Clinical-Pharmacological Investigation of Cyproterone Acetate

Abstract

(1) The antiandrogenic steroid cyproterone acetate exerted a strongly negative nitrogen balance in 8 young male volunteers, the degree of which correlated with the dose administered. In a male patient of 77 years with cancer of the prostate, this catabolic effect proved to be much weaker. In 8 female patients with hirsutism, administration of cyproterone acetate resulted only then in a negative nitrogen balance when the food was deficient in calories and protein. Continuous treatment with cyproterone acetate in female patients is not feasible because of strongly progestational side-effects. These side effects can be avoided by combining cyproterone acetate with ethinyl estradiol as an ‘inverted sequential scheme’, according to Hammerstein and Cupceancy [2]. In most female patients with hirsutism, good or satisfactory results can be obtained by a continuous cyproterone acetate therapy or by the combination treatment of Hammerstein and CUPCEANCY [2].

Diagnosis and management of hirsutism

“…Only in those hirsute patients in whom oral estrogens are contraindicated I favor the use of finasteride over other antiandrogens, and only after ensuring safe nonhormonal contraception to avoid fetal male pseudohermaphroditism in case of unadverted pregnancy. The efficacy of finasteride is similar to that of cyproterone acetate, spironolactone, and flutamide 29,30 but lacks the menstrual disturbances associated with cyproterone acetate and spironolactone when used as single agents, 31,32 and the potential for severe hepatotoxicity of flutamide. 33 Treatment has to be monitored at least annually, and must always consider additional measures related to the etiology of hirsutism such as diet and life-style recommendations in women with PCOS or mineralo and/or glucocorticoids in women with classic congenital adrenal hyperplasia, and very especially quitting smoking must be eagerly advised because this habit worsens the undesirable effects of almost all the drugs available for hirsutism and related conditions.…”

“…Only in those hirsute patients in whom oral estrogens are contraindicated I favor the use of finasteride over other antiandrogens, and only after ensuring safe nonhormonal contraception to avoid fetal male pseudohermaphroditism in case of unadverted pregnancy. The efficacy of finasteride is similar to that of cyproterone acetate, spironolactone, and flutamide 29,30 but lacks the menstrual disturbances associated with cyproterone acetate and spironolactone when used as single agents, 31,32 and the potential for severe hepatotoxicity of flutamide 33 …”