Pharmacological Options for Treatment of Hyperandrogenic Disorders

The document from 2009 reviews various pharmacological treatments for hyperandrogenic disorders, particularly in women with conditions like polycystic ovary syndrome (PCOS). It discusses the effectiveness and side effects of antiandrogenic drugs such as finasteride, which reduces dihydrotestosterone levels and hirsutism scores, and other drugs like spironolactone, cyproterone acetate, and flutamide. The review also covers insulin-sensitizers, ketoconazole, and GnRH-agonists, which have non-classical antiandrogenic effects. While finasteride shows promise for treating hirsutism and androgenic alopecia, it is teratogenic and not ideal for skin manifestations due to weak potency for type 1 reductase in the skin. Other treatments like metformin and thiazolidinediones improve insulin resistance but have their own limitations. The document highlights the need for contraception during treatment with potentially fetotoxic drugs and suggests that weight reduction can also help reduce androgen levels. It concludes by mentioning ongoing research into novel antiandrogen drugs and local therapy options, as well as bifunctional antiandrogens that prevent activation of the androgen receptor.