cyproterone and Hirsutism

Hirsutism and acne in women are common distressing problems. Unwanted hair growth, acne and seborrhoea result from the action of androgens on the skin. Such effects depend not only on increased androgen production by the ovary or adrenal gland but also on the bioavailability of androgen to peripheral tissues. This in turn is related to transport of androgens in plasma by specific binding proteins and to peripheral metabolism of testosterone and androstenedione to their more potent 5 alpha-reduced derivatives. An effective anti-androgen is one which blocks the androgen receptor-mediated actions of testosterone and DHT on skin. CPA, the treatment of choice in the UK, is a potent androgen receptor-blocking steroid which also has progestational properties. When combined with ethinyloestradiol it also suppresses ovarian function, thus reducing androgen production, and provides effective contraception.

Topics: Acne Vulgaris; Androgen Antagonists; Androgens; Cyproterone; Female; Hirsutism; Humans; Spironolactone; Virilism

Topics: Acne Vulgaris; Androgen Antagonists; Carbohydrate Metabolism; Cyproterone; Cyproterone Acetate; Drug Administration Schedule; Ethinyl Estradiol; Female; Glucocorticoids; Gonadotropins, Pituitary; Hirsutism; Humans; Lipid Metabolism; Menstrual Cycle; Progestins

The endocrine abnormalities associated with the development of androgen-dependent hirsutism have been presented and discussed in the light of the frequent finding of ultrasonographic abnormalities suggestive of polycystic ovary syndrome. A simple protocol of investigation, which should ideally include pelvic ultrasonography, has been presented. The treatment of hirsutism by combined anti-androgen and oestrogen therapy has been detailed and other approaches discussed.

Topics: Adrenal Glands; Adrenal Hyperplasia, Congenital; Adrenocortical Hyperfunction; Androgens; Cimetidine; Cyproterone; Female; Hair; Hair Removal; Hirsutism; Humans; Polycystic Ovary Syndrome; Spironolactone; Ultrasonography

Topics: 3-Oxo-5-alpha-Steroid 4-Dehydrogenase; Adrenal Glands; Adrenocorticotropic Hormone; Androgen Antagonists; Androgens; Androstenedione; Biological Transport, Active; Blood Proteins; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dexamethasone; Dihydrotestosterone; Female; Hirsutism; Humans; Kinetics; Ovary; Sex Hormone-Binding Globulin; Skin; Spironolactone

Topics: Androgens; Castration; Circadian Rhythm; Cyproterone; Estradiol Congeners; Ethnicity; Female; Hirsutism; Humans; Menstruation; Metronidazole; Polycystic Ovary Syndrome; Prolactin; Receptors, Androgen; Testosterone

Topics: Acne Vulgaris; Adolescent; Adrenal Hyperplasia, Congenital; Adult; Alopecia; Androgens; Cyproterone; Cyproterone Acetate; Female; Hair; Hirsutism; Humans; Male; Polycystic Ovary Syndrome; Racial Groups; Sex Characteristics; Stress, Psychological; Syndrome

The ongoing development and gradual availability of the new anti-androgens hold exciting clinical implications for the future. The biosynthesis and interchangeability of the sex steroids, the roles of the ovaries and adrenals and the value and interpretation of biochemical assays in clinical practice are briefly discussed. Because the anti-androgens are used primarily for seborrhoea/acne/hirsutism/oligomenorrhoea, the pathophysiological basis of this socially debilitating syndrome is discussed. The classification of the anti-androgens, their indications, side-effects, dosage schemes and results of treatment are reviewed. Finally, a summary of a possible clinical management regimen is presented.

Topics: 17-Ketosteroids; Acne Vulgaris; Adrenal Hyperplasia, Congenital; Androgen Antagonists; Androgens; Androsterone; Contraceptives, Oral, Hormonal; Cyclopentanes; Cyproterone; Dermatitis, Seborrheic; Dihydrotestosterone; Estradiol Congeners; Female; Follicle Stimulating Hormone; Glucocorticoids; Hirsutism; Humans; Hydroxysteroids; Luteinizing Hormone; Male; Medroxyprogesterone; Nandrolone; Prostatic Neoplasms; Receptors, Androgen; Sex Hormone-Binding Globulin; Steroids; Testosterone

Topics: Acne Vulgaris; Adrenal Gland Neoplasms; Alopecia; Androgen Antagonists; Androgens; Cyproterone; Female; Hirsutism; Humans; Pregnancy; Sex Differentiation; Virilism

Topics: Acne Vulgaris; Alopecia; Animals; Bone Development; Cyproterone; Female; Fertility; Hirsutism; Humans; Libido; Male; Prostate; Prostatic Hyperplasia; Prostatic Neoplasms; Puberty; Sebaceous Glands; Seminal Vesicles; Sex Differentiation; Skin; Testis

Many antiandrogens, mainly steroidal and some nonsteroidal agents, have been synthesized and tested in several available biological assays. Unfortunately, many of these compounds have other biological activities which make it difficult to ascertain the precise mechanism of antiandrogenic action. The blocking of androgen action can be accomplished by a number of ways: (1) the inhibition of gonadotropin release and/or synthesis, (2) the interference with testosterone and/or dihydrotestosterone biosynthesis, (3) the blocking of protein synthesis, and (4) the competition with androgens at receptor sites. Although the major reason for the development of antiandrogens is to utilize them in certain clinical situations, some have become important tools in studying androgen action, particularly on the molecular level. The clinical effectiveness of some antiandrogens in prostatic hyperplasias, hirsutism, and acne represents an important advance in therapeutics, but the search for more potent antiandrogens with minimal side effects should continue.

