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<!doctype html><html lang="en-US" data-no-contents-sidebar><head><meta charset="UTF-8"><meta name="viewport" content="width=device-width, initial-scale=1, minimum-scale=1"><title>Spironolactone and Claims About Increased Visceral Fat in Transfeminine People - Transfeminine Science</title><link rel="preload" href="../../assets/images/branding/logo.png" as="image" /><link rel="preload" href="../../assets/images/branding/logo-dark.png" as="image" /><link rel="stylesheet" href="../../assets/css/vendor/normalize.css"><link rel="stylesheet" href="../../assets/css/variables.css"><link rel="stylesheet" href="../../assets/css/site-layout.css"><link rel="stylesheet" href="../../assets/css/article-content.css"><link rel="stylesheet" href="../../assets/css/print.css"><meta name="robots" content="noarchive"><link rel="apple-touch-icon" sizes="180x180" href="../../apple-touch-icon.png"><link rel="icon" type="image/png" sizes="32x32" href="../../favicon-32x32.png"><link rel="icon" type="image/png" 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350 -6 5 -686 5 -692 0z" /><path d="M2459 2096 c-2 -2 -3 -160 -1 -350 l3 -346 1219 0 1219 0 3 346 c2 190 1 348 -1 350 -6 5 -2436 5 -2442 0z" /></g></svg> </span> </button> <span id="sidebar-title">Contents</span></div><div id="sidebar-contents"><div class="toc-h1"><a id="heading-0" href="index.html#top" class="toc-link">Top of page</a><div><div class="toc-h2"><a id="heading-1" href="index.html#references" class="toc-link">References</a></div></div></div></div></div></div><div id="main-area"><div id="article"><h1 id="spironolactone-and-claims-about-increased-visceral-fat-in-transfeminine-people"> <a href="index.html#spironolactone-and-claims-about-increased-visceral-fat-in-transfeminine-people" aria-labelledby="spironolactone-and-claims-about-increased-visceral-fat-in-transfeminine-people" class="anchor-heading"><svg viewBox="0 0 16 16" aria-hidden="true"><use xlink:href="#svg-link"></use></svg></a> Spironolactone and Claims About Increased Visceral Fat in Transfeminine People</h1><p>By <a href="../../about/index.html#aly">Aly</a> | First published October 25, 2020 | Last modified October 2, 2022</p><p>A <a href="https://moderntranshormones.com/2018/01/01/whats-wrong-with-spironolactone/">claim has been originated by some in the online transgender community</a> that the antiandrogen <a href="https://en.wikipedia.org/wiki/Spironolactone">spironolactone</a> increases <a href="https://en.wikipedia.org/wiki/Visceral_fat">visceral fat</a> in transfeminine people and that this effect is irreversible. Visceral fat is a type of adipose tissue located in the intra-abdominal region which surrounds the internal organs (viscera) in that area. In excess, visceral fat causes the abdomen to look bloated and unattractive. The supposed phenomenon of visceral fat accumulation with spironolactone has sometimes been referred to by people in the transgender community as “spiro belly”. The claim is based on theory—specifically that spironolactone has been found to increase levels of the <a href="https://en.wikipedia.org/wiki/Corticosteroid">corticosteroid</a> hormone <a href="https://en.wikipedia.org/wiki/Cortisol">cortisol</a> due to its <a href="https://en.wikipedia.org/wiki/Antimineralocorticoid">antimineralocorticoid</a> activity and cortisol is known to increase visceral fat, which together imply that spironolactone might likewise be able to increase visceral fat. It is also based on claimed <a href="https://en.wikipedia.org/wiki/Anecdotal_evidence">anecdotal observations</a> of transfeminine people taking spironolactone, which are said to corroborate the hypothesis. Despite these claims however, there is no actual direct scientific or medical literature to support the idea that spironolactone increases visceral fat, and there is considerable evidence contradicting it.