everything over the counter and prescription, including Accutane. Nothing helped. My acne was localized on my cheeks, jawline and neck and was devastating to my self esteem.

    I only figured out how to clear it up when a chance visit to a naturopath led to a food allergy test that showed I was incredibly reactive to dairy. I quit all forms of dairy and within two weeks my acne began clearing. Since quitting dairy almost a decade ago I have had clear, beautiful skin. I have suggested quitting dairy to a number of friends who had similar acne issues and all have seen their acne clear up completely after going dairy free.

    • consider the experience

      seconding this.

    • Bridget

      On a similar note, I went vegan and my keratosis pilaris started to vanish like a snowball in hell! I didn’t even know that it *could* go away.

    • Greer Clarke

      You’re right on the money with the change of diet thing, but, like Katie says above, a visit to the dermatologist can still tell you that, not a naturopath. No sugar, low GI foods helped clear up my skin hugely, as recommended by the dermo. That was the first step, but it still didn’t do the job completely, so only then was medication explored.

      • Heather Baringer Carp

        You’re very lucky to have a dermo that will recommend changes in diet and test for food allergies. Not all will. In my own experience, my dermo laughed at my suggestion that what I ate effected my skin. So, I saw a naturopath instead. That was easier for me than searching for a dermo that wanted to find the root of the problem instead of prescribing a pharmaceutical fix.

  • EC

    Agreed about being careful. It has a black box warning because it’s so closely tied with breast cancer. Make sure you talk to your doctor about family history!!

  • Jess

    Pedant moment imminent (sorry)- it’s -lactone, not -lactane. Interesting article though, thank you 🙂

    • Verena von Pfetten

      Well, that’s embarrassing and totally my fault! Fixed it though so THANK YOU!

  • marnie.

    I have been on Spiro for 1 month and i’m already starting to see results. Thanks for this article, funny read!

  • SC

    Beauty issues can often be solved by medication, but I don’t think beauty writers should be recommending medication for beauty issues, even with plenty of disclaimers. A drug that was developed for unrelated issues is being prescribed to combat acne–this should make you raise an eyebrow or two and ponder whether you should be taking this drug at all. New medical research is always coming out, and we often learn that what we once thought was harmless or even beneficial can be quite harmful (eg new research suggest that high cholesterol in old age is actually beneficial as opposed to harmless and that statins, commonly prescribed compounds to lower cholesterol, can actually increase risk of heart disease). The newest research often doesn’t impact the pharmaceutical makets until much later, however. Be informed. Don’t trust a doctor just because they’re a doctor; ask about the newest research and long term side effects. And know that health always trumps beauty.

  • Rachel D.

    Spiro has been great for me (and I’m actually really annoyed I spent so many years taking antibiotics which are harsh on your system!). I haven’t really had any side effects, although the first week or so it made me pee a lot, and then my body adjusted. It’s really one of the only acne medications you can take long-term, too, which is one of the problems with antibiotics. Some doctors are weird about prescribing it, though. My advice? Find another doctor. It’s worth it.

    • pennyjenny

      You can also get it prescribed via Curology w/o seeing a doctor/derm in person, which is nice.

  • Olivia AP

    I needed this! About 4 years ago I took Accute and it did wonders, my acne was gone. BUT, last year mi cheeks were completely covered with little bumps, not red or anything, just clogged pores. It was so bad that I cancelled plans and when I was at work I just wanted the day to end and I couldn’t take Accutane again because it made my eyes so red and dry that I couldn’t stand it. I have taken Spironolactone for about two months now (50 mg) and I have seen a little improvement but I was getting impatient unitil I read this!
    I just have a question, how often do you have to go get medical exams?

    • CLAIRE CARUSILLO

      Hi Olivia,

      For the first three months, I was being tested monthly. Now (about 6 months in), I go every three months!

  • J

    I am insterested in this Spiro you speak of, if it can help reduce periods. I may ask my doc about that.