Topics: Acne Vulgaris; Androgen Antagonists; Animals; Biological Assay; Comb and Wattles; Cyproterone; Female; Fertility; Flutamide; Genitalia, Male; Hirsutism; Male; Phthalimides; Progesterone; Prostatic Hyperplasia; Prostatic Neoplasms; Sebaceous Glands; Sebum; Sex Differentiation; Sexual Behavior, Animal; Sexual Dysfunction, Physiological; Steroids

Topics: Carcinoma; Cyproterone; Female; Hirsutism; Humans; Male; Paraphilic Disorders; Prostatic Hyperplasia; Prostatic Neoplasms; Puberty, Precocious; Sex Offenses

Topics: Alopecia; Anabolic Agents; Androgens; Chlormadinone Acetate; Contraceptives, Oral; Cyproterone; Estrogens; Female; Gonadal Steroid Hormones; Hirsutism; Humans; Hypertrichosis; Male

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Bone Development; Cyproterone; Female; Growth; Hirsutism; Humans; Hypertrichosis; Libido; Male; Prostate; Prostatic Neoplasms; Puberty, Precocious; Seminal Vesicles; Sexual Dysfunction, Physiological; Skin

Topics: Alopecia; Androgen Antagonists; Contraceptives, Oral; Cyproterone; Ethinyl Estradiol; Female; Hair; Hirsutism; Humans; Nandrolone; Pregnancy; Pregnancy Complications

Topics: Androgen Antagonists; Animals; Body Height; Bone Development; Cell Differentiation; Contraceptives, Oral; Cyproterone; Epididymis; Female; Gonads; Hirsutism; Humans; Libido; Male; Pregnadienes; Pregnancy; Prostate; Prostatic Neoplasms; Puberty, Precocious; Sebaceous Glands; Seminal Vesicles; Sexual Dysfunction, Physiological; Testosterone

Although antiandrogens are frequently and successfully used to treat hirsutism, little attention has been paid to optimal duration of treatment and recurrence rate after cessation of therapy.. Our purpose was to determine the recurrence rate of hirsutism after 3 different antiandrogen therapies.. Eighty-one hirsute women referred to a tertiary hirsutism clinic were assigned to one of three regimens: spironolactone 100 mg/day with an oral contraceptive, cyproterone acetate 50 mg/day on days 1 to 10 with an oral contraceptive, or flutamide 250 mg twice a day. Hirsutism scores according to the Ferriman-Gallwey scoring system and endocrine parameters were evaluated before, during, and 1 year after withdrawal of treatment regimens.. Hirsutism scores decreased significantly and similarly in spironolactone, flutamide, and cyproterone acetate treatment groups. However, 1 year after withdrawal of treatment in all antiandrogen therapy groups, hirsutism returned.. Antiandrogens are effective in the treatment of hirsutism. However, cessation of antiandrogen therapy is followed by recurrence.

Topics: Androgen Antagonists; Contraceptives, Oral; Cyproterone; Female; Flutamide; Hirsutism; Humans; Luteinizing Hormone; Recurrence; Spironolactone; Testosterone

The objective of this study was to compare the efficacy of flutamide and cyproterone acetate in the treatment of hirsutism. Twenty-two women with idiopathic hirsutism were randomized to receive either flutamide or cyproterone acetate. Each patient underwent a complete gynecological examination as well as an endocrinological profile and hematological, hepatic and renal function analyses. Hirsutism scores were determined using a modified Ferriman-Gallwey scoring system. These tests were then repeated at 3 and 9 months of therapy. Eleven patients received 250 mg of flutamide twice daily and 11 patients received 100 mg of cyproterone acetate on days 5-14 of the menstrual cycle. Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. There was a trend towards a better response with flutamide, that did not achieve significance. Another significant difference was the increased sex hormone-binding globulin in both groups. A statistically significant decrease was also observed for the levels of testosterone on both drugs. No subject withdrew from the study due to a side-effect. The data suggest that both flutamide and cyproterone acetate were similarly effective in treatment of hirsutism, and that the pure antiandrogen flutamide is a safe, well-tolerated and effective alternative in treatment.

Topics: Adolescent; Adult; Androgen Antagonists; Cyproterone; Female; Flutamide; Hirsutism; Hormones; Humans; Prospective Studies

Polycystic ovary syndrome is the most common endocrinological problem associated with hirsutism. The objective of this study was to compare four different treatment modalities for hirsutism related to this syndrome. Pelvic ultrasonography was performed on all patients who were referred to our Reproductive Endocrinology Outpatient Clinic because of complaints of hirsutism. After exclusion of hyperandrogenism caused by endocrine abnormalities other than polycystic ovary syndrome, 141 patients were included in the study. Patients were divided into four groups in regard to the drug chosen for treatment. Group 1 (n = 48) received low-dose combined oral contraceptive. Group 2 (n = 65) was treated with cyproterone acetate 100 mg daily for the first 10 days of a 21-day cycle with an oral contraceptive containing 2 mg cyproterone acetate, Group 3 (n = 12) with spironolactone (100-200 mg daily) and Group 4 (n = 16) with ketoconazole (400 mg daily). All patients were followed frequently with respect to side-effects, hirsutism scoring, and lipid and hormonal levels. All four drug regimens were effective in the treatment of hirsutism related to polycystic ovary syndrome, but the most effective seemed to be ketoconazole. The decrement level in hirsutism scoring was the largest in the ketoconazole group, followed by the cyproterone, oral contraceptive and spironolactone groups (34.6 +/- 2.2%, 20.1 +/- 2.7%, 18.1 +/- 2.7% and 12.8 +/- 3.7%, respectively, p < 0.05). Although high-density lipoprotein-cholesterol levels increased in all groups, this increment was smaller in Group 4 than in Groups 1 and 2 (5.1 +/- 2.8%, 34.1 +/- 5.5% and 29.1 +/- 4.9%, respectively, p < 0.05), but not statistically different from that in Group 3 (22.3 +/- 5.9%). The free testosterone levels decreased after treatment in all groups, but the decrement ratios did not differ significantly among groups, although the decrease in free testosterone levels with treatment seemed to be higher in the ketoconazole group than in Groups 1, 2 and 3 (57.0 +/- 2.5%, 22.7 +/- 10.2%, 26.7 +/- 6.5% and 9.5 +/- 19.9%, respectively). In conclusion, ketoconazole seems to be an excellent alternative to more-recognized therapies, but its effect on lipoprotein profile requires further study, because the hyperandrogenism, and the other problems related to hyperandrogenism besides hirsutism, should also be treated.

