Cream
Acne Cream
Triple-action topical for acne: antibiotic (clindamycin + erythromycin) and antifungal (ketoconazole). Covers bacterial and fungal acne.
Starting at $101/mo
Hormonal acneAnti-androgenWomen's health
Spironolactone Capsules
RxPrescription onlyTaken by mouth · Once a day · 10–115 mg · Hormonal acne · Anti-androgen · Women's health
Starting at $79/mo
Spironolactone: oral potassium-sparing diuretic that acts as a mild androgen receptor antagonist. FDA-approved for hypertension; widely prescribed off-label for hormonal acne and unwanted facial hair in women.
How many capsules per month?
MonthlyEvery 3 months
30 capsulesper month
You'll receive 30 capsules per month. $99 billed monthly. Cancel anytime.
Real prices from our pharmacy. Longer plans cost less per month and are billed up front. Pause or cancel anytime.
- Blocks androgen (testosterone) at the skin level
- Reduces sebum production and acne breakouts within 2-3 months
- Also reduces unwanted facial and body hair
Every plan includes
- Personalized, physician-guided plan
- 30 capsules per month, monthly and 3-month
- Dispensed by a US-licensed compounding pharmacy
- Unlimited protocol adjustments and messaging
- Ongoing support and check-ins
- Pause or cancel anytime
- Reviewed by our in-house physicians
- Physician-guided care
- Ongoing, expert support
- 100% online
- Free, discreet shipping
What is spironolactone?
(potassium-sparing diuretic and androgen antagonist)
Spironolactone blocks aldosterone in the kidneys and androgen receptors in skin, hair follicles, and sebaceous glands. This reduces testosterone's effects on oil gland activity and follicle sensitivity, treating hormonal acne at its root. It is FDA-approved for hypertension and hyperaldosteronism. Off-label use for acne and hirsutism (unwanted hair) is common and evidence-supported in women.
- How it is taken
- Taken by mouth
- How often
- Once a day
- Dose range
- 10–115 mg
- Form
- Hormonal acne · Anti-androgen · Women's health
50-100
mg daily, typical off-label acne dose
Spironolactone works best for acne driven by androgen excess, polycystic ovary syndrome (PCOS), or idiopathic hormonal acne. It is a pregnancy-category X drug; reliable contraception is required.
How it works,
week by week.
Day 1
Your physician reviews your acne, menstrual history, androgen symptoms, blood pressure, potassium level, and kidney function. Confirms you are not pregnant and establishes a contraception plan.
Week 1
Start with 50-100 mg daily, usually in the morning. Take with food to minimize GI upset. Expect increased urination and possible breast tenderness.
Weeks 2-4
Sebum production decreases. Existing deep acne may get worse before it improves (purging); this is normal. New breakouts decrease; skin texture softens.
Months 2-3
Acne improves significantly. First lab check: serum potassium and kidney function. Your physician adjusts dose if needed or discusses increasing if response is partial.
Months 6-12
Facial and body hair begins to thin and grow more slowly. Acne remains clear with consistent dosing. Annual labs and check-ins ensure continued safety and efficacy.
What you may notice,
and when.
Acne reduction
hormonal breakouts decrease; deep nodules soften
Less oily skin
sebum production drops; pores look smaller
Hair reduction
facial and body hair grows more slowly, lighter
Consistent use
results depend on taking medication daily
Individual results vary. Benefits reflect what Zepym Health members commonly report to their physician at check-ins; they are not the results of a clinical trial.
Safety first:
what to know before you start.
Important safety information and common side effects
Spironolactone is a potassium-sparing diuretic; the main safety concern is hyperkalemia (elevated serum potassium). Risk is higher in people with kidney disease, those taking ACE inhibitors or ARBs, or those with diabetes. Tell your physician about all medications, especially blood pressure drugs and NSAIDs. Spironolactone is absolutely contraindicated in pregnancy (category X); use reliable contraception. Common side effects: breast tenderness, irregular or missed periods, and increased urination. Some women report mood changes or dizziness. Stop and seek care for severe headache, chest pain, severe dizziness, unusual bruising, or signs of hyperkalemia (muscle weakness, irregular heartbeat).
The research behind
spironolactone.
Spironolactone blocks androgen action in the skin and is used off-label for acne in women. The main recent evidence is one large pragmatic placebo-controlled trial, reported in two publications.
- Acne trial19% vs 6% success
The SAFA trial randomized 410 women with persistent facial acne (342 in the primary analysis) to spironolactone 50 mg a day, raised to 100 mg from week 6, or placebo, for 24 weeks. Investigator-rated treatment success at week 12 was 31 of 168 (19%) on spironolactone and 9 of 160 (6%) on placebo.
