Table 3. Antiandrogens Used for the Treatment of Hirsutism
Antiandrogens Dosing
CPA
a
50–100 mg/d on menstrual cycle days 5–15 with EE 20–35 mg
on days 5–25
Spironolactone 100–200 mg/d [given in divided doses (twice daily)]
Finasteride 2.5–5 mg/d
Flutamide
b
250–500 mg/d (high dose)
62.5 to ≤250 mg/d (low dose)
a
Not available in the United States; also prescribed as an OC (2 mg CPA + 35 mcg EE).
b
Flutamide not recommended because of hepatotoxicity.
Other Drug Therapies
➤ ES suggests against using insulin-lowering drugs for the sole indication of
treating hirsutism. (2|⊕⊕
)
➤ ES suggests against using gonadotropin-releasing hormone (GnRH) agonists
except in women with severe forms of hyperandrogenemia (such as ovarian
hyperthecosis) who have a suboptimal response to OCs and antiandrogens.
(2|⊕
)
➤ ES suggests against the use of topical antiandrogen therapy for hirsutism.
(2|⊕
)
Direct Hair Removal Methods
➤ For women who choose hair removal therapy, ES suggests photoepilation
for those whose unwanted hair is auburn, brown, or black, and ES suggests
electrolysis for those with white or blonde hair. (2|⊕⊕
)
➤ For women of color who choose photoepilation treatment, ES suggests using
a long-wavelength, long pulse-duration light source such as Nd:YAG or diode
laser delivered with appropriate skin cooling (2|⊕
).
• Clinicians should warn Mediterranean and Middle Eastern women with facial
hirsutism about the increased risk of developing paradoxical hypertrichosis (PH)
with photoepilation therapy. ES suggests topical treatment or electrolysis over
photoepilation with these patients. (2|⊕⊕
)
➤ For women who desire more rapid response to photoepilation, ES suggests
adding eflornithine topical cream during treatment. (2|⊕⊕
)
➤ For women with known hyperandrogenemia who choose hair removal therapy,
ES suggests pharmacologic therapy to minimize hair regrowth. (2|⊕⊕
)