Topics: Adolescent; Adult; Androgen Antagonists; Cholesterol, HDL; Cholesterol, LDL; Cohort Studies; Contraceptives, Oral, Combined; Cyproterone; Dehydroepiandrosterone; Female; Hirsutism; Humans; Ketoconazole; Luteinizing Hormone; Mineralocorticoid Receptor Antagonists; Polycystic Ovary Syndrome; Spironolactone; Testosterone

Effectiveness of 2-year treatment of hirsutism with low estrogen oral contraceptives (OCs) containing nonandrogenic or antiandrogenic progestogen. Evaluation of changes in plasma lipids.. Ten patients treated with desogestrel 150 micrograms + 30 micrograms ethinyl estradiol, 6 with desogestrel 150 micrograms + 50 micrograms ethinyl estradiol, 10 with cyproterone acetate 2 mg + 35 micrograms ethinyl estradiol. Random allocation. Paired comparisons.. 19 normal women, not treated.. Academic tertiary care.. Women with hirsutism (idiopathic and/or polycystic ovary), 24 of 26 completed treatment.. Two-year treatment.. Hirsutism score, plasma testosterone, and lipids.. Initial hirsutism scores (11.8 +/- 0.6 SE) declined with treatment (-7.2 +/- 0.4, P less than 0.01) to 4.7 +/- 0.6, almost reaching control (3.6 +/- 0.3). Initial plasma cholesterol (4.33 mmol/L +/- 0.30 SE), similar to control (4.78 +/- 0.24), increased slowly over 2 years (+2.04 +/- 0.34, P less than 0.01). High-density lipoproteins cholesterol (1.05 mmol/L +/- 0.04 SE), similar to control (1.12 +/- 0.07), did not change the 1st year and increased at 2 years (+0.57 +/- 0.11, P less than 0.01). No differences appeared among treatment groups.. Treatment is very effective, 2 years for best results. The OCs tested are equally efficacious. Changes in plasma lipids are of some concern but of difficult interpretation.. This study examined the effectiveness of a 2-year treatment for hirsutism with low estrogen oral contraceptives (OCs) containing nonandrogenic or antiandrogenic progestogen and evaluated the changes in plasma lipids. 10 patients were treated with desogestrel 150 mcg + 30 mcg ethinyl estradiol, 6 with desogestrel 150 mcg + ethinyl estradiol, 10 with cyproterone acetate 2 mg + 35 mcg ethinyl estradiol in a random allocation with paired comparisons. 24 of 26 women with hirsutism (idiopathic and/or polycystic ovary) completed the treatment; the control group consisted of 19 normal, untreated women. Initial hirsutism scores (11.8 +or- 0.6 SE) declined with treatment (-7.2 +or- 0.4, p0.01) to 4.7 +or- 0.6, almost reaching control (3.6 +or- 0.3). The initial plasma cholesterol (4.33 mmol/L +or- 0.30 SE) were similar to controls (4.78 +or- 0.24) and increased slowly over the 2 years (=2.04 +or- 0.34, p0.01). High density lipoprotein cholesterol (1.05 mmol/L +or- 0.04 SE) was similar to the controls (1.12 +or- 0.07), did not change the 1st year, and increased at 2 years (+0.57 +or- 0,11, p0.01). No differences appeared among treatment groups. The authors conclude that treatment is very effective and is best when spread over the 2-year period. The OCs tested are equally efficacious. Changes in plasma lipids are of some concern but proved to be difficult to interpret.

Topics: Adult; Cholesterol; Cholesterol, HDL; Contraceptives, Oral, Hormonal; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Desogestrel; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Norpregnenes; Prolactin; Testosterone

The effects of the antiandrogen drugs cyproterone acetate (CPA) and spironolactone on hair growth and androgen levels were compared in a randomized study of 48 hirsute women. Twenty six subjects completed 6 months of therapy with 100 mg/day CPA and 19 subjects completed 6 months of 100 mg/day spironolactone. All except 10 subjects received concomitant estrogen therapy. Measured objectively, total hair diameter fell by 17.1% with spironolactone (P less than 0.001), and by 16.8% with CPA (P less than 0.001). The diameter of the hair medulla fell by 17.8% with spironolactone (P less than 0.01), and by 31.7% with CPA (P less than 0.001). There was no difference between the drugs in their effect on hair diameter. Plasma testosterone levels also fell significantly with both drugs. As a subjective assessment of treatment efficacy, the frequency with which subjects performed cosmetic measures was recorded. This fell by 38% with spironolactone and by 44.7% with CPA (P less than 0.001 both drugs), and again there was no difference between the drugs. Side effects caused cessation of treatment in one subject taking CPA and two subjects taking spironolactone, and milder side effects were noted in two further subjects from each treatment group. We conclude that spironolactone and CPA, in the dosages used in this study, are effective and well tolerated agents for the treatment of hirsutism, and that neither drug demonstrates a particular advantage over the other.

