Anti-androgen treatments.
1. Estrogen plus progestin contraceptives (EPP) are the first-line treatment of moderate hirsutism and acne in women of child bearing age (grade C). 2. CPA, 50mg/day, 20 days out of 28, associated with estrogen is the first-line treatment of "moderate to severe hirsutism" in women of childbearing age (grade C). 3. Spironolactone, given as a contraceptive, can be proposed as a second-line treatment in case of side effects or counter-indications to CPA in moderate to severe hirsutism (grade C) in women of childbearing age. No market authorization in this indication. 4. Flutamide or Finasteride are "only" to be used under the guise of contraception as a "thirdline therapy" in cases of severe hirsutism, the presence of side effects or counter-indications to EPP, CPA 50mg/day or spironolactone (grade C). No market authorization in this indication 5. There is no indication for GnRH analogs as an anti-androgen treatment in women of childbearing age given the current therapeutic alternatives (grade C) 6. Only long-term hair removal treatments can be proposed (grade C): electrolysis or laser hair removal.
Bachelot
Anne
A
Service d'endocrinologie et médecine de la reproduction, groupe hospitalier Pitié-Salpêtrière, Paris, France. anne.bachelot@psp.ap-hop-paris.fr
Chabbert-Buffet
Nathalie
N
Salenave
Sylvie
S
Kerlan
Véronique
V
Galand-Portier
Marie-Béatrice
MB
D000726:Androgen Antagonists / Q000627:therapeutic use*; D017373:Cyproterone Acetate / Q000627:therapeutic use; D004967:Estrogens / Q000627:therapeutic use; D005260:Female; D018120:Finasteride / Q000627:therapeutic use; D005485:Flutamide / Q000627:therapeutic use; D007987:Gonadotropin-Releasing Hormone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006628:Hirsutism / Q000188:drug therapy; D006801:Humans; D017588:Hyperandrogenism / Q000188:drug therapy*; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D011372:Progestins / Q000627:therapeutic use; D013148:Spironolactone / Q000627:therapeutic use
D000726:Androgen Antagonists; D004967:Estrogens; D000451:Mineralocorticoid Receptor Antagonists; D011372:Progestins; D013148:Spironolactone; D007987:Gonadotropin-Releasing Hormone; D017373:Cyproterone Acetate; D018120:Finasteride; D005485:Flutamide