Does Diane 35 (ethinyl estradiol and cyproterone acetate) affect hormone levels?

Yes, Diane-35 Significantly Affects Multiple Hormone Levels

Diane-35 (ethinyl estradiol 35 μg and cyproterone acetate 2 mg) substantially alters hormone levels by suppressing endogenous hormone production while providing exogenous hormones, resulting in measurable changes in androgens, gonadotropins, and binding proteins. 1, 2, 3

Hormonal Changes You Can Expect

Androgen Suppression

• Total and free testosterone levels decrease significantly (p < 0.001) within 3 cycles of Diane-35 treatment 3
• Androstenedione levels drop significantly (p < 0.025) after 3 cycles, with continued lowering thereafter 3
• DHEA-S levels decrease significantly after 6 cycles of treatment 3
• The androgenic index (total testosterone/SHBG ratio) declines substantially, reflecting the combined anti-androgenic effect 4

Sex Hormone-Binding Globulin (SHBG)

• SHBG concentrations increase highly significantly (p < 0.001) after just 3 cycles 3
• This increase in SHBG further reduces free (bioavailable) testosterone by binding circulating androgens 5, 6

Gonadotropin Suppression

• LH and FSH levels are suppressed, with the LH/FSH ratio decreasing highly significantly (p < 0.001) after 3 cycles 3, 4
• This suppression prevents ovulation by inhibiting gonadotropin-releasing hormone 5, 2

Estrogen Dynamics

• Endogenous estradiol (E2) production decreases due to ovarian suppression 4, 7
• However, the synthetic ethinyl estradiol in Diane-35 provides exogenous estrogenic effects that maintain adequate systemic estrogen activity 2
• Estrone (E1) levels also decrease during treatment 4
• The E1/E2 ratio changes as a result of altered ovarian function 4

Progesterone

• Progesterone levels decrease due to anovulation and ovarian suppression 4

Other Hormonal Effects

• Prolactin may show an increasing tendency during treatment 4

Clinical Implications

What These Changes Mean

• The hormonal alterations are intentional therapeutic effects, not adverse reactions—Diane-35 works by suppressing ovarian androgen production and increasing SHBG 5, 3
• These changes result in clinical improvement of androgenic symptoms (acne, hirsutism, seborrhea) typically within 3-12 cycles 3, 4
• Ovarian size decreases significantly (p < 0.001) after 6 cycles in PCOS patients, reaching normal size by 12 cycles 3

Important Caveats

• These are not "low" hormone levels in a pathological sense—the synthetic ethinyl estradiol provides adequate estrogenic effects despite lower endogenous estradiol 2
• The suppression is reversible; normal ovarian function typically resumes after discontinuation, though it may take time 2
• Measuring serum estradiol levels while on Diane-35 is not clinically useful, as the synthetic ethinyl estradiol does not register on standard estradiol assays but provides sufficient estrogenic activity 2

Metabolic Considerations

• Diane-35 monotherapy may have mild negative effects on insulin levels and lipid parameters, though these are generally modest 7
• HDL-cholesterol may improve, but other lipid parameters and atherogenic indices may worsen slightly 7
• Combined treatment with metformin can counteract some metabolic effects while enhancing anti-androgenic benefits 7

Monitoring Recommendations

Baseline Assessment

• Pregnancy status and blood pressure should be checked before initiating Diane-35 1

Ongoing Monitoring

• Blood pressure monitoring during treatment 1
• General health status changes 1
• Hormonal assessment (if clinically indicated) at 3-6 month intervals to document therapeutic response 3, 4