An Evaluation of the Available Pharmacotherapy for the Treatment of Hirsutism

    April 2023 in “ Expert opinion on pharmacotherapy ”
    Leila Asfour, Ahmed Kazmi, Rodney Sinclair
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    TLDR Birth control pills and antiandrogens are the most effective medicines for excessive body hair in women, but combining them with other treatments and psychological support is best.
    Hirsutism, characterized by excessive body hair in a male pattern distribution in women, affects up to 20% of women, with idiopathic hirsutism and polycystic ovarian syndrome (PCOS) accounting for 95% of cases. The most effective pharmacotherapy for hirsutism includes combined oral contraceptive pills (OCP) as first-line therapy, with the addition of oral antiandrogens for severe cases. Antiandrogens and OCPs have been shown to significantly improve hirsutism. However, insulin sensitizers like metformin are found to be the least effective. For optimal management, medical treatments often need to be combined with physical therapies. It's also important to consider psychological support for patients with associated psychosocial morbidity. Despite these findings, the paper notes that robust evidence for the efficacy of pharmacological treatments of hirsutism is lacking due to limitations in current research, such as small sample sizes, short duration, and lack of blinding during studies.
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