Effects of cyproterone acetate, finasteride, and spironolactone in patients with idiopatic hirsutism. Short- and long-term results

Hirsute women (Ferriman-Gallwey score > 6), with both normal ovulatory function (history of regular menstrual cycles and progesterone levels > 13 nmol/L in luteal phase) and normal circulating androgen levels, were defined as having idiopatic hirsutism (IH). Hirsutism affects between 5-10% of female patients, but according to the above definition only 5-15% of hirsute women may have IH. The aim of this study was to evaluate the effects of 12-months cyproterone acetate (25 mg/day for the first 10 days of the cycle), finasteride (5 mg/day), and spironolactone (100 mg/day) administration in patients with IH who received in addition an oral monophasic contraceptive (ethiniyl estradiol 0.03 mg + gestodene 0.075 mg, or ethinyl estradiol 0.05 mg + L-norgestrel 0.5 mg, 21 days/month). Thirty-three women (mean age 23.64±5.30 years, range 17-34 years) with an overall Ferriman-Gallwey (FG) score of 11.39±1.37 (range 8-14) were studied. The analysis of variance showed a significant correlation between age and FG score (r=0.059213, F=165.58, p=0.00). Patients were divided into three groups, according to the different treatment they were to receive: Group A (cyproterone acetate), 12 (36.4%) patients, Group B (finasteride), 12 (36.4%) patients, and Group C (spironolactone), 9 (27.2%) patients. Free testosterone (FT), dehydroepiandrosterone sulphate (DHEAS), androstenedione (AD), and 17-OH-progesterone (17OHP) serum levels were recorded before treatment, 6 and 12 months later, and 6 months after it was suspended. Basal FG scores were 11.17±1.27 (Group A), 12.08±1.08 (Group B), and 10.78±1.56 (Group C). Mean age, basal FG score, and basal hormonal data did not differ (p=NS) among the three groups. Six months from the beginning of the therapy FG score decreased (p<0.05) in all patients: Group A=7.17±1.27 (55.8%), Group B=8.08±1.08 (49.5%), Group C=7.89±0.93 (36.6%). In Groups A and B the clinical improvement was significantly (p<0.05) higher. A further slight (p=NS) decrease of 5.0%, 8.9%, and 14.4% in Groups A, B, and C, respectively, was observed 6 months later, when the treatment was suspended. Final FG scores were similar (p=NS) in all patients: Group A=6.83±0.99 (63.5%), Group B=7.42±1.38 (62.8%), and Group C=6.89±1.54 (56.5%). FT, DHEAS, AD, and 17OHP mean serum levels did not change significantly (p=NS) during the treatment. No adverse reactions or particular side effects were observed, and in general the patient tolerance was good. Six months from the end of the therapy the FG score was 7.92±1.08, 9.08±0.99, and 7.67±1.41 in Groups A, B, and C, respectively, and its increase was significantly (p<0.05) higher in Groups A and B. In conclusion, in patients with IH the short-term effects of finasteride, cyproterone acetate and spironolactone are similar. Following the suspension of therapy clinical improvement may remain for a long time in patients who undergo spironolactone therapy.