TLDR Some antiandrogens may lower testosterone better than others, but it's unclear which is best for feminization in transgender women; more research is needed.
The systematic review evaluated the efficacy of various antiandrogens in achieving feminization in transgender women, including spironolactone, cyproterone acetate (CPA), bicalutamide, GnRH analogues, and 5α-reductase inhibitors. It found significant methodological variability among the four included studies, making meta-analysis unfeasible. While CPA, GnRH analogues, and MPA were more effective than spironolactone in suppressing serum total testosterone, there was no significant difference in body composition changes between CPA and GnRH analogues. The review noted a lack of robust comparisons for breast development and facial/body hair reduction among different antiandrogens and questioned the reliance on serum total testosterone as a marker for feminization. It concluded that more high-quality, prospective randomized controlled studies with clinically relevant endpoints are needed to optimize antiandrogen therapy in transgender women.
25 citations,
December 2017 in “The Journal of Clinical Endocrinology & Metabolism” Birth control pills combined with bicalutamide are more effective at reducing excessive hair growth in women with PCOS than birth control pills alone.
32 citations,
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46 citations,
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97 citations,
November 1986 in “Journal of Steroid Biochemistry” Antiandrogens affect androgen-dependent body functions and are used for various medical conditions, with some risks like fetus feminization, but new forms like 17α-propylmesterolone show promise for acne without systemic effects.
