Medication Summary
Usually, pharmacologic treatments for hirsutism are selected based on the underlying cause. Medications (antiandrogens) often are administered simultaneously while cosmetic hair removal techniques are performed. All of these drugs must be administered continuously, because when they are discontinued, androgens revert to their former levels. These medications are absolutely contraindicated for use during pregnancy, because a risk exists of feminization of a male fetus.
Oral contraceptives are often the initial treatment for hirsutism caused by ovarian hyperandrogenism and idiopathic hirsutism. Oral contraceptives also help enhance antihirsutism effects and prevent adverse effects of menstrual irregularity caused by spironolactone and other antiandrogen therapy. Finasteride, a 5-alpha reductase inhibitor approved for use in benign prostatic hypertrophy and in male-pattern alopecia, blocks conversion of testosterone to its more active metabolite, dihydrotestosterone. Currently, finasteride is being evaluated for use in hormonal treatment of acne accompanied by hirsutism. For androgen-excess syndromes, such as PCOS, the following medications are used, often in combination with oral contraceptives.
Antihypertensives
Class Summary
May have properties that improve symptoms of hirsutism.
Spironolactone (Aldactone)
Spironolactone is effective for hormonal acne and hirsutism. It may cause menstrual irregularities (usually metrorrhagia). Normal menses may resume with a reduction of dosage. Do not administer in patients already receiving antihypertensive medications, cardiac drugs, or diuretics. Spironolactone is not recommended in patients with renal insufficiency.
Antiandrogens
Class Summary
Block active androgen production.
Flutamide (Eulexin)
Flutamide is a nonsteroidal antiandrogen that inhibits androgen uptake or binding of androgen to target tissues. It is approved for the treatment of prostate cancer.
Dermatologic agents
Class Summary
May inhibit cell growth and proliferation.
Eflornithine cream (Vaniqa)
Eflornithine cream is a prescription topical cream that acts as a growth inhibitor, not a depilatory. It inhibits ornithine decarboxylase, an enzyme required for hair growth. It reportedly takes up to 2 months to work in approximately 30% of patients.
Glucocorticoids
Class Summary
For classic CAH, systemic corticosteroids are used. Corticosteroids are effective in reducing serum androgen levels, but contradictory reports exist regarding their therapeutic effect on hair growth.
For late-onset CAH and PCOS, oral contraceptives and spironolactone are used. In addition, small doses of dexamethasone may be helpful in reducing androgen production in late-onset CAH; however, changes suggesting Cushing disease may develop in patients receiving long-term corticosteroids.
Dexamethasone (Decadron, Dexasone)
Dexamethasone decreases immune reactions by suppressing the migration of PMN leukocytes and reducing capillary permeability.
Prednisone (Deltasone, Sterapred, Orasone)
Prednisone may decrease immune reactions by reversing increased capillary permeability and suppressing PMN activity.
Antidiabetic agents
Class Summary
Insulin-sensitizing agents appear to improve symptoms of hirsutism.
Metformin (Glucophage)
Patients with a clinical diagnosis of persistent anovulation who wish to become pregnant may benefit from metformin. It is effective in treating hirsutism in women with PCOS. Women with PCOS also often receive oral contraceptives and/or spironolactone. If PCOS primarily is considered to be a metabolic syndrome of insulin resistance, perhaps first-line treatment should be with an insulin-sensitizing agent such as metformin.
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Idiopathic hirsutism in an elderly woman.
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The patient has late-onset congenital adrenal hyperplasia. She has clinical features similar to those found in polycystic ovarian syndrome, including hirsutism, acne, obesity, diabetes, and menstrual irregularities.
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The photograph depicts hirsutism in a young woman with polycystic ovarian syndrome. Note the acne lesions and excessive hair on her face and neck.
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The photograph depicts familial hirsutism in a Pakistani woman.
