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Antiandrogens for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials

Knowledge and Encounter Research Unit (B.A.S., M.C., D.N.F., D.M.K., M.L.L., R.J.M., P.J.E., V.M.M.) and Division of Endocrinology, Diabetes, Metabolism, and Nutrition (B.A.S., M.C., V.M.M.), Department of Medicine, and Mayo Clinic Libraries (P.J.E.), Mayo Clinic College of Medicine, Rochester, Minnesota 55905; and State University of New York at Geneseo (M.L.L.), Geneseo, New York 14454

Address all correspondence and requests for reprints to: Victor M. Montori, M.D., M.Sc., Mayo Clinic, W18A, 200 First Street SW, Rochester, Minnesota 55905. E-mail: montori.victor{at}mayo.edu.

Context: The relative efficacy of antiandrogens for the treatment of hirsutism remains unclear.

Objective: We performed a systematic review and metaanalyses of randomized controlled trials (RCTs) evaluating the effect of antiandrogens on hirsutism.

Data Sources: We used librarian-designed search strategies for MEDLINE, EMBASE, and Cochrane CENTRAL (up to May 2006), review of reference lists, and contact with hirsutism experts to identify eligible RCTs.

Study Selection: Eligible studies were RCTs of at least 6 months of antiandrogen use in women with hirsutism. Reviewers, with acceptable chance-adjusted agreement ( = 0.72), independently assessed eligibility.

Data Extraction: Reviewers used structured forms to assess and collect methodological quality (allocation concealment, blinding, and loss to follow-up) and study data.

Data Synthesis: Of 348 candidate studies, 12 were eligible (18 comparisons). Their methodological quality was low. Random-effects metaanalyses showed that compared with placebo, antiandrogens reduce Ferriman-Gallwey scores by 3.9 [95% confidence interval (CI), 2.3–5.4; inconsistency (I²) = 0%]. When compared with metformin, spironolactone reduced hirsutism scores by 1.3 (CI, 0.03–2.6) and flutamide by 5.0 (CI, 3.0–7.0; I² = 0%). For these interventions, two to five women need to receive treatment for one to notice improvement. Spironolactone or finasteride in combination with contraceptives (1.7; CI, 0.1–3.3; I² = 0%) or flutamide with metformin (4.6; CI, 1.3–7.9; I² = 40%) appear superior to monotherapy with contraceptives and metformin, respectively. Only three RCTs reported patient self-assessments of hirsutism.

Conclusions: Weak evidence suggests antiandrogens are mildly effective agents for the treatment of hirsutism.

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				K. A. Martin, R. J. Chang, D. A. Ehrmann, L. Ibanez, R. A. Lobo, R. L. Rosenfield, J. Shapiro, V. M. Montori, and B. A. Swiglo Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1105 - 1120. [Abstract] [Full Text] [PDF]