</p><p>The influence of spironolactone on cortisol levels in clinical studies is variable and the magnitude of effect is limited. Hence, the clinical significance of increased cortisol levels with spironolactone is uncertain. Moreover, cortisol is an <a href="https://en.wikipedia.org/wiki/Agonist">agonist</a> of the <a href="https://en.wikipedia.org/wiki/Glucocorticoid_receptor">glucocorticoid receptor</a> (thereby producing <a href="https://en.wikipedia.org/wiki/Glucocorticoid">glucocorticoid</a> effects) and of the <a href="https://en.wikipedia.org/wiki/Mineralocorticoid_receptor">mineralocorticoid receptor</a> (thereby producing <a href="http://en.wikipedia.org/wiki/Mineralocorticoid">mineralocorticoid</a> effects). As already touched on, spironolactone has potent antimineralocorticoid activity (that is, mineralocorticoid receptor <a href="https://en.wikipedia.org/wiki/Receptor_antagonist">antagonism</a>). Hence, even if spironolactone did increase cortisol levels enough to potentially increase visceral fat, its antimineralocorticoid activity could modify the capacity of cortisol to produce this effect. In relation to this, there is accumulating research to suggest that spironolactone may actually <em>decrease</em> visceral fat via its antimineralocorticoid activity. Antimineralocorticoids like spironolactone show <a href="https://en.wiktionary.org/wiki/antiadipogenic">antiadipogenic</a> (anti-fat-accumulation) effects <em>in vitro</em> (<a href="https://doi.org/10.1096/fj.06-7970com">Caprio et al., 2007</a>; <a href="https://doi.org/10.1210/en.2010-0674">Caprio et al., 2011</a>) and have been shown to decrease visceral fat in animals (<a href="https://doi.org/10.1007/s12325-008-0039-5">Karakurt, 2008</a>; <a href="https://doi.org/10.1096/fj.13-245415">Armani et al., 2014</a>; <a href="https://doi.org/10.1038/ijo.2016.13">Mammi et al., 2016</a>; <a href="https://doi.org/10.1139/cjpp-2018-0416">Olatunji et al., 2018</a>). It is possible that they may also be able to do so in humans. Here are some notable literature excerpts relevant to this topic (<a href="https://doi.org/10.1016/bs.vh.2018.10.005">Infante et al., 2019</a>; <a href="https://doi.org/10.1038/nrd.2016.31">Giordano, Frontini, & Cinti, 2016</a>):</p><blockquote><p>A possible explanation for [MR antagonists reducing cardiovascular morbidity and mortality more in patients with abdominal obesity] may be that patients with heart failure and abdominal obesity have higher aldosterone concentrations due to excessive secretion of specific aldosterone-releasing factors from [visceral adipose tissue]. […] Several studies on murine models of genetic and diet-induced obesity have widely reported beneficial effects of MR antagonism in terms of metabolic outcomes, such as body weight, fat mass, adipose tissue inflammation, insulin sensitivity, and lipid metabolism (Armani, Cinti, et al., 2014; Armani, Marzolla, et al., 2014; Garg & Adler, 2012; Guo et al., 2008; Hirata et al., 2009). Nevertheless, data on the outcomes of MR pharmacological blockade for prevention and treatment of obesity and metabolic syndrome are still scarce in humans (Tirosh et al., 2010). Of note, Tanko et al. demonstrated that the powerful MR antagonist drospirenone, in combination with estradiol, leads to a significant reduction of central fat mass and central fat mass/peripheral fat mass ratio in healthy post-menopausal women (Tankó & Christiansen, 2005). Moreover, another study has reported that MR antagonists significantly reduce body mass index and visceral fat area in patients with primary aldosteronism after a 1-year treatment period (Karashima et al., 2016). […] In light of these data, MR antagonism may be a useful therapeutic tool for prevention and treatment of cardiometabolic derangements observed in metabolic syndrome, even though additional studies are deemed necessary to confirm its impact on larger clinical settings.