Comparison of Sequential Cyproterone Acetate/Estrogen Versus Spironolactone/Oral Contraceptive in the Treatment of Hirsutism
TLDR Both cyproterone acetate and spironolactone effectively reduce hair growth in women with hirsutism.
In a study from 1991, 48 hirsute women were randomized to receive either 100 mg/day of cyproterone acetate (CPA) or spironolactone for 6 months, with 26 completing the CPA treatment and 19 completing the spironolactone treatment. Both treatments were accompanied by estrogen therapy for most subjects. The study found that both drugs significantly reduced total hair diameter (CPA by 16.8%, spironolactone by 17.1%) and the diameter of the hair medulla (CPA by 31.7%, spironolactone by 17.8%), with no significant difference between the two drugs. Plasma testosterone levels decreased significantly with both treatments. Subjects also reported a decrease in the frequency of cosmetic measures taken, by 38% with spironolactone and 44.7% with CPA. Side effects led to discontinuation in three subjects, and mild side effects were reported by four others. The conclusion was that both CPA and spironolactone are effective and well-tolerated treatments for hirsutism, with no clear advantage of one drug over the other.