Santer et al., BMJ 2023;381:e074349 - Side effectsheadache 20% vs 12%
Headache was more common on spironolactone (20% vs 12%, p=0.02). The trial reported no serious adverse reactions related to the study medicine.
Santer et al., BMJ 2023;381:e074349 - Week 2481.9% vs 63.3%
Overall acne improvement at 24 weeks was 81.9% on spironolactone and 63.3% on placebo (adjusted OR 2.72, 95% CI 1.50 to 4.93). The difference at week 12 was not significant for overall improvement.
Health Technology Assessment, SAFA trial, 2024 (PMID 39268864)
What the studies found
- Investigator-rated treatment success at week 12 was 19% vs 6% for placebo in 342 women analysed (Santer et al., BMJ 2023).
- Overall acne improvement at week 24 was 81.9% vs 63.3% for placebo (SAFA, Health Technol Assess 2024).
- Quality-of-life score at week 24 was 3.77 points higher than placebo (95% CI 2.50 to 5.03) in the same trial (SAFA, Health Technol Assess 2024).
Trial results are for spironolactone at the SAFA doses, in women with persistent facial acne. Spironolactone is a prescription drug; these capsules are the pharmacy's version of the same drug. Compounded versions were not studied.
What this does not say
- The main trial was in women; we did not find a comparable trial in men for acne.
- The trial measured acne over 24 weeks; longer use was not studied in it.
- The quality-of-life difference at week 12 was small (1.27 points, 95% CI 0.07 to 2.46), and the trial did not test spironolactone for hair loss.
The research
behind it.
Spironolactone reduces sebaceous gland activity and improves acne in 60-90% of women with hormonal acne, PCOS, or elevated androgens. Hair reduction takes longer, usually 6-12 months.
Side effects include hyperkalemia (high potassium) and electrolyte changes; your physician monitors potassium levels and blood pressure. Breast tenderness or irregular periods are common and usually reversible.
Getting started
takes a few minutes.
- 1
Connect with a physician
Answer a few questions online and a US-licensed physician reviews your health, history and goals to make sure treatment is right for you. 100% online. No in-person visit required.
- 2
Get your discreet shipment
If approved, your treatment is compounded by a US-licensed, LegitScript-certified pharmacy, inspected for quality, and shipped discreetly to your door.
- 3
Receive continuous support
Start with one goal, then keep building over time. Unlimited physician messaging, easy refills and dose adjustments, all from the Zepym Health app.
Frequently asked questions
Contact supportHow do I take Spironolactone Capsules?
Taken by mouth, once a day. The starting prescription is 1 capsule (10 mg) each time. Your physician sets your own dose and it is printed on your label.
What strengths does Spironolactone Capsules come in?
The pharmacy carries 4: 10 mg, 55 mg, 75 mg, 115 mg. Your physician chooses which one you get.
How much arrives in each shipment?
30 capsules at the starting strength, shipped to your door from a licensed US pharmacy.
How long until my acne improves?
Most women see improvement in 2-3 months; significant clearance takes 4-6 months. Hair reduction is slower, often 6-12 months. The effects plateau after 6 months. Your physician monitors labs (potassium, kidney function) at baseline and periodically.
Can I use spironolactone with birth control?
Yes. In fact, combining spironolactone with hormonal birth control (pills, patch, IUD) is common and effective for hormonal acne. The birth control helps regulate your cycle while spironolactone targets androgen effects on skin.
What if I miss a dose?
Take it as soon as you remember, unless it is almost time for the next dose. Do not double up. Consistent daily dosing is key; missing doses can reduce effectiveness.
Can I stop suddenly?
No. If you stop spironolactone suddenly, your androgen levels rise again and acne returns within weeks. Taper gradually with your physician's guidance if you need to discontinue.
Are there long-term side effects?
Long-term spironolactone is well tolerated. The main ongoing concern is potassium levels; your physician checks periodically. Fertility remains normal; spironolactone is stopped only if you become pregnant.
Spironolactone educational content reviewed by our physician
Scott Nass, MD Doctor of Medicine, board-certified in Family Medicine
Charles R. Drew University and David Geffen School of Medicine at UCLA. Family Medicine residency at Ventura County Medical Center.
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References
- 1.Spironolactone for hormonal acne in women: a randomized controlled trial. JAAD, 2017
- 2.Androgen excess in women: acne and hirsutism. J Clin Endocrinol Metab, 2013
Prescription products require an online evaluation with a licensed medical professional who will determine if a prescription is appropriate. Products are compounded by a licensed pharmacy. The FDA has not reviewed or approved compounded products for any use for safety, efficacy, or quality. Compounded medications are not FDA-approved brand-name products.