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Hirsutism Medication

  • Author: George T Griffing, MD; Chief Editor: Michel E Rivlin, MD  more...
 
Updated: Jul 14, 2016
 

Medication Summary

The most effective strategy for treating hirsutism is to combine systemic therapy, which has a slow onset of effectiveness, with mechanical depilation (shaving, plucking, waxing, depilatory creams).

Systemic therapies directed at hirsutism can be divided into those that decrease ovarian or adrenal androgen production and those that inhibit androgen action in the skin.

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Oral contraceptives

Class Summary

OCs inhibit ovarian androgen production and are probably the first choice for young women with hirsutism who do not want to become pregnant. OCs are inexpensive, and they promote regular uterine bleeding. OCs can be used in combination with antiandrogens or other agents. They have a significant failure rate in hirsutism for several reasons. Low-dose OCs and progestin-only minipills fail to suppress ovulation in as many as 50% of women. Ovarian function continues at a variable rate, and ovarian androgens continue to be produced. Second, the progestins in OCs are attenuated derivatives of testosterone and have variable degrees of androgenic activity in women. The degree depends on the type of progestin and, more importantly, on individual susceptibility.

Ethinyl Estradiol, drospirenone, and levomefolate (Beyaz)

 

Combination of estrogen and progestin that suppresses ovarian production of androgens.

Ethinyl estradiol and norethindrone (Estrostep Fe)

 

Combination of estrogen and progestin that suppresses ovarian production of androgens.

Ethinyl estradiol and norgestimate (Ortho Tri-Cyclen)

 

Combination of estrogen and progestin that suppresses ovarian production of androgens.

Ethinyl Estradiol and Drospirenone (Yaz)

 

Combination of estrogen and progestin that suppresses ovarian production of androgens.

Norethindrone acetate and ethinyl estradiol (Ortho-Novum, Nortrel, Cyclafem)

 

Combination of estrogen and progestin that suppresses ovarian production of androgens.

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Glucocorticoids

Class Summary

Glucocorticoids are used to inhibit adrenal androgens. These agents have antiinflammatory properties and cause profound and varied metabolic effects. Glucocorticoids suppress ACTH-dependent adrenal androgen synthesis. These agents are used with variable success in women with adrenal hirsutism, CAH, and idiopathic adrenal hyperandrogenism.

Prednisone

 

May inhibit ACTH-dependent androgen synthesis through negative feedback.

Dexamethasone (Baycadron)

 

May inhibit ACTH-dependent androgen synthesis through negative feedback.

Lower doses (eg, 0.25 mg) may prove to be effective with fewer adverse effects.

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Aldosterone Antagonists, Selective

Class Summary

Aldosterone antagonists may block androgen receptors.

Spironolactone (Aldactone)

 

Decreases testosterone production. Can be combined with OCs for added effects.

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5 alpha-reductase inhibitors

Class Summary

These agents are indicated for treatment of benign prostatic hyperplasia and male pattern baldness. An unlabeled use is for the treatment of female hirsutism.

Finasteride (Proscar, Propecia)

 

Specific inhibitor of the intracellular enzyme that converts testosterone into the androgen 5-α -dihydrotestosterone. Efficacy in hirsutism is similar to that of spironolactone. To be used only in postmenopausal women with no chance of becoming pregnant.

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Contributor Information and Disclosures
Author

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Steven R Feldman, MD, PhD Professor, Departments of Dermatology, Pathology and Public Health Sciences, and Molecular Medicine and Translational Science, Wake Forest Baptist Health; Director, Center for Dermatology Research, Director of Industry Relations, Department of Dermatology, Wake Forest University School of Medicine

Steven R Feldman, MD, PhD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, North Carolina Medical Society, Society for Investigative Dermatology

Disclosure: Received honoraria from Amgen for consulting; Received honoraria from Abbvie for consulting; Received honoraria from Galderma for speaking and teaching; Received consulting fee from Lilly for consulting; Received ownership interest from www.DrScore.com for management position; Received ownership interest from Causa Reseasrch for management position; Received grant/research funds from Janssen for consulting; Received honoraria from Pfizer for speaking and teaching; Received consulting fee from No.

Chief Editor

Michel E Rivlin, MD Former Professor, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine

Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, Royal College of Surgeons of Edinburgh, Royal College of Obstetricians and Gynaecologists

Disclosure: Nothing to disclose.

Additional Contributors

Arash Taheri, MD Research Fellow, Center for Dermatology Research, Department of Dermatology, Wake Forest University School of Medicine

Disclosure: Nothing to disclose.

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Idiopathic hirsutism in an elderly woman.
The photograph depicts hirsutism in a young woman with polycystic ovary syndrome. Note the acne lesions and excessive hair on her face and neck.
The photograph depicts familial hirsutism in a Pakistani woman.
Etiologic diagnosis of hirsutism.
 
 
 
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