A comparison between finasteride, flutamide, and finasteride plus flutamide combination in the treatment of hirsutism

Abstract

To investigate the clinical efficacy and safety of the finasteride (5 mg/day) plus flutamide (125 mg/day) combination therapy in unselected women with hirsutism, 44 women were involved in the study. The effects of such combination treatment have not been reported previously. The patients were assigned to 3 treatment groups: 14 patients (group 1) were treated with finasteride (5 mg per day), 16 patients (group 2) were treated with flutamide (125 mg per day), and 14 patients (group 3) were treated with finasteride (5 mg per day) plus flutamide (125 mg per day) for 12 months. Serum FSH, LH, estradiol, total testosterone, free testosterone, androstenedione, DHEAS, and SHBG were obtained. Hirsutism score was measured before and after treatment. Blood chemistry and side effects were evaluated during the study. The reductions in hirsutism score (% of the baseline) at 6 months were as follows: 24% for group 1, 35% for group 2, and 33% for group 3. Combination therapy resulted in (49%) similar improvement to flutamide alone (45%), but significantly (p<0.05) more efficacious improvement in hirsutism when compared to finasteride (32%) after 12 months of treatment. In conclusion, flutamide is more effective than finasteride and the combination of these two drugs is not better than flutamide alone, but better than finasteride in hirsute women.

The efficacy and use of finasteride in women: a systematic review

“…Many RCTs compared treatment with finasteride (5 mg/day) to other drugs . Finasteride reduced the FG score and hair diameter more than flutamide (250 mg twice/day) after 6 months of therapy, but flutamide was more effective at 12 months .…”

“…While some studies demonstrated comparable effects between finasteride and flutamide (250–500 mg/day), others showed finasteride to be less effective . The combination therapy of finasteride with flutamide was most efficacious compared to either monotherapy . RCTs showed no significant difference between finasteride and spironolactone (100 mg/day) reductions in hirsutism scores after 6 months, but spironolactone was more effective after 9–12 months .…”

The role of androgen and androgen receptor in skin-related disorders

“…This is most likely due to the ability of finasteride to block the conversion of testosterone to the much more potent DHT [80]. However, in another study, flutamide was shown more effective than finasteride in treating hirsute women [106]. The efficacy of finasteride as compared to flutamide needs further verification.…”

Hirsutism: Diagnosis and Treatment

“…Other trials suggested that spironolactone and flutamide were more effective than finasteride [27,28]. In women with hirsutism, finasteride is used in doses of 2.5-7.5 mg/d.…”