Prolonged treatment of hirsutism with flutamide alone in patients affected by polycystic ovary syndrome

Abstract

Hirsutism is a common symptom of women affected by polycystic ovary syndrome (PCOS). The effectiveness of the antiandrogen flutamide alone was studied in 25 patients affected by PCOS with severe hirsutism for a period of 24 months. Seventeen of these patients had not been treated before and eight had had previous but unsatisfactory therapy. Nineteen patients showed a normal body weight (BMI < 25 kg/m2) whereas six were obese (BMI > 35 kg/m2). A chemical and endocrinological evaluation and an assessment of the degree of hirsutism, assigned by Ferriman-Gallwey score (mean 22 +/- 3.038), was performed under baseline conditions. Patients started treatment with flutamide (Eulexin, Schering-Plough, Kenilworth, USA) at the dose of 500 mg daily. A chronobiological assessment of gonadotropin episodic secretion and of gonadotropin response to GnRH challenge (10 micrograms in bolus) was done before and on day 7 of flutamide administration. During treatment, our patients showed a marked and significant reduction of hirsutism starting from a score of 6 and reaching the maximum (9.6 + 2.1) at 24 months of therapy. No relevant hormonal changes or side-effects were observed during therapy. Our data demonstrate that hirsutism in PCOS can rapidly and markedly respond to treatment with flutamide alone without important side-effects even if administered for a long period.

RETRACTED: Comparison of finasteride versus flutamide in the treatment of hirsutism

“…In agreement with our findings, many authors report that flutamide does not significantly modify hormone parameters (29,32), while other studies show a significant decrease in T and DHEAS, favoring the hypothesis that flutamide may reduce androgen synthesis (inhibiting the 17,20 desmolase adrenal activity) or increase androgen catabolism (24,33,34).…”

“…Investigators who used both drugs with the same dosage as ourselves for 6-12 months report that finasteride decreases the Ferriman-Gallwey score from 11% (25) to 63.8% (26) in PCOS and from 10.6% (27) to 63% (28) in idiopathic hirsutism. Findings with flutamide range from 36.4% (29) to 53% (30) in PCOS and from 30.1% (31) to 70.9% (24) in idiopathic hirsutism.…”

Metformin versus flutamide in the treatment of metabolic consequences of non-obese young women with polycystic ovary syndrome: a randomized prospective study

“…Some reports have suggested that flutamide reduces both adrenal and ovarian androgen synthesis [55][56][57] , restores ovulation and ameliorates the metabolic profile of hyperandrogenic women 30,31 , whereas other reports have suggested no substantial effects on circulating androgens, lipids, or insulin sensitivity 32-37 . In our study, flutamide decreased androgen levels, but failed to improve insulin sensitivity in non-obese PCOS women after a short therapy period.…”

Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: A randomised controlled study

“…In contrast to our study, some reports suggest that flutamide works by reducing both adrenal and ovarian androgen synthesis, 5-7 whereas others have documented that flutamide has no substantial effect on circulating androgens, lipids or insulin sensitivity. [8][9][10][11] It is known that combined OCs can reduce circulating androgen levels through the suppression of circulating LH and the stimulation of sex hormonebinding globulin (SHBG) levels. 3 CPA/EE has previously been reported to significantly decrease total and free testosterone, androstenedione, DHEAS, and DHT levels and increase SHBG levels in hyperandrogenic hirsute women.…”

“…5,6 Some reports suggest that flutamide achieves this via a reduction in both adrenal and ovarian androgen synthesis; 5-7 however, others document no substantial effects on circulating androgens, lipids or insulin sensitivity following treatment with flutamide. [8][9][10][11] In terms of dosage the efficacy of low-dose flutamide therapy on hirsutism has been observed to be similar to that of higher daily doses (500-750 mg) used either alone or in combination with an OC. [5][6][7][8] When long-term treatment is anticipated, the use of a low dose reduces both the cost of therapy and the likelihood of side effects.…”