Anti-Androgens in Gynecological Practice

In 1988, it was recognized that hirsutism and acne in women, often causing distress, were the result of androgens acting on the skin. These conditions were influenced by both the production of androgens by the ovaries or adrenal glands and the bioavailability of these androgens to peripheral tissues, which was determined by plasma transport proteins and the conversion of testosterone and androstenedione to more potent derivatives. An effective anti-androgen was defined as one that could block the actions of testosterone and DHT at the androgen receptor level in the skin. Cyproterone acetate (CPA) was considered the preferred treatment in the UK due to its strong androgen receptor-blocking capabilities and progestational properties. When CPA was combined with ethinyloestradiol, it not only suppressed ovarian function, reducing androgen production, but also served as an effective contraceptive.