</p></blockquote><blockquote><p>An anti-obesity drug whose primary mode of action is to induce browning should act predominantly on visceral fat, thereby directly counteracting the major cause of obesity-associated metabolic disorders. Accumulation of abdominal visceral fat is, to some extent, linked to increased local levels and/or activity of androgen and glucocorticoid steroid hormones<sup>145,146</sup>. These hormones are also ligands of the mineralocorticoid receptors, which are found on white and brown adipocytes and could have a role in abdominal visceral fat accumulation and BAT to WAT conversion<sup>147–151</sup>.** […] **In this context, mineralocorticoid receptor antagonism has been shown to protect mice from the adverse obesogenic and metabolic effects of a high-fat diet via conversion of a substantial amount of visceral and subcutaneous WAT into BAT<sup>153</sup>. Given that mineralocorticoid receptor antagonists are widely prescribed diuretics, used to manage chronic heart failure, hyperaldosteronism and female hirsutism<sup>154</sup>, patients receiving such drugs should also be assessed for weight loss and metabolic parameters to establish whether these compounds have anti-obesity properties.</p></blockquote><p>A number of studies have assessed the influence of antimineralocorticoids like spironolactone and <a href="https://en.wikipedia.org/wiki/Eplerenone">eplerenone</a> (another antimineralocorticoid) on visceral fat in humans. Spironolactone (12.5–100 mg/day) and eplerenone (25–100 mg/day) decreased visceral fat in people with pathologically high levels of <a href="https://en.wikipedia.org/wiki/Aldosterone">aldosterone</a> (a major endogenous mineralocorticoid hormone) (<a href="https://doi.org/10.1038/hr.2015.129">Karashima et al., 2016</a>). A study of cisgender girls with <a href="https://en.wikipedia.org/wiki/Polycystic_ovary_syndrome">polycystic ovary syndrome</a> (PCOS) found that a combination of spironolactone (50 mg/day), <a href="https://en.wikipedia.org/wiki/Pioglitazone">pioglitazone</a>, and <a href="https://en.wikipedia.org/wiki/Metformin">metformin</a> decreased visceral fat (<a href="https://doi.org/10.1155/2018/4192940">Diaz et al., 2018</a>). However, this study was of course confounded by the other medications. In addition to the preceding studies, many other clinical studies (at least 10) have assessed and similarly found no indication of increased visceral or abdominal fat with spironolactone (25–200 mg/day) (as measured by visceral fat directly or by indirect related measures like <a href="https://en.wikipedia.org/wiki/Waist_circumference">waist circumference</a> or <a href="https://en.wikipedia.org/wiki/Waist–hip_ratio">waist–hip ratio</a>) (<a href="https://doi.org/10.1016/0010-7824(91)90112-S">Wild et al., 1991</a>; <a href="https://doi.org/10.1210/jcem.81.6.8964851">Lovejoy et al., 1996</a>; <a href="https://doi.org/10.1210/jc.2003-031780">Ganie et al., 2004</a>; <a href="https://doi.org/10.2337/dc06-0618">Meyer, McGrath, & Teede, 2007</a>; <a href="https://doi.org/10.1007/s12325-008-0039-5">Karakurt et al., 2008</a>; <a href="https://doi.org/10.1016/j.contraception.2011.12.011">Vieira et al., 2012</a>; <a href="https://doi.org/10.1210/jc.2013-1040">Ganie et al., 2013</a>; <a href="https://doi.org/10.1111/j.1365-2265.2012.04466.x">Harmanci et al., 2013</a>; <a href="https://doi.org/10.1111/jog.12543">Leelaphiwat et al., 2015</a>; <a href="https://doi.org/10.1530/EJE-17-0516">Alpañés et al., 2017</a>). I was not able to identify any studies assessing visceral fat with higher doses of spironolactone (>200 mg/day). Additional studies are also underway to assess the possibility that spironolactone could decrease visceral fat.