Cyproterone Acetate for Hirsutism

November 2025 in “ Cochrane Database of Systematic Reviews ”

Mushi J Matjila, Paul Andre Le Roux, Zephne M. van der Spuy

cyproterone acetate hirsutism spironolactone flutamide finasteride

From the encyclopedia

Cyproterone →

a synthetic anti-androgen and weak progestogen that inhibits DHT binding to androgen receptor

Spironolactone →

powerful topical and oral anti-androgen used mostly by women

Finasteride →

Frontline, gold standard treatment for combatting androgenic alopecia

Studysummary This study observed some differences in clinical outcomes when comparing CPA with spironolactone, flutamide, and finasteride, but no differences with other therapies, possibly due to small study size and non-standardized assessments; adverse effects could not be fully compared across treatments.

Our plain-language summary. Not medical advice or a treatment recommendation. Consult a qualified healthcare professional before changing treatment. Full disclaimer

This updated Cochrane review assessed the effectiveness and safety of cyproterone acetate (CPA), alone or with ethinylestradiol, in treating hirsutism in women. The review included 23 studies with 1,557 women, but most studies were small, limiting the strength of the conclusions. CPA, especially when combined with ethinylestradiol, showed no significant difference in reducing hair growth or hormone levels compared to other treatments like spironolactone, finasteride, and flutamide. However, CPA was likely more effective than spironolactone at 6 months and finasteride at 24 months. The evidence was insufficient to compare adverse effects across treatments, highlighting the need for larger, well-designed studies. The current evidence suggests CPA or spironolactone, ideally combined with ethinylestradiol, as effective treatments for unwanted hair growth.

View this study on cochranelibrary.com →

Discuss this study in the Community →

Research cited in this study

40 / 40 results

Recommendations From The 2023 International Evidence-Based Guideline For The Assessment And Management Of Polycystic Ovary Syndrome

research Recommendations From The 2023 International Evidence-Based Guideline For The Assessment And Management Of Polycystic Ovary Syndrome

2 citations , August 2023 in “Human Reproduction”

This update of the 2023 International Guideline for PCOS offers refined diagnostic criteria and management recommendations, emphasizing evidence-based care, but notes that research quality remains low to moderate.

The Efficacy of Oral Isotretinoin Versus Cyproterone Compound in Female Patients With Acne and the Triad of Cutaneous Hyperandrogenism: A Randomized Clinical Trial

research The Efficacy of Oral Isotretinoin Versus Cyproterone Compound in Female Patients With Acne and the Triad of Cutaneous Hyperandrogenism: A Randomized Clinical Trial

2 citations , January 2014 in “Advanced Biomedical Research”

This article describes SAHA syndrome, which includes symptoms of nodulocystic or severe acne, female pattern hair loss, and hirsutism, but reports no new results.

research An Approach to the Patient with Hirsutism

49 citations , September 2012 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This review discusses the physiology of hair growth, common abnormal patterns of hirsutism, and examines differential diagnoses and treatment options, but provides no new clinical findings.

research The Investigation and Management of Hirsutism

26 citations , July 2012 in “Journal of family planning and reproductive health care”

This review explores treatment approaches for excess male-pattern body hair in women and emphasizes the importance of effective management, but reports no new clinical findings.

Epidemiology, Diagnosis, and Management of Hirsutism: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome Society

research Epidemiology, Diagnosis, and Management of Hirsutism: A Consensus Statement by the Androgen Excess and Polycystic Ovary Syndrome Society

378 citations , November 2011 in “Human reproduction update”

This review discusses the epidemiology, causes, diagnosis, and management of hirsutism in women, noting that effective treatment requires addressing the root cause as well as the hair growth.

Polycystic Ovary Syndrome: A Complex Condition with Psychological, Reproductive, and Metabolic Manifestations That Impacts Health Across the Lifespan

research Polycystic Ovary Syndrome: A Complex Condition with Psychological, Reproductive, and Metabolic Manifestations That Impacts Health Across the Lifespan

926 citations , June 2010 in “BMC Medicine”

This review emphasizes the need for comprehensive guidelines to address the cardiometabolic and psychological features of polycystic ovary syndrome, alongside its reproductive aspects, and reports no new results.

research Parenteral and Oral Cyproterone Acetate Treatment in Severe Hirsutism

5 citations , March 2010 in “Gynecologic and obstetric investigation”

This study found that parenteral administration of cyproterone acetate was more effective than high-dose oral treatment in reducing facial hair diameter and improving dermatological parameters in patients with severe hirsutism, despite similar androgen suppression.