Topics: Adult; Androgen Antagonists; Androgens; Contraceptives, Oral; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estrogens; Female; Hair; Hirsutism; Humans; Middle Aged; Prospective Studies; Spironolactone; Testosterone

The objective was to determine if cyproterone acetate (CPA) therapy for hirsute women demonstrated a dose response.. A double-blind dose-ranging study of the effect of 3 doses of cyproterone acetate for a period of 12 months.. Twenty-one hirsute women received the Dianette contraceptive pill (35 micrograms ethinyl oestradiol + 2 mg CPA, Schering Healthcare, UK), 20 received Dianette plus 20 mg CPA and 19 received Dianette plus 100 mg CPA: supplementary CPA was administered on days 1-10 of the birth control pill cycle as described by Hammerstein.. Hair growth was measured using the clinical scale of Ferriman and Gallwey and by direct measurement of hair shaft diameter and linear growth of hair on the face, forearm, abdomen and thigh.. Thirty-eight women completed 12 months therapy, eight withdrew due to side-effects and 14 were lost to follow-up. All three dose schedules produced significant reductions in clinical hair growth scores. This reduction was seen after 6 months with Dianette alone (P less than 0.005) and after 3 months with both the higher doses (P less than 0.01). There were no significant differences between the effect of different doses at any of the three-monthly time points. Hair diameter measurements were reduced by all doses after 12 months: face by 27*, 37, 37%*, forearm 5, 10, 8%*, abdomen 22*, 39*, 33%*, thigh 12, 24*, 30%* (median reductions (*P less than 0.01) for Dianette, D + 20 mg CPA and D + 100 mg CPA respectively). There were no significant reductions in daily linear growth rates. A comparison of the percentage reduction in hair shaft diameter at each site demonstrated no significant difference between doses, although the reductions by the three doses on the forearm, abdomen and thigh suggested a trend towards a dose response.. We conclude that cyproterone acetate 2 mg daily appears to be as effective as higher doses in the therapy of hirsute women.

Topics: Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Double-Blind Method; Drug Administration Schedule; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans

The effects of oral administration of cyproterone acetate (CPA) (50 mg) associated with natural estrogens, was investigated in two groups of hirsute women. One group received 17-beta estradiol valerianate (E2) (2 mg) (n = 22) and the other, micronized E2 (2 mg) plus estriol (E3) (1 mg) daily (n = 22) for 21 days every month. After a six month period of treatment, hirsutism improved in 70% of the patients. The more frequent adverse effect was amenorrhea. Except in one, weight gain was prevented by a low calorie diet in overweight patients. During treatment, the plasma concentration of E2 was within the normal range for the follicular phase, whereas estrone was higher, and significantly (p less than 0.001) higher under E2 + E3 than under E2 alone (43.5 +/- 29.1 vs 23.9 +/- 6.1 ng/dl). The binding capacity of sex-steroid binding-protein (SBP) was increased by E2 + E3, and was not affected by E2; transcortin levels were unchanged during treatment. The plasma levels of SBP-unbound testosterone and of delta 4-androstenedione were significantly suppressed by CPA, while DHEAS was not significantly reduced. We concluded that oral administration of CPA and natural estrogens, is a well tolerated and efficient treatment of hirsutism.

Topics: Adolescent; Adult; Androgen Antagonists; Androstenedione; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Drug Therapy, Combination; Estradiol; Estriol; Female; Hirsutism; Humans; Sex Hormone-Binding Globulin; Testosterone; Transcortin

Thirty late-onset adrenal hyperplasia patients consulting for isolated hirsutism were randomly divided into two groups; group 1 (n = 16) was treated with hydrocortisone in order to suppress androgen adrenal secretion, and group 2 (n = 14) received cyproterone acetate (CPA) antiandrogen therapy to inhibit peripheral androgen activity. The clinical and hormonal effects of each type of treatment were evaluated. Before treatment, the clinical and hormonal profiles of the two patient groups did not differ significantly. Excellent clinical evolution in terms of the regression of hirsutism was observed in the CPA-treated patients (54% decrease in the clinical score in 1 yr), in contrast with the slight decrease in hirsutism (26%) after hydrocortisone treatment. In hydrocortisone-treated patients, plasma androgen decreased to normal levels: testosterone from 3.05 +/- 1.45 to 1.46 +/- 0.42 nmol/L and delta 4-androstenedione from 13.6 +/- 4.1 to 6.33 +/- 1.47 nmol/L. Conversely, in CPA-treated patients, only a slight decrease in testosterone from 2.98 +/- 1.98 to 2.29 +/- 0.64 nmol/L and in delta 4-androstenedione from 12.9 +/- 5.9 to 9.86 +/- 2.23 nmol/L was observed. This slight decrease in plasma androgens contrasts with the rapid clinical improvement after CPA. These results emphasize the importance of peripheral receptivity to androgens in the clinical expression of hyperandrogenism. Moreover, they indicate that peripheral antiandrogen therapy may be more appropriate in late-onset adrenal hyperplasia patients than conventional adrenal inhibition using cortisone therapy.

