Cyproterone acetate for hirsutism

Area of Science:

• Endocrinology
• Pharmacology

Background:

• Hirsutism, a common endocrine issue causing excessive hair growth in women, is often managed with cyproterone acetate (CPA) and ethinylestradiol.
• This review is an update of previous research on CPA for hirsutism, first published in 2003.

Purpose of the Study:

• To evaluate the benefits and harms of cyproterone acetate (CPA), alone or with ethinylestradiol, for treating hirsutism.
• To compare CPA's effectiveness against other medications in reducing hair growth and improving endocrine profiles in women with hirsutism.

Main Methods:

• Conducted a systematic search of multiple databases for randomized controlled trials (RCTs) up to December 2022.
• Included RCTs involving women of reproductive age with idiopathic hirsutism or hirsutism secondary to ovarian hyperandrogenism (Ferriman Gallwey score > 7).
• Analyzed primary outcomes such as clinical parameters (FG scores, hair growth) and secondary outcomes including endocrine markers and side effects.

Main Results:

• Limited differences were found in hirsutism scores (FG) and free testosterone levels when comparing different doses of CPA with ethinylestradiol.
• Cyproterone acetate (CPA) plus ethinylestradiol showed comparable efficacy to finasteride, spironolactone, and ketoconazole in reducing hirsutism, with some evidence suggesting slight advantages over flutamide.
• Evidence suggests CPA plus ethinylestradiol may offer little to no difference in efficacy compared to finasteride or spironolactone when combined with ethinylestradiol, though some comparisons showed uncertainty.

Conclusions:

• While some differences in clinical outcomes were observed between CPA and specific agents like spironolactone and finasteride, overall clinical differences were not significant across many comparisons.
• Small study sizes and inconsistent assessment methods limit definitive conclusions on the comparative efficacy and safety of various hirsutism treatments.
• Larger, well-designed studies are necessary to thoroughly compare the efficacy and safety profiles of available therapeutic options for hirsutism.