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Spironolactone for hirsutism

Spironolactone (also known as Aldactone) is arguably the number one hirsutism treatment of choice for dermatologists in the US. Spironolactone has antiandrogenic effects that may enhance treatment of several androgen-excess conditions, particularly severe hirsutism. Some dermatologists suggest that the effects of spironolactone are somewhat inferior to cyproterone acetate (CPA). However, CPA is not available in the US.

Spironolactone has several properties that make it suitable for use in treating hirsutism. It interferes with the production of testosterone and it increases the metabolism of any testosterone that is produced. Spironolactone binds to cell androgen receptors and blocks them from binding to naturally produced androgens. In addition with long term spironolactone use, there is a gradual reduction in 5 alpha reductase activity. It is this enzyme that converts testosterone to the more potent, hair follicle stimulating, dihydrotestosterone.

Treatment protocols may involve continuous spironolactone use at 50mg to 200mg per day or cyclic use. For example 50mg or 100mg twice daily from the 4th to the 22nd day of the menstrual cycle. Numerous treatment protocols involving spironolactone have been used in different studies, but no particular treatment approach has been shown to be significantly superior. Combination therapy with an oral contraceptive pill or dexamethasone appears to have an improved beneficial effect on hirsutism and limits side effects.

Side effects with spironolactone are generally transient. As with all antiandrogens , spironolactone use should be avoided during pregnancy and in women who have a family history of breast cancer, although there is no proven association between spironolactone and breast malignancy.

{{kat note: Visit the source link above for a link to MORE aldactone resources – many of the below references are HOT links at the source page}}

Spironolactone for hirsutism references

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Wong IL, Morris RS, Chang L, Spahn MA, Stanczyk FZ, Lobo RA. A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women. J Clin Endocrinol Metab. 1995 Jan;80(1):233-8.
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