Topics: Adolescent; Adrenal Hyperplasia, Congenital; Adult; Androstenedione; Cyproterone; Cyproterone Acetate; Estradiol; Female; Hirsutism; Humans; Hydrocortisone; Testosterone

An open, randomized, multicenter study was carried out to compare two oral contraceptives as regards their therapeutic efficacy in androgenization symptoms such as acne, seborrhea and hirsutism in women. The preparations used were the combination of 2 mg cyproterone acetate (CPA) with 0.035 mg ethinyl estradiol (EE) (Diane 35, Schering AG, Berlin-West) and 0.150 mg desogestrel (DG) with 0.03 mg ethinyl estradiol (Marvelon, Organon, Oss, The Netherlands). The duration of therapy was 9 months. The combination of CPA-EE was used by 83 patients for 658 cycles and the combination of DG-EE by 79 women for 618 cycles. No pregnancy occurred under either therapy. Both preparations are well tolerated. However, some side-effects, such as reduced libido, nervousness and breast tenderness, were observed more frequently (p less than 0.05) in the DG-EE group than among the users of the CPA-EE combination. The therapeutic outcome was better in the CPA-EE group, especially in cases of facial acne (p less than 0.05). Seborrheic symptoms also responded better to the CPA-EE therapy. The results show that the CPA-EE combination is superior to the DG-EE combination in the treatment of acne and seborrhoea.

Topics: Acne Vulgaris; Adult; Breast; Contraceptives, Oral, Combined; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Desogestrel; Female; Hirsutism; Humans; Multicenter Studies as Topic; Norpregnenes; Randomized Controlled Trials as Topic

In patients with adrenal hirsutism or enzyme deficiencies in steroidogenesis, elevated adrenal androgens could be normalized by dexamethasone. We were interested to see if dexamethasone would be as effective as cyproterone acetate in treating hirsutism in selected patients with adrenal pathogenesis. Therefore 28 patients with hirsutism of adrenal origin or enzyme deficiency were treated cyclically either with cyproterone acetate and ethinylestradiol (2 mg cyproterone acetate + 0.035 mg ethinyl-estradiol days 1-21, +10 mg cyproterone acetate days 1-15) (n = 15) or with 0.25-0.5 mg dexamethasone daily at 10 pm (n = 13). In the dexamethasone group there was a significant drop in dehydroepiandrosterone and dehydroepiandrosterone sulfate levels within 9 months, but there was a diminution in hirsutism in only four women (31%); in four out of seven menstrual irregularities decreased. In the cyproterone acetate group hirsutism diminished significantly in 66% (n = 10) without suppression of adrenal androgens. Weight gain occurred in a few cases in both groups; other side effects developed in 33% in the cyproterone acetate group. Preselection of patients with hirsutism is useful with respect to diagnosis; adrenal pathogenesis should not generally indicate dexamethasone treatment of hirsutism unless there is a desire for pregnancy, because cyproterone acetate is a more powerful agent in reducing hair growth.

Topics: 3-Hydroxysteroid Dehydrogenases; Adrenal Hyperplasia, Congenital; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dexamethasone; Female; Gonadal Steroid Hormones; Hirsutism; Humans; Steroid Hydroxylases

Antiandrogens, preventing androgen action at target tissue level, are used in the treatment of various androgen-dependent diseases. Pharmacologically these substances have either a steroidal structure, like cyproterone acetate (CPA) and spironolactone (SPL), or a non-steroidal structure, like flutamide (FLU). In women with hyperandrogenism (PCO syndrome, idiopathic hirsutism, acne), clinical benefit may be obtained with CPA, which also displays a progestational activity and an antigonadotropic effect. CPA (25-50 mg/day) is used in combination with ethinyl-estradiol (EE) (20-30 micrograms/day) in reversed sequential regimen. SPL, less effective than CPA may be employed in moderate hirsutism and acne at dosages of 100-200 mg/day. During SPL treatment menstrual irregularities are frequent: in this case an association with oral contraceptives is indicated. SPL + bromocriptine (2.5-5 mg/day) has been experienced with success in PCO syndrome. The pure antiandrogen FLU, inducing progressive increase in LH and testosterone secretion, may be used only in combination with oral contraceptives. In men antiandrogens have been tested in BPH and prostatic carcinoma. In BPH the decrease in nuclear receptors and DHT nuclear content during CPA or FLU may represent the rational base of the medical treatment. An improvement in urinary obstructive manifestation has been observed with CPA alone or associated with tamoxifen (100 mg + 100 mg day). In advanced prostatic carcinoma antiandrogens represent a good alternative to estrogen therapy with less side effects and in combination with surgical or medical castration (LH-RH analogues) achieve a complete androgen blockade. An increase in the percentage of remissions and survival has been reported.

Topics: Acne Vulgaris; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Female; Flutamide; Hirsutism; Humans; Male; Prostatic Neoplasms; Spironolactone

The purpose of this study was to compare, by a randomized double-blind study, involving 30 women with either acne or mild hirsutism, the effects on plasma androgens and lipoproteins, of two hormonal preparations used in acne and ensuring reliable contraception, namely DianeR (cyproterone acetate 2 mg and ethinylestradiol 50 micrograms per pill - D-50) and Diane 35 (cyproterone acetate 2 mg and ethinylestradiol 35 micrograms per pill - D-35). Both drugs, used over a 6-month period (treatment cycle of 21 days with a pill-free interval of 7 days), induced an impressive decrease of free testosterone levels and of 5 alpha-androstane-3 alpha, 17 beta-diol-glucuronide, a parameter of peripheral androgen formation; also dehydroepiandrosterone sulfate levels decreased significantly. Except for an increase of both total T and dihydrotestosterone and as well as for a more important increase in SHBG levels during treatment with D-50, consequences of its more pronounced estrogen dominance in comparison to D-35, the effects of both drugs on androgen levels were similar. The effects on lipids were characterized by a non-significant increase of total cholesterol and a significant increase of HDL-C, HDL2-C and Apo-Al lipoproteins, which were somewhat more pronounced during D-50 treatment. Triglycerides increased significantly during D-50 but hardly during D-35 treatment, whereas HDL-C/LDL-C increased similarly during treatment with either drug. It is concluded that, being as efficient as D-50 in treatment of acne and hirsutism and taking into account its reliable contraceptive effects, without unfavourable effects, as far as atherogenesis is concerned, on plasma lipids, D-35 is to be preferred over D-50.

