Treatment of Hyperandrogenic Alopecia in Women

In a 2003 study, 36 premenopausal women with hyperandrogenic alopecia were treated with cyproterone acetate with ethinyl estradiol, flutamide, or finasteride, while 12 women were observed without treatment. The study found that flutamide at a dose of 250 mg daily was the only treatment that led to a statistically significant improvement, with a 21% reduction in Ludwig scores. However, only 3 out of 12 patients reported subjective hair regrowth. Finasteride did not show significant effects, possibly due to different scalp concentrations of 5α-reductase isoenzymes in women. The study was limited by its small sample size and lack of a placebo control group. Mild liver enzyme elevations were observed in 2 out of 12 women on flutamide. The authors concluded that flutamide could modestly improve alopecia in women, but longer treatment might be necessary for better results, and finasteride was ineffective for female alopecia.