Interventions for Hirsutism Excluding Laser and Photoepilation Therapy Alone: Abridged Cochrane Systematic Review Including GRADE Assessments

The document reviewed the effectiveness of various interventions for hirsutism, excluding laser and light-based therapies. It included 157 randomized controlled trials (RCTs) with 10,550 participants, most of which were deemed to have a 'high risk' of bias. The quality of evidence was generally moderate to very low. Oral contraceptives (OCPs) containing ethinyl oestradiol and cyproterone acetate were compared with OCPs containing ethinyl oestradiol and desogestrel, showing both to be effective without a significant difference between them. Flutamide and spironolactone were more effective than placebo, with spironolactone being as effective as flutamide and finasteride in some studies. However, finasteride and gonadotropin-releasing analogues had inconsistent results across RCTs. Metformin was found to be ineffective, while cyproterone acetate combined with OCPs showed greater reductions in Ferriman–Gallwey scores. Lifestyle interventions only reduced body mass index without improving hirsutism. No RCTs for cosmetic treatments were found. The document suggests that further RCTs are needed to investigate combinations of OCPs with antiandrogens or finasteride, as well as different antiandrogens and 5α-reductase inhibitors.