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.
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.
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.
Aldosterone Antagonists, Selective
Class Summary
Aldosterone antagonists may block androgen receptors.
Spironolactone (Aldactone)
Decreases testosterone production. Can be combined with OCs for added effects.
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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Idiopathic hirsutism in an elderly woman.
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The photograph depicts hirsutism in a young woman with polycystic ovary 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.
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Etiologic diagnosis of hirsutism.
