Therapeutic target
Improvement of the symptomatology
Therapy recommendations
The therapeutic recommendations listed here refer only to idiopathic hirsutism.
The type of therapy, whether local or systemic, depends on the severity and the patient’s situation (premenopausal, with or without a desire for children or contraception (birth control pills), or postmenopausal). Systemic endocrine therapies (hormone therapies) are effective against alopecia (hair loss) and acne in addition to hirsutism, which may be desirable. There are no generally binding guidelines for therapy.
If contraception is desired at the same time, a combined hormonal contraceptive with an antiandrogenic progestin is a suitable initial preparation.
If contraception is contraindicated or not desired, antiandrogens (drugs that inhibit the action of male sex hormones) such as spironolactone or finasteride (contraindicated in pregnancy) are an option. If the patient wishes to have children, they reduce free testosterone levels until the onset of gravidity (pregnancy). If the effect is insufficient, a combination of several preparations may be necessary or useful, e.g. estrogens with an antiandrogenic progestogen and the non-steroidal adrogen receptor blocker finasteride or the aldosterone antagonist spironolactone.
See also under “Further therapy“.
The following is an overview of hormone therapy as a function of sexual maturity or perimenopause/menopause and the degree of hirsutism:
- Sexual maturity:
- Hormonal systemic antiandrogenic therapy for mild hirsutism with oral contraceptives (birth control pills; only the estrogen-progestin combinations containing cyproterone acetate are indications for hirsutism therapy) + in combination with local and cosmetic therapy, if necessary.
- Hormonal systemic combined antiandrogenic therapy for moderate or severe hirsutism with oral contraceptives + if necessary in combination with local and cosmetic therapy.
- Hormone-free systemic possibly combined antiandrogenic therapy (non-steroidal antiandrogens: aldosterone antagonist, 5α reductase inhibitors) in mild hirsutism, childbearing or contraindication (contraindications) against ovulation inhibitors.
- Hormone-free systemic possibly combined antiandrogenic therapy (non-steroidal antiandrogens: aldosterone antagonist, 5α reductase inhibitors) in moderate or severe hirsutism, childbearing or contraindication against ovulation inhibitors.
- Perimenopause/Menopause:
- Hormonal systemic antiandrogenic therapy estrogen-progestin preparation + cyproterone acetate) for mild hirsutism with hormones + if necessary in combination with local and cosmetic therapy.
- Hormonal systemic antiandrogenic therapy for moderate or severe hirsutism with hormones + if necessary in combination with local and cosmetic therapy.
- Hormone-free systemic antiandrogenic therapy (non-steroidal antiandrogens: aldosterone antagonist, 5α reductase inhibitor) for mild, moderate or pronounced hirsutism when contraindicated or refused + if necessary in combination with local and cosmetic therapy.
Note
- The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) advises physicians to avoid daily doses above 10 mg of cyproterone if possible (risk of meningioma formation).
Notice.
The success of therapy can be seen only after four to six months!
