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ARTICLE |

Treatment of Hirsutism With Spironolactone FREE

David C. Cumming, MD; James C. Yang, MD; Robert W. Rebar, MD; Samuel S. C. Yen, MD
[+] Author Affiliations

Reprint requests to Department of Reproductive Medicine T-002, University of California, San Diego, School of Medicine, La Jolla, CA 92093 (Dr Yen).


JAMA. 1982;247(9):1295-1298. doi:10.1001/jama.1982.03320340049034
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Clinical and endocrine evaluations of 39 patients with hirsutism were performed to determine the effectiveness and site(s) of action of an antiandrogenic compound, spironolactone. Treatment with spironolactone at a dose of 200 mg/day resulted in a clear beneficial effect on the quantity and quality of facial hair growth in 19 of 20 patients with moderate to severe hirsutism. Regression of hirsutism in terms of diameter, density, and the rate of facial hair growth was noticeable within two months. The maximal effect was observed at six months and was maintained at 12 months of treatment. Spironolactone was equally effective in reducing hirsutism in women with polycystic ovary syndrome and idiopathic hirsutism. These clinical observations were associated with a prompt and sustained reduction in levels of androgen of ovarian origin without affecting levels of adrenal androgen and cortisol. Apart from diuresis, which was limited to the first few days of treatment, there were no discernible side effects during the one year of this study. Our results indicate that spironolactone is a highly effective and safe agent for the treatment of hirsutism through its inhibitory action on both ovarian androgen secretion and peripheral androgen action.

(JAMA 1982;247:1295-1298)

REFERENCES

Horton R, Neisler J:  Plasma androgens in patients with polycystic ovarian syndrome . J Clin Endocrinol Metab 1968;;28:479-484.
Bardin CW, Lipsett MB:  Testosterone and androstenedione blood production rates in normal women and women with idiopathic hirsutism or polycystic ovaries . J Clin Invest 1967;; 46:891-897.
Price VH:  Testosterone metabolism in the skin . Arch Dermatol 1975;;111:1496-1502.
Ismail AAA, Davidson DW, Souka AR, et al:  The evaluation of the role of androgens in hirsutism and the use of a new anti-androgen cyproterone acetate for therapy . J Clin Endocrinol Metab 1974;;39:81-95.
Vigersky RA, Mehlman I, Glass AR, et al:  Treatment of hirsute women with cimetidine . N Engl J Med 1980;;303:1042.
Boiselle A, Tremblay R:  New therapeutic approach to the hirsute patient . Fertil Steril 1979;;32:276-279.
Shapiro G, Evron S:  A novel use of spironolactone: Treatment of hirsutism . J Clin Endocrinol Metab 1980;;51:429-432.
Menard RH, Guenther TM, Kon H, et al:  Studies on the destruction of adrenal and testicular cytochrome P450 by spironolactone . J Biol Chem 1979;;254:1726-1733.
Corvol P, Michaud A, Menard J, et al:  Antiandrogenic effect of spironolactones: Mechanism of action . Endocrinology 1975;;97:52-58.
Louvet JP, Harman SM, Schreiber JR, et al:  Evidence for a role of androgen in follicular maturation . Endocrinology 1974;;97:366-372.
Yen SSC:  The polycystic ovary syndrome . Clin Endocrinol 1980;;12:177-208.
Yen SSC, Llerena O, Little B, et al:  Disappearance rates of endogenous luteinizing hormone and chorionic gonadotropin in man . J Clin Endocrinol Metab 1968;;28:1763-1767.
Yen SSC, Vicic WJ:  Serum follicle-stimulating hormone levels in puberty . Am J Obstet Gynecol 1970;;106:134-137.
Ehara Y, Siler T, VandenBerg G, et al:  Circulating prolactin levels during the menstrual cycle: Episodic release and diurnal variation . Am J Obstet Gynecol 1973;;117:962-970.
DeVane GW, Czekala NH, Judd HL, et al:  Circulating gonadotropins, estrogens, and androgens in polycystic ovarian disease . Am J Obstet Gynecol 1975;;121:496-500.
Anderson DC, Hopper BR, Lasley BL, et al:  A simple method for the assay of eight steroids in small volumes of plasma . Steroids 1976;; 28:179-196.
Nisula BD, Dunn JF:  Measurement of testosterone binding parameters for both testosterone estradiol binding globulin and albumin in individual serum samples . Steroids 1979;;34:771-791.
Buster JE, Abraham AE:  Radioimmunoassay of plasma dehydroepiandrosterone sulfate . Anal Lett 1972;;5:543-557.
Casey JH:  Chronic treatment regimens for hirsutism in women: Effect on blood production rates of testosterone and on hair growth . Clin Endocrinol 1975;;4:313-325.
Tamaoki BI:  Steroidogenesis and cell structure: Biochemical pursuit of sites of steroid biosynthesis . J Steroid Biochem 1975;;4:89-118.

