Hirsutism medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview[edit]

Pharmacologic medical therapies for hirsituism include oral contraceptives, androgen receptor blockers, 5-alpha reductase inhibitors, gonadotrophin-releasing hormone (GnRH agonist), adrenal suppressive glucocorticoids, insulin-sensitising agents, and biological modifiers of hair follicular growth. Treatment options are systemic therapy and topical therapy.

Medical Therapy[edit]

  • Pharmacologic medical therapies for hirsituism include:<ref name="pmid20418968">{{#invoke:Citation/CS1|citation

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Hirsutism[edit]

  • 1. Adult
    • 1.1 Systemic therapy
      • Preferred regimen (1): Ethinyl estradiol 30 μg PLUS norethindrone 1 mg PO daily over a 9-month period<ref name="pmid2136834">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Preferred regimen (2): Mestranol 100 μg PLUS norethindrone 2 mg PO daily for about 2 weeks<ref name="GivensAndersen1974">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Preferred regimen (3): Ethinyl estradiol 30 μg PLUS desogestrel 150 mcg PO daily for 4-7 months<ref name="pmid3156694">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Preferred regimen (4): Spironolactone starting dose of 50 mg PO q12h; may be increased to 200 mg PO daily.<ref name="pmid1826112">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Alternative regimen (1): Cyproterone Acetate 50-100 mg PO daily<ref name="pmid12749435">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

|CitationClass=journal }}</ref>

      • Alternative regimen (3): Finasteride 1-5 mg PO daily<ref name="pmid9854686">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Alternative regimen (4): Flutamide 125-250 mg PO q12h
      • Alternative regimen (5): Bicalutamide 25 mg PO daily<ref name="pmid20218823">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Alternative regimen (6): Metformin 500-1000 mg PO q12h<ref name="pmid21856600">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Alternative regimen (7): Rosiglitazone 4-8 mg PO daily
      • Alternative regimen (8): Pioglitazone 10-30 mg PO daily<ref name="pmid23159176">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

|CitationClass=journal }}</ref>

      • Alternative regimen (10): Prednisone 5-10 mg PO daily<ref name="pmid22064667">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

    • 1.2 Topical Therapy
      • Preferred regimen (1): Eflornithine hydrochloride 13.9% cream topical q12h<ref name="pmid18252793">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

      • Preferred regimen (2): Finasteride 0.25% or 0.5% cream topical daily<ref name="pmid22658123">{{#invoke:Citation/CS1|citation

|CitationClass=journal }}</ref>

Group Medicine Dosage Mechanism of action Side effect Notes
Oral Contraceptive Pills (OCPs) Ethinyl estradiol/
Norethindrone
30 μg /
1.0 mg
Mestranol/norethindrone 100 μg / 2mg
Ethinyl estradiol/
desogestrel
30 μg /
150 mcg
Antiandrogens Spironolactone 100-200 mg
Cyproterone Acetate 50-100 mg

-

Cyproterone Acetate/
ethinyl estradiol
2 mg /
35 μg
Flutamide 125-250 mg
Bicalutamide 25 mg
5-alpha reductase inhibitors Finasteride 1-5 mg

-

Dutasteride 0.5 mg
Gonadotrophin-releasing hormone (GnRH agonist) Leuprolide 7.5 mg
Adrenal suppressive glucocorticoids Prednisone 5-10 mg

-

Insulin-sensitising agents Metformin 500-1000 mg
  • These are best choices for hirsutism along with insulin resistance
  • It is not suggested to prescribe these drugs just for hirsutism
Rosiglitazone 4-8 mg
Pioglitazone 10-30 mg

References[edit]

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