research An Open Randomized Comparative Study of an Oral Contraceptive Containing Ethinyl Estradiol and Cyproterone Acetate with and without the GnRH Analogue Goserelin in the Long-Term Treatment of Hirsutism

18 citations , March 2010 in “Gynecologic and obstetric investigation”

This study found that both combined therapy with goserelin and oral contraceptives, and oral contraceptives alone, significantly reduced hair diameter in severe hirsutism without a significant difference between treatments.

research Spironolactone Versus Placebo or in Combination with Steroids for Hirsutism and/or Acne

112 citations , April 2009 in “Cochrane library”

This review found some evidence suggesting that spironolactone can effectively reduce hirsutism in women but did not support its use for treating acne vulgaris.

research Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Meta-Analyses of Randomized Controlled Trials

150 citations , February 2008 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study suggests that antiandrogens may slightly reduce hirsutism severity compared to placebo, but evidence is weak and their relative efficacy remains uncertain.

research A Systematic Review of Commonly Used Medical Treatments for Hirsutism in Women

75 citations , November 2007 in “Clinical endocrinology”

This study found that several drugs, including flutamide and spironolactone, significantly reduced hirsutism in women, with reduced effectiveness in those with higher BMI.

Current Recommendations for the Diagnostic Evaluation and Follow-Up of Patients Presenting with Symptomatic Polycystic Ovary Syndrome

research Current Recommendations for the Diagnostic Evaluation and Follow-Up of Patients Presenting with Symptomatic Polycystic Ovary Syndrome

19 citations , October 2004 in “Best Practice & Research in Clinical Obstetrics & Gynaecology”

This review discusses the complexities in diagnosing polycystic ovary syndrome and emphasizes the need for individualized assessment based on each patient's specific symptoms and history, but reports no new results.

research Finasteride Versus Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism

39 citations , August 2004 in “International journal of gynaecology and obstetrics”

This study found that both finasteride and a regimen of cyproterone acetate plus ethinyl estradiol effectively reduced hirsutism in women, with similar results despite differing hormonal effects.

research Revised 2003 Consensus on Diagnostic Criteria and Long-Term Health Risks Related to Polycystic Ovary Syndrome (PCOS)

4025 citations , December 2003 in “Human Reproduction”

This review discusses the evolution of diagnostic criteria for polycystic ovary syndrome and emphasizes its association with various metabolic and cardiovascular risks, but it provides no new research findings.

research Cyproterone Acetate for Hirsutism

78 citations , October 2003 in “Cochrane library”

This review found that adding cyproterone acetate to estradiol showed a subjective improvement in hirsutism versus placebo, but comparisons with other therapies revealed no clinical differences.

research Metformin or Antiandrogen in the Treatment of Hirsutism in Polycystic Ovary Syndrome

192 citations , September 2003 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study suggests that metformin may be more effective than Dianette in treating moderate to severe hirsutism in women with PCOS, while also reducing markers of insulin resistance.

research Use of Cyproterone Acetate, Finasteride, and Spironolactone to Treat Idiopathic Hirsutism

56 citations , April 2003 in “Fertility and Sterility”

This study found that while cyproterone acetate, finasteride, and spironolactone had similar short-term effects in treating idiopathic hirsutism, spironolactone provided more lasting benefits one year after treatment.

research Update and Future of Hormonal Therapy in Acne

78 citations , January 2003 in “Dermatology”

This article reviews hormonal therapy as a treatment for acne in women and suggests that emerging research on hormone synthesis and metabolism in the skin could guide future drug development.

research Comparison of Diane 35 and Diane 35 Plus Finasteride in the Treatment of Hirsutism

63 citations , March 2001 in “Fertility and Sterility”

This study found that Diane 35 combined with finasteride led to a greater reduction in hirsutism scores over 12 months compared to Diane 35 alone.

research A Prospective, Randomized Trial Comparing Flutamide (250 mg/d) and Finasteride (5 mg/d) in the Treatment of Hirsutism

50 citations , May 2000 in “Fertility and Sterility”

This study found that flutamide was more effective than finasteride in reducing hair growth in women with hirsutism over a one-year period.

research Comparison of Diane 35 and Diane 35 Plus Finasteride in the Treatment of Hirsutism

50 citations , April 2000 in “Fertility and Sterility”

This study found that a combination therapy of Diane 35 with finasteride was more effective at reducing hirsutism scores in women with idiopathic hirsutism or polycystic ovary syndrome after 3 months compared to Diane 35 alone.

research Antiandrogen Treatment of Polycystic Ovary Syndrome

52 citations , June 1999 in “Endocrinology and Metabolism Clinics of North America”

This review concludes that antiandrogens with ovarian suppression may significantly improve hirsutism and androgenetic alopecia in women with PCOS, but treatment needs to continue unless the underlying PCOS cause is addressed.

