A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women
IL Wong, RS Morris, L Chang, MA Spahn, FZ Stanczyk and RA Lobo
Department of Obstetrics and Gynecology, University of Southern California School of Medicine, Los Angeles 90033.
Enhanced 5 alpha-reductase activity has been found in the skin of the
majority of women with hirsutism. Finasteride is a specific competitive
inhibitor of 5 alpha-reductase, preferentially inhibiting the type 2
isoenzyme. Therefore, we randomly assigned 14 hirsute women in a 2:1 ratio
to 1 of 2 treatment arms: 1) finasteride (F) treatment (n = 9; 5 mg,
orally, daily), or 2) spironolactone (S) treatment (n = 5; 100 mg, orally,
daily). Each group was treated for 6 months. Patients were evaluated at
baseline and after 3 and 6 months of treatment. The 2 groups were similar
in age, weight, hip/waist ratio, baseline Ferriman- Gallwey score (F, 19
+/- 2; S, 19 +/- 2), and baseline androgen levels. Finasteride treatment
resulted in a significant increase in testosterone (T; P < 0.01) and the
T/dihydrotestosterone ratio (P < 0.01). Finasteride caused a significant
decrease in 5 alpha-androstane- 3 alpha,17 beta-diol glucuronide (3
alpha-diolG; P < 0.05), the 3 alpha- diolG/T ratio (P < 0.01), and
the 3 alpha-diolG/androstenedione ratio (P < 0.05). All changes were
consistent with 5 alpha-reductase inhibition. In contrast, spironolactone
treatment did not result in significant changes in serum hormone levels.
Both treatments produced a significant decrease in anagen hair diameters
[F, -14.0 +/- 6.7% (P < 0.05); S, -13.4 +/- 3.8% (P < 0.05)] and
Ferriman-Gallwey scores [F, - 2.1 +/- 0.4 (P < 0.05); S, -2.5 +/- 0.7 (P
< 0.05)]. In conclusion, despite significantly different effects on
androgen levels, finasteride and spironolactone treatment resulted in a
similar clinical effect on hirsutism. Both caused significant, but limited,
improvement in hirsutism. Although promising, further studies with
finasteride are needed to verify its effectiveness as a treatment for
hirsutism. Such studies will also provide a better understanding of the
relative contribution of 5 alpha-reductase isoenzymes to hirsutism.
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