Topics: Acne Vulgaris; Adolescent; Adult; Androgens; Cyproterone; Cyproterone Acetate; Dose-Response Relationship, Drug; Double-Blind Method; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Lipids; Sex Hormone-Binding Globulin; Triglycerides

The clinical appearance of female idiopathic hirsutism and its pathophysiological aspects and the antiandrogen drugs in relation to the therapy of hirsutism are discussed. Two compounds have been widely employed, namely cyproterone acetate, mainly in the 'reverse sequential regimen', and spironolactone, with or without the association of a contraceptive pill containing cyproterone acetate and ethinylestradiol. The ability to compete with dihydrotestosterone in skin androgen receptors, shared by these two compounds, has led to excellent clinical results for many years. A topical antiandrogen therapy would be a further advantage for these patients.

Topics: 17-alpha-Hydroxyprogesterone; Adult; Androgen Antagonists; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estradiol; Ethinyl Estradiol; Female; Hirsutism; Humans; Hydroxyprogesterones; Prolactin; Spironolactone; Testosterone

We compared the efficacy and safety of cyproterone acetate (Shering AC, Berlin, FRG) at a low (Diane, 2 mg) or a high dose (Androcur, 100 mg) in the treatment of 158 patients with severe hirsutism. At baseline, no difference was observed in mean hirsutism total index (19.5 Diane versus 20.1 Androcur) or distribution (facial, bust, or abdomen). By the end of the study, patient loss in Diane and Androcur groups was 29.1% and 27.8%, respectively, and the mean percent difference in the scoring index was as follows: total, 24.6 Diane versus 30.8 Androcur, P less than 0.05; facial, 30.1 Diane versus 33.0 Androcur, P less than 0.10; bust, 12.1 Diane versus 31.2 Androcur, P less than 0.02; and abdomen, 20.1 Diane versus 31.2 Androcur, P less than 0.02. Except for breast tenderness (Diane greater than Androcur), amenorrhea, and weight gain, (Androcur greater than Diane), the incidence of side effects was comparable in both groups.

Topics: Adolescent; Adult; Amenorrhea; Body Weight; Breast Diseases; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Double-Blind Method; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Random Allocation; Time Factors

Low-dose hormonal contraceptives with specifically reduced estrogen are now the drug of choice for the prevention of internal risks. The antiandrogenic hormonal contraceptives have also had to be adapted to this situation. In a study involving 144 women, most of whom were suffering from moderately severe androgenization, Diane-35 (reduced to 0.035 mg ethinyl estradiol) was used as an antiandrogenically active hormonal contraceptive. From the sixth treatment cycle onward acne and seborrhea were significantly improved or already healed. In the 12th treatment cycle the treatment success rate was almost 90%. The side effects occurring with higher-dose hormonal contraceptives were reduced, cycle behavior was acceptable, and the incidence of metrorrhagia corresponded to that found with other micropills.

Topics: Acne Vulgaris; Adult; Alopecia; Androgen Antagonists; Clinical Trials as Topic; Contraceptives, Oral, Hormonal; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Menstrual Cycle; Middle Aged

Thirty-four patients with hirsutism were treated for 9 months with 100 mg cyproterone acetate (CA) given on days 5-15 of the menstrual cycle together with a combination oral contraceptive containing 2 mg CA and 50 micrograms ethinyloestradiol (Diane) given on days 5-25 of the cycle. After 9 months treatment patients were randomised to a 12 month double-blind cross-over trial comparing Diane plus 25 mg CA with Diane plus placebo, to test the efficacy of low-dose CA as maintenance therapy. Thirty-one patients (92%) experienced moderate or good subjective improvement in hirsutism on high-dose CA, associated with a 40% mean overall improvement in objective hirsutism grade and 13% overall reduction in hair growth rate measured by a photographic technique. Minor or moderate side effects were experienced by 64% of patients and severe side effects by 11% at this dosage. There was a mean subjective relapse rate of 33% when patients were changed to low dose CA, and relapse rates were not significantly different between the two regimens with 28% relapsing on 25 mg CA + Diane and 48% on placebo and Diane (P less than 0.05). Despite significant subjective relapse with low-dose treatment there was no significant deterioration in objective hirsutism grade or hair growth rate determined photographically. Levels of plasma testosterone, sex hormone binding globulin, free testosterone (derived) and androstenedione fell significantly on high dose CA and this reduction was maintained during low dose therapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adult; Androstenols; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Double-Blind Method; Drug Therapy, Combination; Ethinyl Estradiol; Female; Follow-Up Studies; Hirsutism; Humans; Sex Hormone-Binding Globulin; Testosterone

Topics: Adolescent; Adult; Androgen Antagonists; Androgens; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Hydrocortisone; Middle Aged

Topics: Adult; Androgen Antagonists; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans

The effects of cyproterone acetate (CA) administration on the pituitary-adrenal axis were studied in 30 hirsute females. The patients were treated continuously with a daily dose of 100 mg of CA for a maximal period of 12 months. Insulin-induced hypoglycaemia and ACTH infusion were performed on pre-treatment conditions and after 1, 4, 6 and 12 months of CA treatment. From a clinical point of view, a dramatic improvement of hirsutism was evident after 6 months of therapy. The most commonly reported side effects were amenorrhoea and transient uterine haemorrhage. Apart from asthenia, no symptoms of adrenal insufficiency were noticed. No changes in pituitary-adrenal secretion were observed during the first 4 months of therapy. From the 6th month, a reduction in basal as well as stimulated cortisol levels was seen. Simultaneously, an enhanced ACTH response to hypoglycaemia was observed. Both effects became more pronounced after 1 year of treatment. There were no significant changes in ACTH basal values. Six months after discontinuation of the drug, adrenocortical reserve improved but was still slightly reduced when compared to pre-treatment range at that time. These findings suggest a time-dependent negative effect of CA on adrenal steroidogenesis which shows a reversible character 6 months after antiandrogen withdrawal. Therefore, steroid cover should be considered for intercurrent illness in patients treated for longer than 6 months with this therapeutic regime.

