Androgen excess: Investigations and management
November 2016
in “Best Practice & Research in Clinical Obstetrics & Gynaecology”
TLDR The conclusion is that managing androgen excess requires long-term treatment, including hormonal contraceptives and androgen blockers, with follow-up after six months.
The document from 2016 provides an overview of the evaluation and management of androgen excess (AE), a condition often associated with polycystic ovary syndrome (PCOS) that can lead to hirsutism, acne, and female pattern hair loss (FPHL). It emphasizes the importance of using the modified Ferriman-Gallwey method to score hair growth and the need for high-quality assays to measure biochemical hyperandrogenism, including total and free testosterone levels. Management strategies include hormonal contraceptives and androgen blockade, with treatments varying in response time—acne often improves quickly, hirsutism takes 6 to 8 months, and FPHL may take 12 to 18 months to respond. The document also discusses various treatments for hirsutism, such as hormonal contraceptive combinations, antiandrogens, insulin sensitizers, and cosmetic approaches, noting that combined treatments are often more effective than monotherapy. For acne and FPHL, it mentions the effectiveness of hormonal contraceptives with antiandrogenic progestins, topical agents, and 2% topical minoxidil, respectively. Laser therapy and intense pulsed light (IPL) are highlighted as effective hair removal techniques. The document underscores that medical therapies for AE are often lifelong, with follow-up recommended at least six months after initiating treatment.
View this study on doi.org →
Cited in this study
research A Review of Medical and Surgical Treatment Options for Androgenetic Alopecia
Use finasteride, minoxidil, and follicular unit transplantation for hair loss treatment.
research THERAPY OF ENDOCRINE DISEASE: Treatment of hirsutism in the polycystic ovary syndrome
Effective hirsutism treatment for women with PCOS should be personalized and may include lifestyle changes and medication.
research Diagnosis and Treatment of Polycystic Ovary Syndrome: An Endocrine Society Clinical Practice Guideline
The guideline suggests using specific criteria to diagnose PCOS, recommends various treatments for its symptoms, and advises screening for related health issues.
research Hirsutism – From Diagnosis to Use of Antiandrogens
Antiandrogens are the main treatment for hirsutism, with individualized care and safe, affordable options needed.
research A randomized, single-blind trial of 5% minoxidil foam once daily versus 2% minoxidil solution twice daily in the treatment of androgenetic alopecia in women
5% minoxidil foam once daily works as well as 2% minoxidil solution twice daily for female hair growth and is more convenient.
research Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society
Experts recommend using evidence-based methods to diagnose and treat hirsutism, focusing on symptoms and underlying causes.
research Evidence-based (S3) guideline for the treatment of androgenetic alopecia in women and in men
Use minoxidil for hair loss; finasteride and dutasteride for men, dutasteride for women.
research Defining hirsutism in Chinese women: a cross-sectional study
An mFG score of 5 or more indicates above-normal hair growth in Southern Chinese women.
research Visually scoring hirsutism
research The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report
The report concludes that PCOS is mainly a condition of excess male hormones and its definition may change as new information is discovered.
research Insulin Sensitizers for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials
Insulin sensitizers may slightly reduce hirsutism but are less effective than other treatments.
research Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials
Antiandrogens are somewhat effective in reducing excessive hair growth in women.
research Effects of two estroprogestins containing ethynilestradiol 30mug and drospirenone 3 mg and ethynilestradiol 30mug and chlormadinone 2 mg on skin and hormonal hyperandrogenic manifestations
Both birth control pills improved hormone levels and skin conditions in women with hyperandrogenism, but the one with drospirenone was more effective.
research A systematic review of commonly used medical treatments for hirsutism in women
Certain medications including flutamide, spironolactone, and others effectively reduce excessive hair growth in women, especially when combined with lifestyle changes.
research Low sex hormone-binding globulin is associated with low high-density lipoprotein cholesterol and metabolic syndrome in women with PCOS
Women with PCOS who have low SHBG are more likely to have low good cholesterol and metabolic syndrome.
research Relative Prevalence of Different Androgen Excess Disorders in 950 Women Referred because of Clinical Hyperandrogenism
Most women referred for excess male hormone symptoms had polycystic ovary syndrome (PCOS), with other conditions being less common.