</p><p>With regard to the anecdotal claims of spironolactone increasing visceral fat in transfeminine people, it’s important to note that <a href="https://en.wikipedia.org/wiki/Anecdotal_evidence">anecdotes are unreliable</a> and are <a href="https://en.wikipedia.org/wiki/Hierarchy_of_evidence">considered to be the lowest form of evidence in medicine</a>. This is for well-founded reasons—succinctly, anecdotes very often don’t hold up when rigorous studies are conducted. It’s probable that excess abdominal fat—a problem which afflicts many—has been misattributed to spironolactone rather than to the real causes in transfeminine people. It’s notable in this regard that androgens are known to increase visceral fat and that men have twice as much visceral fat as women on average (<a href="https://doi.org/10.1016/j.jsbmb.2007.09.001">Blouin, Boivin, & Tchernof, 2008</a>; <a href="http://doi.org/10.1007/s13679-014-0119-6">Zerradi et al., 2014</a>). It’s possible that many transfeminine people may have excess visceral fat due to prior androgen exposure and that this visceral fat may not fully reverse with hormone therapy. As we know, hormone therapy unfortunately isn’t able to reverse all established bodily sexual dimorphism.</p><p>Besides increased visceral fat, <a href="https://moderntranshormones.com/2018/01/01/whats-wrong-with-spironolactone/">many other serious adverse effects with spironolactone have been claimed</a>. However, these claimed adverse effects are likewise based on anecdotes and theory, and there is a lack of direct clinical evidence to support such side effects. In actuality, spironolactone even at high doses appears to be well-tolerated per studies and systematic reviews. The claimed side effects of spironolactone may actually largely be due to phenomena like <a href="https://en.wikipedia.org/wiki/Nocebo">nocebo</a> and misattribution—which can be controlled for in systematic studies but not in the case of anecdotal observations.</p><p>To summarize, no research, animal or clinical, has found increased visceral fat with spironolactone, and there is accumulating evidence that spironolactone may cause the very opposite effect. More studies are needed to further characterize this possible benefit of spironolactone in humans however.</p><h2 id="references"> <a href="index.html#references" aria-labelledby="references" class="anchor-heading"><svg viewBox="0 0 16 16" aria-hidden="true"><use xlink:href="#svg-link"></use></svg></a> References</h2><ul><li>Alpañés, M., Álvarez-Blasco, F., Fernández-Durán, E., Luque-Ramírez, M., & Escobar-Morreale, H. F. (2017). Combined oral contraceptives plus spironolactone compared with metformin in women with polycystic ovary syndrome: a one-year randomized clinical trial. <em>European Journal of Endocrinology</em>, <em>177</em>(5), 399–408. [DOI:<a href="https://doi.org/10.1530/eje-17-0516">10.1530/eje-17-0516</a>]</li><li>Armani, A., Cinti, F., Marzolla, V., Morgan, J., Cranston, G. A., Antelmi, A., Carpinelli, G., Canese, R., Pagotto, U., Quarta, C., Malorni, W., Matarrese, P., Marconi, M., Fabbri, A., Rosano, G., Cinti, S., Young, M. J., & Caprio, M. (2014). Mineralocorticoid receptor antagonism induces browning of white adipose tissue through impairment of autophagy and prevents adipocyte dysfunction in high‐fat‐diet‐fed mice. <em>The FASEB