RALES Trial
New England Journal of Medicine (1999)
25mg daily reduced all-cause mortality by 30% in 1,663 severe HFrEF patients.
How it works
Marek's Guided Optimization® Program combines advanced lab testing, a dedicated health coach and medical provider, and a personalized treatment plan, all built around your data.
Resources
The process
1
Start your assessment
Complete your 45-min intake assessment
2
Get your labs drawn
4,000 partnered lab locations nationwide
3
Review with your coach
Screen-by-screen lab review
4
Receive your protocol
Treatment delivered to your door
Why Marek
The only program pairing you with a dedicated health coach and medical provider, built on precision diagnostics, with no subscription required.
Resources
Meet our co-founder
Derek
Co-Founder · MPMD Podcast
"Over time, I found it incredibly difficult to get medical oversight for myself and my family that reflected the latest research, and that was preventative. That's why I started Marek Health."
Excellent on Trustpilot
What we test
Every client's lab panel is hand-selected from 1,000+ available biomarkers, built around their specific goals.
Panel categories
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Treatments
700+ medical provider-prescribed therapies built from your labs. Browse by category or explore the full formulary.
Spironolactone
Oral tablet (100mg)Available in all 50 statesMarketing purposes only. Actual medications, if prescribed, are dispensed by a licensed pharmacy.
heart
SpironolactoneSpironolactone
Aldosterone antagonist and anti-androgenic agent. Cornerstone in heart failure (RALES: 30% mortality reduction), resistant hypertension, and women's health (acne, hirsutism, female-pattern hair loss).
30% mortality reduction in HFrEF (RALES)
Potassium-sparing
Anti-fibrotic cardiac/renal effects
Anti-androgenic benefits for PCOS, acne, hirsutism
No commitment · HSA/FSA eligibleNo commitment · HSA/FSA eligible
How it works
Mechanism of action
Competitively inhibits aldosterone at mineralocorticoid receptors, reducing sodium reabsorption and potassium loss. Also binds androgen receptors (anti-androgenic). MR blockade reduces fibrosis, inflammation, and oxidative stress beyond the kidney.
The baseline panel.
Every Marek client receives this baseline panel before a provider review. Your provider may add additional biomarkers based on your health history, symptoms, and goals, pulling from 1,000+ available markers. See more biomarkers →
Hormone Profile
12 markers
Sex hormones
- Total TestosteroneLC/MS
- Free TestosteroneEquilibrium Dialysis
- Estradiol, Sensitive / UltrasensitiveLC/MS
- Sex Hormone Binding Globulin (SHBG)
- ProgesteroneLC/MSFemale panel
- Prolactin
- Luteinizing Hormone (LH)
- Follicle-Stimulating Hormone (FSH)
- hCG, Total, QuantitativeFemale panel, pre-menopause
Adrenals & neurosteroids
- Cortisol
- DHEA-S
Growth hormone / IGF-1
- Insulin-Like Growth Factor I (IGF-1)
Thyroid Status
3 markers
Thyroid hormones
- Thyroid Stimulating Hormone (TSH)
- Free T4
- Free T3
Heart Health
9 markers
Cardiovascular health
- Total Cholesterol
- HDL Cholesterol
- LDL Cholesterol
- LDL:HDL Ratio
- VLDL Cholesterol
- Triglycerides
- Apolipoprotein-B (ApoB)
- C-Reactive Protein, High Sensitivity (hsCRP)
- Lipoprotein(a) (Lp(a))
Metabolism
3 markers
Insulin sensitivity
- Blood Glucose
- Fasting Insulin
- HbA1c
Organ Function
26 markers
Liver & pancreas
- AST
- ALT
- Bilirubin, Total
- γ-Glutamyl Transferase (GGT)
Kidney function
- BUN
- Creatinine w/ eGFR
Comprehensive Metabolic Panel (CMP)
- Glucose
- Blood Urea Nitrogen (BUN)
- Creatinine
- eGFR
- BUN/Creatinine Ratio
- Sodium
- Potassium
- Chloride
- Carbon Dioxide, Total
- Calcium
- Protein, Total
- Albumin
- Globulin, Total
- Albumin/Globulin (A/G) Ratio
- Alkaline Phosphatase (ALP)
- AST
- ALT
Prostate health
- Prostate-Specific Antigen (PSA)Male panel
- Free PSAMale panel
- % Free PSAMale panel
Nutrient Status
31 markers
Vitamins & minerals
- Vitamin D, 25-OHD (25-Hydroxy)
- Magnesium, RBC
Iron status
- Iron
- Iron Saturation
- TIBC
- UIBC
- Ferritin
Complete Blood Count (CBC)
- White Blood Count (WBC)
- Red Blood Count (RBC)
- Hemoglobin (Hgb)
- Hematocrit (HCT)
- MCV
- MCH
- MCHC
- Red Cell Distribution Width (RDW)
- Platelets
- Neutrophils
- Neutrophils (Absolute)
- Lymphocytes
- Lymphocytes (Absolute)
- Neutrophil/Lymphocyte Ratio
- Monocytes
- Monocytes (Absolute)
- Eosinophils
- Eosinophils (Absolute)
- Basophils
- Basophils (Absolute)
- Immature Cells
- Immature Granulocytes
- Immature Granulocytes (Absolute)
- NRBC, w/ Reflex for Immature Cells
Clinical evidence
The research behind Spironolactone.
Safety profile
Monitoring & safety information.
Commonly reported side effects
- Hyperkalemia
- Gynecomastia/breast tenderness (men)
- Menstrual irregularities
- Nausea
- Decreased libido
Less common but serious risks
- Severe hyperkalemia (life-threatening arrhythmia)
- Acute kidney injury
Generally not appropriate for
- Serum K+ >5.0
- eGFR <30
- Addison's disease
- Concurrent eplerenone
Typical monitoring
- Serum potassium and sodium (baseline, 1 week, 4 weeks, then 1 to 3 months)
- Renal function
- Blood pressure
- Gynecomastia/breast symptoms (men)
FAQ
Quick answers.
Aldosterone antagonist and anti-androgenic agent. Cornerstone in heart failure (RALES: 30% mortality reduction), resistant hypertension, and women's health (acne, hirsutism, female-pattern hair loss).
30% mortality reduction in HFrEF (RALES). Potassium-sparing. Anti-fibrotic cardiac/renal effects. Anti-androgenic benefits for PCOS, acne, hirsutism.
Common side effects include: hyperkalemia, gynecomastia/breast tenderness (men), menstrual irregularities, nausea, decreased libido. Most side effects are dose-dependent and may resolve with continued use or dose adjustment.
Aldosterone antagonist and anti-androgenic agent. Cornerstone in heart failure (RALES: 30% mortality reduction), resistant hypertension, and women's health (acne, hirsutism, female-pattern hair loss).
Treatments are dependent on licensed clinical prescription. Client costs vary based on individual labs and panel in treatments and services.