Topics: Adrenocorticotropic Hormone; Adult; Blood Glucose; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Hydrocortisone; Insulin; Pituitary-Adrenal System; Time Factors

Cyproterone acetate (CPA) in association with percutaneously administered estradiol has been used for the treatment of 150 hirsute patients for periods ranging from 6 months to 3 years. A spectacular clinical improvement ensued. Plasma testosterone (T) and androstenedione (A) fell from 69.0 +/- 24 to 33.0 +/- 8 and 210 +/- 103 to 119 +/- 25 ng/dl (mean +/- SD) respectively after 3 months of treatment and remained low thereafter. In contrast, T glucuronide (TG) and 3 alpha-androstanediol (Adiol) remained high during the whole course of treatment: 37 +/- 9 and 115 +/- 43 micrograms/24 h respectively. In vitro T 5 alpha-reductase activity (5 alpha-R) in pubic skin decreased from 147 +/- 34 to 79 +/- 17 fmol/mg skin after 1 year of treatment. To elucidate the discrepancy between plasma and urinary androgens levels, T production rate (PR) and metabolic clearance rate (MCR) were measured with the constant infusion technique in 7 patients before and after 6 months of treatment. PR decreased from 988 +/- 205 to 380 +/- 140 micrograms/24 h (mean +/- SD). In contrast MCRT increased from 1275 +/- 200 to 1632 +/- 360 1/24 h; this increase in MCRT explains the striking plasma T concentration fall and the high TG and Adiol excretion relative to the decrease in PR. Antipyrine clearance rate (n = 8) increased from 36.3 +/- 5.2 to 51.5 +/- 7.4 ml/min whereas 6 beta hydroxycortisol remained unchanged. In conclusion, CPA acts through several mechanisms: (1) it lowers the androgen input to the target cells by (a) depressing T production through its antigonadotropic effect and (b) accelerating T metabolic inactivation due to a partial enzymatic inducer effect on the liver; (2) at the target cell level it competes with any remaining T for the receptor binding sites; (3) the decrease in the androgen-dependent skin 5 alpha-R is a consequence of both actions of androgen suppression and androgen receptor blockade; it reinforces the antiandrogenic effect of CPA.

Topics: 3-Oxo-5-alpha-Steroid 4-Dehydrogenase; Androgen Antagonists; Androgens; Androstenedione; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Female; Follow-Up Studies; Hirsutism; Humans; Reference Values; Skin; Testosterone

The review discusses (1) the relationship between the endocrine actions of antiandrogens and their therapeutic efficacy and (2) recent chemical and pharmacokinetic data on cyproterone acetate (CPA). It also provides (3) a comparison of CPA and spironolactone regarding the tentative benefits and risks and offers (4) general rules for the drug treatment of androgenized women. Clinical results indicate that those agents are most effective which not only competitively inhibit androgen binding at the receptor level but also suppress androgen secretion and/or production. The combined mode of action is observed with CPA as well as spironolactone. Pharmacokinetic studies underline the necessity to restrict CPA administration in huge doses to the first half of a treatment cycle in order to avoid bleeding disturbances. Also it appears that individual differences in CPA bioavailability do not satisfactorily explain the lack of therapeutic response in about 30% of the cases. Data are presented hinting that the 15 beta-hydroxy-, metabolite of CPA may actually be the biologically active agent. In addition preliminary results are given indicating that intramuscular CPA is therapeutically more effective than oral CPA.

Topics: Acne Vulgaris; Androgen Antagonists; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Progestins; Spironolactone; Structure-Activity Relationship; Testosterone

Topics: Adult; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Female; Follow-Up Studies; Hirsutism; Humans; Middle Aged; Polycystic Ovary Syndrome

Topics: Adolescent; Adult; Clinical Trials as Topic; Cyproterone; Cyproterone Acetate; Estradiol; Female; Hirsutism; Humans; Menstruation; Thyroxine

Topics: Acne Vulgaris; Androgen Antagonists; Chlormadinone Acetate; Clinical Trials as Topic; Cyproterone; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Hirsutism; Humans; Mestranol; Skin Diseases

The combination of 2 mg cyproterone acetate, a pronounced antiandrogenic substance, in combination with 0.05 mg ethinyl estradiol has undergone intensive multiphasic clinical evaluation. The preparation with the trade name Diane has proven to be not only a reliable contraceptive, but also a very potent drug for the treatment of both acne and seborrhea, and of milder cases of hirsutism. The effect of Diane on markedly increased hair growth was not so pronounced. In addition to the presentation of the most pertinent steps of the clinical investigation of Diane, the possible mode of actions of antiandrogens alone and in combination with an estrogen is discussed.

