10 Treatment of hirsutism with spironolactone

The discovery of compounds possessing antiandrogenic activities has led to their utilization in the treatment of hirsutism of various aetiologies. Spironolactone generally lowers the plasma testosterone by altering its formation and metabolism as well as by decreasing its blood production rate; the medication also contributes to increase the peripheral conversion of testosterone to oestradiol. A major action is that spironolactone inhibits androgen binding to receptor molecules in the cytosol or the nucleus of target tissues such as the skin. During the last five years, we have studied over 450 cases of hirsutism. Approximately 80% of these women were treated with spironolactone alone or in association with dexamethasone (2.5%) or an oral contraceptive (15%). Hirsutism was classified according to Lorenzo (1970). Good to very good clinical results were observed in 80% of the patients who were under study for a minimum of 3 to 4 years. Adverse side-effects were recorded in less than 5% of our group of patients. On the basis of our data and our clinical experience, we conclude that spironolactone is an effective drug in the treatment of female hirsutism.