Journal</em>, <em>28</em>(8), 3745–3757. [DOI:<a href="https://doi.org/10.1096/fj.13-245415">10.1096/fj.13-245415</a>]</li><li>Blouin, K., Boivin, A., & Tchernof, A. (2008). Androgens and body fat distribution. <em>The Journal of Steroid Biochemistry and Molecular Biology</em>, <em>108</em>(3–5), 272–280. [DOI:<a href="https://doi.org/10.1016/j.jsbmb.2007.09.001">10.1016/j.jsbmb.2007.09.001</a>]</li><li>Caprio, M., Fève, B., Claës, A., Viengchareun, S., Lombès, M., & Zennaro, M. (2007). Pivotal role of the mineralocorticoid receptor in corticosteroid‐induced adipogenesis. <em>The FASEB Journal</em>, <em>21</em>(9), 2185–2194. [DOI:<a href="https://doi.org/10.1096/fj.06-7970com">10.1096/fj.06-7970com</a>]</li><li>Caprio, M., Antelmi, A., Chetrite, G., Muscat, A., Mammi, C., Marzolla, V., Fabbri, A., Zennaro, M., & Fève, B. (2011). Antiadipogenic Effects of the Mineralocorticoid Receptor Antagonist Drospirenone: Potential Implications for the Treatment of Metabolic Syndrome. <em>Endocrinology</em>, <em>152</em>(1), 113–125. [DOI:<a href="https://doi.org/10.1210/en.2010-0674">10.1210/en.2010-0674</a>]</li><li>Díaz, M., Gallego-Escuredo, J. M., López-Bermejo, A., de Zegher, F., Villarroya, F., & Ibáñez, L. (2018). Low-Dose Spironolactone-Pioglitazone-Metformin Normalizes Circulating Fetuin-A Concentrations in Adolescent Girls with Polycystic Ovary Syndrome. <em>International Journal of Endocrinology</em>, <em>2018</em>, 4192940. [DOI:<a href="https://doi.org/10.1155/2018/4192940">10.1155/2018/4192940</a>]</li><li>Ganie, M. A., Khurana, M. L., Eunice, M., Gulati, M., Dwivedi, S. N., & Ammini, A. C. (2004). Comparison of Efficacy of Spironolactone with Metformin in the Management of Polycystic Ovary Syndrome: An Open-Labeled Study. <em>The Journal of Clinical Endocrinology & Metabolism</em>, <em>89</em>(6), 2756–2762. [DOI:<a href="https://doi.org/10.1210/jc.2003-031780">10.1210/jc.2003-031780</a>]</li><li>Ganie, M. A., Khurana, M. L., Nisar, S., Shah, P. A., Shah, Z. A., Kulshrestha, B., Gupta, N., Zargar, M. A., Wani, T. A., Mudasir, S., Mir, F. A., & Taing, S. (2013). Improved Efficacy of Low-Dose Spironolactone and Metformin Combination Than Either Drug Alone in the Management of Women With Polycystic Ovary Syndrome (PCOS): A Six-Month, Open-Label Randomized Study. <em>The Journal of Clinical Endocrinology & Metabolism</em>, <em>98</em>(9), 3599–3607. [DOI:<a href="https://doi.org/10.1210/jc.2013-1040">10.1210/jc.2013-1040</a>]</li><li>Giordano, A., Frontini, A., & Cinti, S. (2016). Convertible visceral fat as a therapeutic target to curb obesity. <em>Nature Reviews Drug Discovery</em>, <em>15</em>(6), 405–424. [DOI:<a href="https://doi.org/10.1038/nrd.2016.31">10.1038/nrd.2016.31</a>]</li><li>Harmanci, A., Cinar, N., Bayraktar, M., & Yildiz, B. O. (2012). Oral contraceptive plus antiandrogen therapy and cardiometabolic risk in polycystic ovary syndrome. <em>Clinical Endocrinology</em>, <em>78</em>(1), 120–125. [DOI:<a href="https://doi.org/10.1111/j.1365-2265.2012.04466.x">10.1111/j.1365-2265.2012.04466.x</a>]</li><li>Infante, M., Armani, A., Marzolla, V., Fabbri, A., & Caprio, M. (2019). Adipocyte Mineralocorticoid Receptor. In Litwack, G. (Ed.). <em>Aldosterone</em> (<em>Vitamins and Hormones, Volume 109</em>) (pp. 189–209). Amsterdam: Elsevier Academic Press. [DOI:<a href="https://doi.org/10.1016/bs.vh.2018.10.005">10.1016/bs.vh.2018.10.005</a>]</li><li>Karakurt, F., Sahin, I., Güler, S., Demirbas, B., Culha, C., Serter, R., Aral, Y., & Bavbek, N. (2008). Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: A randomised controlled study. <em>Advances in Therapy</em>, <em>25</em>(4), 321–328. [DOI:<a href="https://doi.org/10.1007/s12325-008-0039-5">10.1007/s12325-008-0039-5</a>]</li><li>Karashima, S., Yoneda, T., Kometani, M., Ohe, M., Mori, S., Sawamura, T., Furukawa, K., Seta, T., Yamagishi, M., & Takeda, Y. (2015). Comparison of eplerenone and spironolactone for the treatment of primary aldosteronism. <em>Hypertension Research</em>, <em>39</em>(3), 133–137. [DOI:<a href="https://doi.org/10.1038/hr.2015.129">10.1038/hr.2015.129</a>]</li><li>Leelaphiwat, S., Jongwutiwes, T., Lertvikool, S., Tabcharoen, C., Sukprasert, M., Rattanasiri, S., & Weerakiet, S. (2014). Comparison of desogestrel/ethinyl estradiol plus spironolactone versus cyproterone acetate/ethinyl estradiol in the treatment of polycystic ovary syndrome: A randomized controlled trial. <em>Journal of Obstetrics and Gynaecology Research</em>, <em>41</em>(3), 402–410. [DOI:<a href="https://doi.org/10.1111/jog.12543">10.1111/jog.12543</a>]</li><li>Lovejoy, J. C., Bray, G. A., Bourgeois, M. O., Macchiavelli, R., Rood, J. C., Greeson, C., & Partington, C. (1996). Exogenous androgens influence body composition and regional body fat distribution in obese postmenopausal women–a clinical research center study. <em>The Journal of Clinical Endocrinology & Metabolism</em>, <em>81</em>(6), 2198–2203. [DOI:<a href="https://doi.org/10.1210/jcem.81.6.8964851">10.1210/jcem.81.6.8964851</a>]</li><li>Mammi, C., Marzolla, V., Armani, A., Feraco, A., Antelmi, A., Maslak, E., Chlopicki, S., Cinti, F., Hunt, H., Fabbri, A., & Caprio, M. (2016). A novel combined glucocorticoid-mineralocorticoid receptor selective modulator markedly prevents weight gain and fat mass expansion in mice fed a high-fat diet. <em>International Journal of Obesity</em>, <em>40</em>(6), 964–972. [DOI:<a href="https://doi.org/10.1038/ijo.2016.13">10.1038/ijo.2016.13</a>]</li><li>Meyer, C., McGrath, B. P., & Teede, H. J. (2007). Effects of Medical Therapy on Insulin Resistance and the Cardiovascular System in Polycystic Ovary Syndrome. <em>Diabetes Care</em>, <em>30</em>(3), 471–478. [DOI:<a href="https://doi.org/10.2337/dc06-0618">10.2337/dc06-0618</a>]</li><li>Olatunji, L. A., Adeyanju, O. A., Michael, O. S., Usman, T. O., Tostes, R. C., & Soladoye, A. O. (2019). Ameliorative effect of low-dose spironolactone on obesity and insulin resistance is through replenishment of estrogen in ovariectomized rats. <em>Canadian Journal of Physiology and Pharmacology</em>, <em>97</em>(1), 65–74. [DOI:<a href="https://doi.org/10.1139/cjpp-2018-0416">10.1139/cjpp-2018-0416</a>]</li><li>Vieira, C. S., Martins, W. P., Fernandes, J. B., Soares, G. M., dos Reis, R. M., de Sá, M. F., & Ferriani, R. A. (2012). The effects of 2 mg chlormadinone acetate/30 mcg ethinylestradiol, alone or combined with spironolactone, on cardiovascular risk markers in women with polycystic ovary syndrome. <em>Contraception</em>, <em>86</em>(3), 268–275. [DOI:<a href="https://doi.org/10.1016/j.contraception.2011.12.011">10.1016/j.contraception.2011.12.011</a>]</li><li>Wild, R. A., Demers, L. M., Applebaum-Bowden, D., & Lenker, R. (1991). Hirsutism: Metabolic effects of two commonly used oral contraceptives and spironolactone. <em>Contraception</em>, <em>44</em>(2), 113–124. [DOI:<a href="https://doi.org/10.1016/0010-7824(91)90112-s">10.1016/0010-7824(91)90112-s</a>]</li><li>Zerradi, M., Dereumetz, J., Boulet, M., & Tchernof, A. (2014). Androgens, body fat Distribution and Adipogenesis. <em>Current Obesity Reports</em>, <em>3</em>(4), 396–403. [DOI:<a href="https://doi.org/10.1007/s13679-014-0119-6">10.1007/s13679-014-0119-6</a>]</li></ul></div></div><div id="footer"> <span id="footer-subcontainer"> <span id="site-copyright">© 2024 <span translate="no" class="notranslate">Transfeminine Science</span></span> </span></div></div></body></html> |