From the Guidelines
Treatment for hyperandrogenism, characterized by dangerously high levels of testosterone, should primarily focus on reducing testosterone levels and addressing the underlying cause, with spironolactone being a key medication, at a dose of 100 to 150 mg daily, as it has shown significant improvement in symptoms in up to 85% of patients 1.
Key Considerations
- The choice of treatment depends on the severity of the condition, the patient's overall health, and specific factors such as the presence of polycystic ovarian syndrome (PCOS) or hidradenitis suppurativa (HS).
- Hormonal therapies, including anti-androgens and combined oral contraceptives, are considered based on the patient's symptoms and medical history.
- Lifestyle modifications, including weight loss, regular exercise, and a balanced diet, are also crucial in managing hyperandrogenism, especially in patients with insulin resistance.
Medication Options
- Spironolactone: An anti-androgen that has been shown to improve symptoms in up to 85% of patients with HS, at a dose of 100 to 150 mg daily 1.
- Finasteride: May be beneficial as an adjunctive therapy, with doses ranging from 1.25 to 5 mg daily 1.
- Metformin: An insulin-sensitizing drug that can help reduce androgen levels, particularly in patients with insulin resistance, at a dose of 500 mg 2 to 3 times daily 1.
- Combined Oral Contraceptives: Containing ethinyl estradiol and drospirenone or cyproterone acetate can help suppress ovarian androgen production in women.
Approach to Treatment
The approach to treating hyperandrogenism involves a comprehensive evaluation of the patient's condition, including the severity of symptoms, underlying causes, and overall health. A treatment plan that includes medication, lifestyle modifications, and regular monitoring of hormone levels and other health parameters is essential for effectively managing hyperandrogenism and improving the patient's quality of life.
From the Research
Treatment for Hyperandrogenism
The treatment for hyperandrogenism, or dangerously high levels of testosterone, typically involves medications that can help reduce androgen levels. Some of the key treatment options include:
- Spironolactone: This medication is often used to treat hyperandrogenism in women, particularly those with polycystic ovary syndrome (PCOS) 2, 3, 4, 5.
- Combined oral contraceptives: These can help regulate menstrual cycles and reduce androgen levels in women with PCOS 4.
- Metformin: This medication is often used to treat insulin resistance and metabolic disturbances associated with PCOS, but it may not be as effective as spironolactone in reducing androgen levels 4.
Mechanism of Action
Spironolactone works by blocking the effects of androgens, such as testosterone, on the body 2, 3. It can help reduce hirsutism, improve menstrual regularity, and decrease androgen levels in women with PCOS.
Efficacy and Safety
Studies have shown that spironolactone is effective in reducing androgen levels and improving clinical features of PCOS, including hirsutism and menstrual dysfunction 2, 3, 4, 5. It is generally well-tolerated, but may cause side effects such as acne, breast tenderness, and menstrual irregularities.
Comparison with Other Treatments
Spironolactone has been compared with other treatments, such as metformin, in women with PCOS 4. While metformin may be effective in improving insulin sensitivity and reducing metabolic disturbances, spironolactone may be more effective in reducing androgen levels and improving clinical features of PCOS.
Important Considerations
It's essential to note that the treatment for hyperandrogenism should be individualized and based on the specific needs and medical history of each patient. Women with PCOS should be monitored regularly for changes in androgen levels, menstrual regularity, and metabolic parameters, and adjustments to treatment should be made as needed 2, 3, 4, 5.