A Prospective Randomized Trial Comparing Low Dose Flutamide, Finasteride, Ketoconazole, and Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism

research A Prospective Randomized Trial Comparing Low Dose Flutamide, Finasteride, Ketoconazole, and Cyproterone Acetate-Estrogen Regimens in the Treatment of Hirsutism

113 citations , April 1999 in “The Journal of Clinical Endocrinology and Metabolism”

This study found that all four treatments—flutamide, finasteride, ketoconazole, and EE-CPA—significantly reduced hirsutism, but EE-CPA and flutamide appeared most effective, with varying effects on androgen levels and side-effect profiles.

research Treatment of Hirsutism: Comparisons Between Different Antiandrogens with Central and Peripheral Effects

75 citations , March 1999 in “Fertility and sterility”

This study concluded that finasteride, cyproterone acetate, and flutamide were similarly effective at reducing hirsutism in women, though they acted through different mechanisms.

research Hirsutism II: Treatment

15 citations , August 1998 in “Australasian journal of dermatology”

This review discusses various treatments for hirsutism, including cosmetic techniques, anti-androgens like spironolactone, and new drugs such as finasteride and flutamide, but it reports no new clinical results.

research Comparison of Cyproterone Acetate Plus Ethinyl Estradiol and Finasteride in the Treatment of Hirsutism

49 citations , June 1998 in “Journal of Endocrinological Investigation”

In this study, both cyproterone acetate-estrogen combination (Diane®) and finasteride were effective in reducing hirsutism, but Diane® showed greater long-term efficacy and cost-effectiveness.

research Oral Contraceptives and Cyproterone Acetate in Female Acne Treatment

30 citations , January 1998 in “Dermatology”

This review discusses hormonal influences and treatment considerations in female acne, particularly highlighting the role of androgens in persistent or resistant cases, and reports no new clinical findings.

research Treatment of Androgen Excess in Females: Yesterday, Today, and Tomorrow

9 citations , January 1997 in “Gynecological Endocrinology”

This review discusses the regulation of hair growth, causes of excessive androgen secretion, and current safe solutions for hyperandrogenism manifestations in women but reports no new clinical results.

research Cyproterone Acetate for Severe Hirsutism: Results of a Double-Blind Dose-Ranging Study

94 citations , July 1991 in “Clinical endocrinology”

In this study, cyproterone acetate at 2 mg daily was found to be as effective as higher doses in reducing hair growth for hirsute women over 12 months.

research Comparison of Sequential Cyproterone Acetate/Estrogen Versus Spironolactone/Oral Contraceptive in the Treatment of Hirsutism

68 citations , May 1991 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

This study found that both cyproterone acetate and spironolactone effectively reduced hair diameter and plasma testosterone levels in hirsute women, with no significant differences between the two treatments.

research Hirsutography: Photographic Measurement of Linear Hair Growth in Hirsute Women During Comparison of Anti-Androgen Treatments

4 citations , January 1991 in “Journal of obstetrics and gynaecology”

This study found that both spironolactone with Ovysmen and cyproterone acetate with ethinyloestradiol significantly reduced hair growth in hirsute women, with no difference in effect between treatments.

research Ketoconazole Therapy for Women with Acne and/or Hirsutism

46 citations , August 1990 in “The Journal of clinical endocrinology and metabolism/Journal of clinical endocrinology & metabolism”

In this study, ketoconazole treatment improved acne in all women and reduced hirsutism in some, but it caused several side effects and requires careful monitoring.

research Anti-Androgens in Gynecological Practice

7 citations , September 1988 in “Baillière's clinical obstetrics and gynaecology”

This article discusses the mechanisms of hirsutism and acne in women, highlighting cyproterone acetate with ethinyloestradiol as an effective anti-androgen therapy in the UK, but it reports no new clinical findings.

research The Hair Cycle on the Human Thigh and Upper Arm

67 citations , July 1985 in “British journal of dermatology/British journal of dermatology, Supplement”

This study found that males have significantly longer hair on their thighs compared to females, mainly due to a longer anagen phase and a greater rate of growth.

research Female Hirsutism: Pathophysiological Considerations and Therapeutic Implications

53 citations , October 1984 in “Endocrine reviews”

This review highlights that idiopathic hirsutism is characterized by local hyperandrogenization affecting hair growth, without other signs of hyperandrogenism, and shows no new results; racial differences in prevalence are noted but not in androgenic steroids.