research Hirsutism and the Variable Response of the Pilosebaceous Unit to Androgen
Different women's hair and skin glands respond to hormones in varied ways, which can cause unwanted hair growth even with normal hormone levels, and more research is needed to treat this effectively.
research Evaluation and treatment of male and female pattern hair loss
Early diagnosis and treatment, using finasteride, minoxidil, or hair transplantation, improves hair loss outcomes.
research A comparison between spironolactone and spironolactone plus finasteride in the treatment of hirsutism
Spironolactone plus finasteride reduces hirsutism more effectively.
research Androgen Excess in Women: Experience with Over 1000 Consecutive Patients
Most women with excess male hormones have Polycystic Ovary Syndrome, and hormonal therapy can improve symptoms but may cause side effects.
research Prevalence of polycystic ovaries in women with androgenic alopecia
Women with androgenic alopecia are more likely to have polycystic ovaries and higher androgen levels, which may indicate PCOS.
research Current and novel methods for assessing efficacy of hair growth promoters in pattern hair loss
New methods improve how we test hair growth treatments, but challenges like slow hair changes and high costs remain.
research Effects of minoxidil 2% vs. cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial
Minoxidil works better for female hair loss, but cyproterone reduces scalp oiliness and causes menstrual issues.
research Urinary steroids in women with androgenic alopecia
Women with hair loss had higher levels of certain hormones, suggesting a link to a condition like PCOS.
research Relapse of hirsutism following long‐term successful treatment with oestrogen–progestogen combination
Most patients experienced hirsutism again after stopping hormone treatment, indicating long-term treatment is needed to maintain results.
research Treatment of hirsutism: comparisons between different antiandrogens with central and peripheral effects
Finasteride, CPA, and flutamide are all equally effective in reducing excessive hair growth in women.
research Comparison of cyproterone acetate plus ethinyl estradiol and finasteride in the treatment of hirsutism
Cyproterone acetate plus ethinyl estradiol is generally more effective in treating hirsutism, but consider side effects and patient characteristics.
research Comparison of finasteride versus spironolactone in the treatment of idiopathic hirsutism
Finasteride reduces hair growth better, but spironolactone has more side effects.
research Electrolysis: Observations from 13 years and 140,000 hours of experience
Electrolysis is effective for permanent hair removal, but technique is key to avoid scarring, and sometimes hormonal treatment is needed for women with hirsutism.
research The Role of Oral Contraceptives in the Treatment of Hyperandrogenic Disorders
Oral contraceptives help treat hyperandrogenic disorders, improving symptoms like excessive hair and acne.
research Androgens and human hair growth
research The hyperandrogenic-insulin-resistant acanthosis nigricans syndrome: therapeutic response
Most patients improved with oral contraceptives, but some needed additional treatment.
research Patterned androgenic alopecia in women
"Male-pattern" hair loss is common in women, especially after menopause, and doesn't always mean there's a problem with hormone balance.
research 9 Pilosebaceous physiology in relation to hirsutism and acne
Male hormones are important for hair and oil gland development and can cause conditions like excessive hair growth and acne.
research Classification of the types of androgenetic alopecia (common baldness) occurring in the female sex
Common baldness, also known as Androgenetic Alopecia, is caused by a combination of genetic factors and hormones called androgens.
Related
research Managing the PCOS-Related Symptoms of Hirsutism, Acne, and Hair Loss
Birth control pills and anti-androgen medications help manage hair growth, acne, and hair loss in women with PCOS.
research Polycystic ovary syndrome and acne.
Women with PCOS often have acne because of high androgen levels, and the article reviewed how to treat this type of acne.
research Ovarian morphology and prevalence of polycystic ovary syndrome in reproductive aged women with or without mild acne
Women with mild acne are more likely to have polycystic ovary syndrome (PCOS) than those without acne.
research ANTIANDROGEN TREATMENT OF POLYCYSTIC OVARY SYNDROME
Antiandrogen treatments combined with oral contraceptives can help manage hair growth and hair loss in women with PCOS.