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Hirsutism

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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|⊕⊕ )

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