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Birth
control pill hirsutism
Some types of progestins can have androgenic effects and some
women on birth control pills with an older formulation can find
hair loss or hirsutism is actually promoted by the pill. Synthetically
made progestins in birth control pills are not the same as naturally
produced progestins like progesterone. Some synthetic progestins'
molecular conformation mean they are the right shape to fit into
androgen receptors in hair follicles and elsewhere and elicit a
response. Some synthetic progestins are structurally very similar
to testosterone and/or estrogen so their androgenic or antiandrogenic
effects supplement an individual's natural hormone production levels.
The response is quite variable from person to person. While some
people have excess hair growth from using the pills others may develop
hair loss.
New birth control pill formulations contain progestins with less
androgenic activity. For example norgestimate or desogestrel are
non-androgenic progestins used in modern birth control pill formulations.
Those that find birth control pills promote excess hair growth or
hair loss usually find switching to another formulation helps. Excess
hair growth is usually reversible, but some dermatologists suggest
that once androgenetic alopecia is activated it is difficult to
stop or reverse even when the original trigger factor is removed.
Of course estrogens and progestins as in birth control pills or
hormone replacement therapy are used to treat excess hair growth.
Some people get confused with this as estrogens are antiandrogens
and as such is should help reduce the effects of androgenic hair
loss. Whether estrogens promote hair growth or are used to limit
growth depends on the type of hair follicles involved. Estrogens
help reduce androgen production but androgens have different effects
on different types of hair follicles. Androgens promote hair loss
in sensitive scalp hair follicles but promote hair growth in facial
(beard, mustache), chest, axilla and to some degree arm and leg
areas where hair follicles are also receptive to androgens.
Brief
list of birth control pills for hirsutism avoidance
Barbara Reed did an excellent review in Fitzpatrick's Journal
Sept/Oct 94 on "The Pill". She listed them in order of
less androgenicity to more androgenicity (least likely to cause
hirsutism to most likely to cause hirsutism) as: Desogen, Ortho-Cept,
Ortho-Cyclen, Ortho Tri-Cyclen, Micronor, Nor-Q D, Ovcon-35, Brevicon/Modicon,
Ortho Norvum 7/7/7, Ortho Novum 10-11, Tri-Norinyl, Norinyl and
Ortho 1/35, Demulen 1/35, Triphasil/Tri-Levien, Nordette, Lo/Ovral,
Ovrette, Ovral, Loestrin1/20, Loestrin 1.5/30.
She listed these as the best birth control pills for women who
want to avoid acne, alopecia, or hirsutism: Desogen, Ortho-Cept,
Ortho-Cyclen, Ortho-Tri-Cyclen, Brevicon, Modicon, Ovcon-35, and
Demulen-35. Newer oral contraceptive formulations containing progestins
with minimal androgenic potential should have the generic names
norgestimate, desogestrel, or gestodene on the side of the packet.
Norgestimate is generally regarded as the least androgenic progestin
found in contraceptive pills.
Newer brand names have come to market since the writing of this
article. As a rule when choosing a birth control pill with "good"
progestins look at the active ingredients on the pack for the generic
progestin names "Desogestrel", "Gestodene",
or "Norgestimate".
Birth
control pill hirsutism references
- Kaplan
B. Desogestrel, norgestimate, and gestodene: the newer progestins.
Ann Pharmacother. 1995 Jul-Aug;29(7-8):736-42.
- Carr BR.
Re-evaluation of oral contraceptive classifications. Int J Fertil
Womens Med. 1997;Suppl 1:133-44.
- Darney
PD. The androgenicity of progestins. Am J Med. 1995 Jan 16;98(1A):104S-110S.
- Coenen
CM, Thomas CM, Borm GF, Rolland R. Comparative evaluation of the
androgenicity of four low-dose, fixed-combination oral contraceptives.
Int J Fertil Menopausal Stud. 1995;40 Suppl 2:92-7.
- Jones EE.
Androgenic effects of oral contraceptives: implications for patient
compliance. Am J Med. 1995 Jan 16;98(1A):116S-119S.
- Darney
PD. OC practice guidelines: minimizing side effects. Int J Fertil
Womens Med. 1997;Suppl 1:158-69.
- Rosenberg
MJ, Waugh MS, Meehan TE. Use and misuse of oral contraceptives:
risk indicators for poor pill taking and discontinuation. Contraception.
1995 May;51(5):283-8.
- Zaun H. [Hair-growth disorders in relation
to pregnancy and hormonal contraception]. Z Geburtshilfe Perinatol.
1973 Apr;177(2):67-73.
- Zaun H. [Hair growth disorders following
sex hormone treatment - therapy of hair growth disorders using
sex hormones]. Hautarzt. 1973 Jan;24(1):1-6.
- Laur S. [Growth of hair during a combined
antiandrogen and estrogen therapy in female test persons]. Arch
Dermatol Forsch. 1972;244:515-23.
- Zaun H. [The influence of several ovulation
inhibiting hormone preparations on scalp hair growth]. Dtsch
Med Wochenschr. 1970 Jul 3;95(27):1433-6.
- Baker H. Adverse cutaneous reaction to
oral contraceptives. Br J Dermatol. 1969 Dec;81(12):946-9.
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