The Effect of Spironolactone on Hirsutism and Female Androgen Metabolism

Abstract

An objective evaluation of the anti-androgen effects of spironolactone was performed in a consecutive series of 12 hirsute patients receiving a daily dose of 150 mg; nine completed the study. Using a computer assisted image analyser, hair diameter on two weekly shavings decreased significantly over a 12 month period in three of the patients, although growth rate and mean diameter did not change in the group as a whole. Plasma testosterone fell significantly to a mean of 53% of basal levels. The mean free testosterone (derived) fell significantly to 64% of basal by the sixth month (P = less than 0.005) and remained significantly depressed the remainder of the study. There was subjective benefit in hair growth and greasiness and a significant reduction in the semi-objective Ferriman-Gallwey index in nine of 10 subjects assessed for at least 9 months. We conclude that although spironolactone was not consistently successful, it may represent effective therapy for a sub group of patients with hirsutism.

Managing hirsutism in gynaecological practice

“…Spironolactone is an aldosterone antagonist used as a potassium‐sparing diuretic but it also has potent peripheral anti‐androgen activity and has been shown to be effective in the treatment of hirsutism 63,64 . It complexes with the intracellular androgen receptor to form a biologically inactive compound and its action is enhanced by its effect on the metabolic clearance of testosterone.…”

The Effect of Drugs on Hair

“…Spironolactone is a potent competitive inhibitor for DHT receptor binding sites and inhibits testosterone biosynthesis (MENARD et al 1974). SHAPIRO and EVRAN (1980) reported therapeutic promise in hirsutism, but subsequent studies have shown that spironolactone alone is much less effective than Hammerstein's regime (DORRINGTON-WARD et al 1985;CHAPMAN et al 1986). One small study of spironolactone in combination with an oral contraceptive (CHAPMAN et al 1985) has demonstrated more encouraging results.…”

Hormone therapy in acne

“…Its use in acne, androgenetic alopecia and hirsutism is established. [49][50][51] It is very effective in recalcitrant acne associated with PCOS. [49] CPA can be used either with OCPs in a combined formulation or as separate preparation, which may be used with OCP or spironolactone When used singly it is administered from day 1 to 10 of the menstrual cycle.…”