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Horton R, Neisler J:  Plasma androgens in patients with polycystic ovarian syndrome . J Clin Endocrinol Metab 1968;;28:479-484.
Bardin CW, Lipsett MB:  Testosterone and androstenedione blood production rates in normal women and women with idiopathic hirsutism or polycystic ovaries . J Clin Invest 1967;; 46:891-897.
Price VH:  Testosterone metabolism in the skin . Arch Dermatol 1975;;111:1496-1502.
Ismail AAA, Davidson DW, Souka AR, et al:  The evaluation of the role of androgens in hirsutism and the use of a new anti-androgen cyproterone acetate for therapy . J Clin Endocrinol Metab 1974;;39:81-95.
Vigersky RA, Mehlman I, Glass AR, et al:  Treatment of hirsute women with cimetidine . N Engl J Med 1980;;303:1042.
Boiselle A, Tremblay R:  New therapeutic approach to the hirsute patient . Fertil Steril 1979;;32:276-279.
Shapiro G, Evron S:  A novel use of spironolactone: Treatment of hirsutism . J Clin Endocrinol Metab 1980;;51:429-432.
Menard RH, Guenther TM, Kon H, et al:  Studies on the destruction of adrenal and testicular cytochrome P450 by spironolactone . J Biol Chem 1979;;254:1726-1733.
Corvol P, Michaud A, Menard J, et al:  Antiandrogenic effect of spironolactones: Mechanism of action . Endocrinology 1975;;97:52-58.
Louvet JP, Harman SM, Schreiber JR, et al:  Evidence for a role of androgen in follicular maturation . Endocrinology 1974;;97:366-372.
Yen SSC:  The polycystic ovary syndrome . Clin Endocrinol 1980;;12:177-208.
Yen SSC, Llerena O, Little B, et al:  Disappearance rates of endogenous luteinizing hormone and chorionic gonadotropin in man . J Clin Endocrinol Metab 1968;;28:1763-1767.
Yen SSC, Vicic WJ:  Serum follicle-stimulating hormone levels in puberty . Am J Obstet Gynecol 1970;;106:134-137.
Ehara Y, Siler T, VandenBerg G, et al:  Circulating prolactin levels during the menstrual cycle: Episodic release and diurnal variation . Am J Obstet Gynecol 1973;;117:962-970.
DeVane GW, Czekala NH, Judd HL, et al:  Circulating gonadotropins, estrogens, and androgens in polycystic ovarian disease . Am J Obstet Gynecol 1975;;121:496-500.
Anderson DC, Hopper BR, Lasley BL, et al:  A simple method for the assay of eight steroids in small volumes of plasma . Steroids 1976;; 28:179-196.
Nisula BD, Dunn JF:  Measurement of testosterone binding parameters for both testosterone estradiol binding globulin and albumin in individual serum samples . Steroids 1979;;34:771-791.
Buster JE, Abraham AE:  Radioimmunoassay of plasma dehydroepiandrosterone sulfate . Anal Lett 1972;;5:543-557.
Casey JH:  Chronic treatment regimens for hirsutism in women: Effect on blood production rates of testosterone and on hair growth . Clin Endocrinol 1975;;4:313-325.
Tamaoki BI:  Steroidogenesis and cell structure: Biochemical pursuit of sites of steroid biosynthesis . J Steroid Biochem 1975;;4:89-118.
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