Anti-Androgen Treatments for Hirsutism and Acne in Women of Childbearing Age

The document outlines the recommended treatments for moderate to severe hirsutism and acne in women of childbearing age. Estrogen plus progestin contraceptives (EPP) are suggested as the first-line treatment for moderate hirsutism and acne. For moderate to severe hirsutism, cyproterone acetate (CPA) at a dose of 50mg/day for 20 days out of 28, combined with estrogen, is recommended as the first-line treatment. Spironolactone is considered a second-line treatment in cases where CPA is not suitable due to side effects or contraindications. Flutamide or Finasteride are reserved as third-line therapies for severe hirsutism when other treatments are not appropriate, but they require concurrent contraception due to lack of market authorization for this indication. Gonadotropin-releasing hormone (GnRH) analogs are not recommended given the availability of other treatments. For long-term hair removal, only electrolysis or laser hair removal are advised. All these recommendations are graded as level C, indicating a lower level of evidence or expert consensus.