    Dairy made a huge difference for my skin, as well! I was inconsistent about giving it up for the long term, but when I did my skin changed dramatically. Also, now your attention can be drawn to my cute nose freckles, which always just blended in with the other bad spots before.

  • Dani

    What kind of IUD did you use? Copper or hormonal?

    • CLAIRE CARUSILLO

      I have the hormonal Mirena IUD. Great for a lot of my needs; not so much for skin.

  • I really recommend anyone who is having skin trouble have a crack at Dr Perricones skin clearing diet. It’ll change your lyfe. https://www.perriconemd.com/anti-aging-diets/3-day-skin-clear-diet.html

  • Queef Sniffer
    • Greer Clarke

      How ’bout no

  • cuffers27

    This article is so timely for me. I got a hormonal IUD about 9 months ago and it was all fine except for the last couple of months when I have had persistent cystic spots along my jawline. Didn’t actually realise you could still get hormonal spots when you didn’t have a hormone cycle… Anyway, gonna try some of these other recommendations re diet etc before I go as extreme as meds but thanks for the insight.

  • Katie

    I don’t even know where to begin with how much this article concerns me. I love love love Man Repeller, most notably because pieces on here are typically entertaining and thoughtful reflections by intelligent young women. This piece, on the other hand, is a repulsive infomercial for a drug. This article essentially says “Hey! I’m a beauty writer who knows more about pharmaceuticals than my medical degree carrying doctor and can *definitely* recommend them to thousands of women whose health I know nothing about.” It is irresponsible to encourage women to request a specific prescription medication from their doctor, and honestly I’m disappointed in the editorial team at MR for thinking this was an acceptable piece to publish.

    For the record, I work in the pharmaceutical industry, and if you are having skin concerns you should see a board certified dermatologist and ask for their thoughts on the appropriate treatment for your condition. There are hundreds of drugs out there. Knowing which one to chose is one of the reasons dermatologists are paid >$150/hr.

    • Olivia AP

      OMG relax, she is not saying that should force your doctor to get a prescpription, she is just talking about her acne experience and how this drug, that many people may not know, helped her a lot. Obviously you sould go to your doctor and be responsible, the article is not suggesting otherwise…

    • CLAIRE CARUSILLO

      Hi Katie! Definitely not saying this works for everyone, and as I’m sure you know because of yr profession, every body reacts different to both IUDs and Spiro. I wrote the article because Spiro helped me in a major way, and not a lot of women realize that this non-Accutane, non-anti-biotic solution exists and could help with debilitating skin issues. I want everyone to be safe, and if anyone out there is requesting a prescription based on this piece, I’d hope their doctor would tell her to SLOW DOWN and CHECK HERSELF.

      • gg

        I think what most people don’t realize, and you probably wouldn’t if you DON’T work in the medical field, is that every day, people go to doctors and request specific medications because they read that it worked as a cure for someone else – someone with a potentially vastly different medical history. Then, when/if they are denied (usually for perfectly sound medical reasons) they go to another provider, and another, until they find someone who will sign off their prescription pad without much thought. This is part of the reason why so many bacteria are becoming immune to antibiotics; people insist they have a sinus infection, for example, and they keep going until someone gives them antibiotics, when they really had a virus. [PSA: about 90% of upper respiratory infections (ear/nose/throat/bronchial) are caused by viruses, and viruses do not respond to antibiotics.]

        Unfortunately, there are doctors who will do this, and they do it often. I would advise that anyone curious about Spironolactone (or any other) specific medicine ask to have an actual conversation with their doctor, not just an ask-and-ye-shall-receive. They should be willing and able to explain the benefits/adverse affects, or give you a good reason for approving/disapproving your request. Trust that what they are telling you is sound information.

        Please, if you are going to write a testimonial about a drug, add more than an “ask your doctor!” thrown in near the end. It’s frustrating to see patients come in asking for drugs they think will work for whatever problem, and get cursed at or put down for not ethically being able to immediately give them something that would have more negatives than positives, not to mention heart-breaking when you know they are frustrated as well.

