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Spironolactone
for hirsutism
Spironolactone (also known as Aldactone) is arguably the number
one hirsutism treatment of choice for dermatologists in the US.
Spironolactone has antiandrogenic effects that may enhance treatment
of several androgen-excess conditions, particularly severe hirsutism.
Some dermatologists suggest that the effects of spironolactone are
somewhat inferior to cyproterone acetate (CPA). However, CPA is
not available in the US.
Spironolactone has several properties that make it suitable for
use in treating hirsutism. It interferes with the production of
testosterone and it increases the metabolism of any testosterone
that is produced. Spironolactone binds to cell androgen receptors
and blocks them from binding to naturally produced androgens. In
addition with long term spironolactone use, there is a gradual reduction
in 5 alpha reductase activity. It is this enzyme that converts testosterone
to the more potent, hair follicle stimulating, dihydrotestosterone.
Treatment protocols may involve continuous spironolactone use at
50mg to 200mg per day or cyclic use. For example 50mg or 100mg twice
daily from the 4th to the 22nd day of the menstrual cycle. Numerous
treatment protocols involving spironolactone have been used in different
studies, but no particular treatment approach has been shown to
be significantly superior. Combination therapy with an oral contraceptive
pill or dexamethasone appears to have an improved beneficial effect
on hirsutism and limits side effects.
Side effects with spironolactone are generally transient. As with
all antiandrogens , spironolactone use should be avoided during
pregnancy and in women who have a family history of breast cancer,
although there is no proven association between spironolactone and
breast malignancy.
Spironolactone
for hirsutism references
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