Is cyproterone only for women, or can men use it too?

Cyproterone acetate, commonly abbreviated as CPA in medical literature, is a synthetic steroidal compound with powerful antiandrogenic and progestogenic effects.

Although it has been traditionally prescribed more often to women, particularly for conditions like acne, hirsutism, and polycystic ovary syndrome (PCOS), framing it as a gender-exclusive drug is both outdated and misleading. In reality, cyproterone is also used in male patients, but only under specific clinical scenarios and not without controversy.

Understanding what it means for a drug to be "antiandrogenic" is crucial. Antiandrogens are substances that block the biological effects of androgens, which are male sex hormones like testosterone and dihydrotestosterone (DHT). Cyproterone achieves this in two ways. First, it competes with androgens for receptor binding sites in various tissues. Second, it suppresses the release of gonadotropins from the hypothalamus, which in turn lowers the production of testosterone in the testes. The outcome is a notable reduction in circulating testosterone and a decreased androgenic effect at the cellular level.

While public narratives and even some treatment guidelines tend to associate CPA use with women's health issues, the drug has also been clinically employed in men—particularly in the treatment of prostate cancer, certain paraphilic disorders, and within gender-affirming hormone therapy for transgender women. However, its use in male populations remains selective and is shaped by ongoing debates about its safety profile and long-term outcomes. In prostate cancer—a hormonally dependent malignancy—cyproterone has been used to slow tumor progression by suppressing testosterone. An important clinical trial published in European Urology evaluated CPA’s effectiveness compared to another antiandrogen, flutamide. Conducted in 2000, this randomized, double-blind trial included 915 men with advanced prostate cancer and was followed over five years.

The study showed that while cyproterone was effective in suppressing testosterone, patients treated with it had a lower overall survival rate compared to those receiving flutamide. This raised critical concerns about its long-term utility and the trade-offs between hormonal control and mortality risk. In another context, cyproterone has been used in Europe to manage paraphilic disorders—conditions characterized by intense sexual urges toward socially or legally unacceptable targets, such as pedophilia or exhibitionism. A 2010 observational study published in the Journal of Sexual Medicine examined 79 men undergoing CPA therapy for these disorders over a period of 12 months. The results indicated a significant reduction in sexual impulses, based primarily on patient self-reports and clinician assessments. However, the absence of a control group and reliance on subjective reporting limited the study’s scientific rigor. These weaknesses caution against generalizing the results.

The risk profile of cyproterone has drawn increasing attention, especially following a 2020 safety review by the European Medicines Agency (EMA). The review examined cohort data and pharmacovigilance reports over a span of 10 years and found a statistically significant association between high cumulative doses of CPA (more than 25 grams) and the development of meningiomas—a type of benign brain tumor. Based on these findings, the EMA imposed restrictions on the use of high-dose CPA and recommended limiting treatment duration. **While causality was not definitively established, the strength of the correlation led to regulatory action. **

Despite its documented use in male populations, cyproterone acetate has not received approval from the U.S. Food and Drug Administration (FDA) for any indication. The FDA has not provided a detailed public rationale, but it is generally understood that the decision stems from a combination of concerns about safety, limited comparative efficacy, and the availability of alternative therapies with better risk-benefit profiles.

Cyproterone is not a gender-exclusive drug. However, its use should never be generalized or assumed to be safe without extensive medical evaluation.

Its pharmacological action on sex hormones makes it a powerful therapeutic agent but also a compound that demands close monitoring. The evidence shows clear efficacy in very specific male health conditions, but also highlights serious potential risks, especially with prolonged or high-dose use. National regulations vary, reflecting divergent interpretations of the scientific evidence. Thus, any use—regardless of gender—should be guided strictly by scientific criteria and risk assessment, not outdated assumptions about who the drug is "meant for."

User Experiences: Can Men Use Cyproterone?

Some users have experimented with cyproterone alongside other treatments. One user followed an extreme anti-androgen regimen including oral CPA, topical minoxidil, dutasteride, and bicalutamide. Despite this aggressive approach, they still experienced follicle miniaturization, showing the stubborn nature of male-pattern baldness and perhaps the limits of anti-androgens alone in men. Others suggested topical anti-androgens like RU58841 or pyrilutamide as less systemically risky options.

Another member considered using CPA as a short-term strategy to reverse hair loss, followed by finasteride for maintenance. However, concerns about CPA's testosterone-lowering effects and associated health risks—such as liver strain and the well-documented risk of meningioma with long-term use—prompted discussions around alternatives like spironolactone (Reddit).

In contrast, transgender women and nonbinary individuals undergoing hormone therapy have shared largely positive outcomes with CPA, often used in combination with estradiol and minoxidil. These users report meaningful regrowth and reduced shedding as part of broader hormone replacement regimens. However, it's important to note that these individuals typically seek systemic suppression of testosterone for gender-affirming purposes, not merely for hair preservation.

In summary, while CPA is effective at suppressing androgens, its systemic effects—especially testosterone suppression—make it risky or unnecessary for most cisgender men with androgenic alopecia. The community largely agrees that safer, more targeted therapies like finasteride, dutasteride, and topical anti-androgens are better suited for male hair loss management.

References

Loblaw, D. A., Virgo, K. S., Nam, R., Somerfield, M. R., Ben-Josef, E., Mendelson, D. S., ... & Bennett, C. L. (2000). Initial hormonal management of androgen-sensitive metastatic, recurrent, or progressive prostate cancer: 2000 update of an American Society of Clinical Oncology practice guideline. European Urology, 37(3), 306–313. https://pubmed.ncbi.nlm.nih.gov/10765069/

Thibaut, F., & Collet, S. (2010). The role of androgen deprivation therapy in the treatment of paraphilic disorders. Journal of Sexual Medicine, 7(2 Pt 1), 586–593. https://pubmed.ncbi.nlm.nih.gov/19673881/

European Medicines Agency. (2020). EMA restricts use of cyproterone-containing medicines due to meningioma risk. https://www.ema.europa.eu/en/news/ema-restricts-use-cyproterone-containing-medicines-due-meningioma-risk

U.S. Food and Drug Administration. (2023). Drug Approval Reports. https://www.fda.gov/drugs

Reddit. (2022, December 6). Extreme regimen and still miniaturized hairs. AGA is just impossible to beat. Retrieved from https://reddit.com/r/tressless/comments/zeg4vo/extreme_regimen_and_still_miniaturized_hairs_aga/

Reddit. (2025, June 21). Cypro to reverse hairloss + Fin? Retrieved from https://reddit.com/r/tressless/comments/1lgs1tm/cypro_to_reverse_hairloss_fin/

Reddit. (2024, August 27). 5 months of nuking T, 2 months of minoxidil. Retrieved from https://reddit.com/r/tressless/comments/1f2uc8c/5_months_of_nuking_t_2_months_of_minoxidil/

Reddit. (2023, September 16). Hair follicles do die - my “hair” is the proof of that statement. Retrieved from https://reddit.com/r/tressless/comments/16kga1t/hair_follicles_do_die_my_hair_is_the_proof_of/