    • A dermatologist prescribed spiro and minocycline and they are the only things that clear up and prevent my painful, cystic acne, which I’ve had since puberty.

      I too tried EVERYTHING else (except Accutane) and nothing worked. I eat well and have experimented with cutting out dairy, gluten, and all yummy stuff. My acne is truly a hormonal problem, not related to diet, or hygiene.

      I don’t see this as an ad for spiro; it’s just a testimonial which can benefit other acne sufferers.

  • Kat

    All of this so you could keep an IUD inside you?? Are you NUTS? Get that thing taken out, stat. All the other issues go away. Did that not ever occur to you? Yikes. I learned the hard way with IUDs too. My first one was a dream, fantastic plastic (Mirena, not the copper kind) so after five years of period free bliss, when it was time to replace, I didn’t give it a second thought. The second one, that’s when all hell broke loose. It took me over a year to bite the bullet and admit the new IUD was the cause of all my brand new health issues and have it removed and get my life back. Just a thought.

    • CLAIRE CARUSILLO

      Hi Kat! It definitely occurred to me, but after talking with my gynecologist, endocrinologist, and (!) my psychiatrist, we all decided it was best for me to keep that little sucker in there (it’s the Mirena, FWIW). I’m so sorry about the pain!! I’ve definitely hard lot of IUD horror stories, and the great lesson here for me is every uterus is ~~different~~ and **special**

  • Gabi

    Claire- this is an amazing article. I completely feel you in all aspects. I too judge periods of time by whether my skin is bad or good. I have also tortured my skin for a “quick fix” that hasn’t really worked at all. My DREAM (besides world peace of course) is for perfect skin that requires minimal makeup and that I don’t have to obsess over in an unhealthy way.

    So my question is – is this an antibiotic? It sounds like your doctor prescribed it to you, so that’s why I asked. I was an an antibiotic for a little while last year but when I went off of it my skin went psycho again – ipso facto I would say Fall of 2015 was NAHT good based of my skin. Anyways, I know that going on and off antibiotics isn’t good for you, and isn’t a permanent fix. So I was just wondering how long you plan on staying on this for and such. Thanks for the article!

    • CLAIRE CARUSILLO

      Gabi, it’s not an antibiotic –– it’s a diuretic, weirdly enough. And yeah, I can’t do the antibiotics either. Once I went on my first (and last) round of Doxycycline and my skin reacted so poorly that every item of clothing that touched me left a burning rash for 2 weeks. Eeek!

  • Shae

    This topic is very near and dear to me, having spent the last 3 years struggling with horrible cystic acne (after going off birth control). BC cured me of all my high school skin problem but unfortunately I didn’t “outgrow” those skin problems like I hoped I would when I finally stopped taking it. The acne I experienced after going off BC was the worst…that being said 3 emotional and long years later I’ve finally figured out a holistic remedy that works for me. I second what people have commented here, dairy is huge, as well as sugar. Eliminate both of those and you can see a difference…Lastly I encourage anyone who wants a holistic solution to check out Lara Briden’s blog (search “acne” in her search bar on the site). I take all of the supplements she recommends and I swear that’s finally what did the trick for me. Thank you MR for posting something that I think is going to become a growing issue as we women continue to figure out the effects of BC and how those hormones affect our skin.

    • CLAIRE CARUSILLO

      Shae! My sister in arms/hormonal acne! I’m glad you’ve finally found something that works for you, because it’s taken years for me! I’m endlessly fascinated (and maybe terrified?) by the mounting pile of research that’s coming out w/r/t BC and acne. It’s rough out there!

  • Greer Clarke

    Claire, I really loved this article and thank you for sharing! I had a similar thing where my acne was only getting worse towards the end of high school, and my friends would be on the floor over two pimples emerging over night, meanwhile I’m sitting there thinking “If you can count your pimples don’t f*ing complain about them to me”. Going on Roaccutane, or Isotretinoin, was one of the best things I ever did. Same delay, but same amazing effects (not-so-amazing side effects too, but hey, there’s plenty of nice closed in shoes to hide those ingrown toenails. Yes, ingrown toenails were a side effect.)

