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Hirsutism: Antiandrogen Comparisons
Title:Treatment of hirsutism: comparisons between different antiandrogens with central and peripheral effects
Author: F. Fruzzetti et al.
Address: Pisa Italy
Source: Fertility and Sterility 71: 445-451(March)1999
Summary: Flutamide, a nonsteroidal antiandrogen, finasteride, an inhibitor of 5 a-reductase, and cyproterone acetate (CPA), an antiandrogen with progestational activity were compared as to their clinical and endocrinologic effects in the treatment of hirsutism. The one year study included 42 women in a randomized , open, controlled design. Hirsutism was evaluated using the Ferrimen- Gallwey scale. Endocrine parameters were evaluated every 3 months. All three agents significantly decreased the Ferriman-Gallwey score. CPA plus ethinyl estradiol (n=13) significantly decreased levels of total and free testosterone, androstenedione, dihydrotestosterone, and 3-a-androstanediol glucuronide. Flutamide(n=15) showed no effect on these parameters. Finasteride (n=14) significantly increased total testosterone levels, but reduced dihydrotestosterone, and 3-a-androstanediol glucuronide concentrations. It was concluded that hirsutism was equally decreased by these 3 agents, despite different mechanisms of action.
Comment: Finasteride is gaining strength in the treatment of hirsutism. It has a good safety profile. Unfortunately it is very expensive. Flutamide may cause liver toxicity. CPA is not available in the US. Although the method of action differs, they have not been shown to be clinically superior to spironolactone. With Spironolactone, bleeding may be a problem, if not use with an oral contraceptive. Due to the theoretical risk of feminizing a female fetus, all of these drugs are contraindicated in patients who are trying to become pregnant.