  • I’ve been using Sprinolactone on and off for about 5 years and it has been LIFECHANGING. I can’t recommend it enough for adult acne.

  • PCE

    This is crazy – I just left my doctors office and he was recommending this to help with some symptoms I have from PCOS… I’m definitely looking into it, and I’ll keep you posted!

  • Cynthia L.

    I took a hormonal pill for more than 3 years to help with my acne, it worked, I LOVED it, but not long ago I began feeling not that good. After some blood tests I discovered my triglycerides and colesterol had gone wild, they doubled the normal levels, all because of that pill. I’m now working on this problem and had to stop taking the hormones. I know is not the same medication that the article is talking about, but I highly recommend to the readers to go with a doctor and have regular tests before start taking a new medicine.

  • Morgan

    i’m so happy to hear people talking about this medication. I stopped talking birth control at the age of 20 after being on it since I was 15 with no breaks ever. My hormones suffered terribly because of this. My body was so confused how to function as an adult woman without birth control hormones. I developed severe acne not only on my face but back and chest which I never in my life suffered from before. Growing up I have moderate acne I never was the girl with clear skin but never awful. Normal teenage stuff maybe slightly worse. I went to my doctor and they prescribed me Sprio and I immediately went back on birth control. My doctor didn’t give me much background info on the drug except it works for acne. And honestly I didn’t care what it did I was so desperate to find a cure. Well after about three months on 75mg I will tell over the course of that time every day my skin started to get worse. I mean cystic, poor girl, painful, rashy awful skin. I developed depression, would really leave the house and look in the mirror and cry most mornings. I was completely lost and confused, my doctor told me this would clear up my acne but it has only gotten significantly worse. I took to the internet where there is an amazing community of women who like me have resorted to Sprio. Basically all the blogs said, “it will get worse before it gets better” and “stick it out, I promise all worth it” I was already this far into taking it so I stuck it out around month 4 my skin began to clear and soon after my 21st birthday my skin was more beautiful then ever. I continued taking Spiro for about a year and slowly weened off of it (ever though I was very scared of revenge acne coming back). I knew the drug wasn’t good longterm. Well I didn’t get any revenge acne and haven’t seen a pimple since stopping. It’s been 3 years and I now have skin I never dreamed of having. People cannot believe I ever had bad acne in my life. I never thought I would be proud of my skin. I love to not wear makeup in public now because I feel most proud and beautiful. Anyone looking into trying Spiro just know everyones journey is different. And it gets worse before it gets better, think of your skin as purging out any possible pimples in the future to make room for beautiful clear what dreams are made of skin. Some other positive side effects were that I almost stopped growing body hair so i rarely shaved and weight loss because it is a diuretic. Have faith in the medication and stick it out because it will change your life!

  • sarah531

    I’ve been on Spiro for about 5 years now for my mild PCOS symptoms and it has been a WONDER. No more cystic acne, regaining of hair growth where I want it and reduction where I don’t. I will say that a warning my doctor had for me is you CANNOT take spironolactone if you are pregnant or looking to become pregnant. Since it is an androgen blocker, it actually blocks the uptake of testosterone in your body. Great for acne prevention and unwanted hirutism but catastrophic for growing babies. If you were developing a male child it would lead to abnormal development of the fetus. Just something to keep in mind before you talk to your doctor!

  • Olivia

    I know I’m a bit late commenting on this article but I had the same amazing outcome from taking Spiro! I recommend it to anyone I know that has been struggling with painful cystic acne. I don’t take it anymore and my skin has been fine, I’ll get a cyst every couple of months due to stress or my period but I can just go to the dermatologist across the street from my work and get a cortisone shot. Those two things have been the only treatments that have ever worked for me. There is no shame in having to take pharmaceuticals. It works for some people, and it might not work for others. But I’m so glad you feel better taking Spiro! It changed my skin for the better!!