Topics: Acne Vulgaris; Adolescent; Adult; Chemical Phenomena; Chemistry; Clinical Trials as Topic; Contraceptives, Oral; Contraceptives, Oral, Combined; Cyproterone; Cytosol; Dermatitis, Seborrheic; Double-Blind Method; Drug Combinations; Drug Evaluation; Ethinyl Estradiol; Female; Hirsutism; Humans; Norgestrel; Ovulation; Pregnancy; Random Allocation; Receptors, Progesterone; Testosterone

Topics: Acne Vulgaris; Androgen Antagonists; Clinical Trials as Topic; Cyproterone; Drug Combinations; Estrogens; Female; Hirsutism; Humans; Progestins

Topics: Acne Vulgaris; Adult; Aged; Androgen Antagonists; Clinical Trials as Topic; Cyproterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Male; Middle Aged; Nitrogen; Polycystic Ovary Syndrome

Treatment of virilization symptoms in 230 patients is reported. 68 patients were treated with Planovin (4 mg megestrol acetate and .05 mg ethinyl estradiol), 77 with SH81041 (100 mg Cyproterone acetate for 10 days and .05 mg ethinyl estradiol for 21 days), and 85 were treated first and Planovin and then with SH81041. Acne, seborrhea, hirsutism, and alopecia improved under treatment with each preparation; results were similar with acne and alopecia, while SH81041 was somewhat more effective than Planovin in treating seborrhea and hirsutism. Therapeutic results obtained during treatment with SH81041 in acne and alopecia are retained during Planovin treatment, but seborrhea and hirsutism become worse again. Successful treatment was independent of the severity of hirsutism and the duration of of treatment. Side effects included breakthrough bleeding and sweating.

Topics: 17-Ketosteroids; Acne Vulgaris; Adolescent; Adult; Alopecia; Androgen Antagonists; Clinical Trials as Topic; Cyproterone; Dermatitis, Seborrheic; Ethinyl Estradiol; Female; Hirsutism; Humans; Megestrol; Virilism

Using anti-androgenic contraception is one of the methods of birth control. It also has a significant, non-contraceptiveimpact on women's body. These drugs can be used in various endocrinological disorders, because of their abilityto reduce the level of male hormones.The aim of our study is to establish a correlation between taking different types of anti-androgenic drugs and intensity ofhirsutism, acne, menstrual pain intensity and sexuality.. 570 women in childbearing age that had been using oral contraception for at least three monthstook part in our research. We examined women and asked them about quality of life, health, direct causes and effects ofthat treatment, intensity of acne and menstrual pain before and after. Our research group has been divided according tothe type of gestagen contained in the contraceptive pill: dienogest, cyproterone, chlormadynone and drospirenone. Additionally,the control group consisted of women taking oral contraceptives without antiandrogenic component.. The mean age of the studied group was 23 years ± 3.23. 225 of 570 women complained of hirsutism.The mean score for acne intensity before the use of contraception was 2.7 ± 1.34. The mean score for acne intensity after3 months of using contraception was 1.85 ± 1.02 (p < 0.001). 192 women reported excess hairiness in one or more areabefore treatment. Mean value based on Ferriman-Gallway scale before the treatment was 6.23 ± 6.21 and 5.39 ± 5.6 afterthe treatment (p < 0.001).. All groups of drugs effectively reduced pain and acne severity. Cyproterone and drospirenone turned outas the most effective drugs in treating hirsutism. Surprisingly, according to our research, dienogest does not have anyimpact on body hairiness.

Topics: Acne Vulgaris; Adult; Androgen Antagonists; Androstenes; Contraceptives, Oral; Cyproterone; Dysmenorrhea; Female; Hirsutism; Humans; Prospective Studies; Quality of Life; Sexuality; Young Adult

Following a European review, products containing the ethinylestradiol + cyproterone combination are back on the French market for women with acne (as second-line treatment) or hirsutism. Yet experience has shown that frequent off-label prescription of this combination for contraceptive purposes exposes many women to an unjustified risk of thromboembolism.

Topics: Acne Vulgaris; Cyproterone; Ethinyl Estradiol; Hirsutism; Humans; Off-Label Use; Thromboembolism

We have developed a non-isotopic TR-FIA for Cyproterone acetate and Cyproterone in plasma. Synthesis of the biotinylated tracers, biotinylated Cyproterone acetate, and Cyproterone, as well as the preparation of anti-Cyproterone acetate and anti-Cyproterone antisera are reported. The specificity of anti-Cyproterone acetate antiserum resulting from the coupling of link bridge (link bridge between steroid and BSA), on the 3-position on the steroid skeleton, allowed to carry out the Cyproterone acetate assay directly on extracted plasma (without chromatography). On the other hand Cyproterone assays require a purification step, including extraction plus chromatography, because the plasma Cyproterone acetate concentrations in Cyproterone acetate-treated women are 200 times higher than for Cyproterone. Theses plasma TR-FIA of Cyproterone acetate and Cyproterone presented the advantage of needing only small doses of radioactivity for recovery controls, and better practicability related to the only existing RIA described to date.

Topics: Acne Vulgaris; Animals; Antibody Specificity; Blood Chemical Analysis; Cyproterone; Cyproterone Acetate; Female; Fluoroimmunoassay; Hirsutism; Humans; Rabbits; Reference Standards; Sensitivity and Specificity

Antiandrogens have been found to be effective in the treatment of acne and hirsutism. Cyproterone acetate has been used in Europe for many years, but in the United States it has only been approved as an orphan drug to treat severe hirsutism. Spironolactone is approved in the United States for its antialdosterone effect but not for its antiandrogenic effect, although it is widely used for the latter purpose. While cyproterone is a more effective drug than spironolactone, it is more likely to produce undesirable side effects.

Topics: Acne Vulgaris; Cyproterone; Hirsutism; Humans; Spironolactone

A retrospective analysis of 21 hirsute women seen at a gynaecological endocrine clinic revealed a high incidence of infertility, menstrual irregularities and abnormal androgen profile. Polycystic ovarian syndrome (PCOS) was the underlying abnormality in the majority of cases. Cyproterone acetate (CPA) with ethinyl oestradiol in a reverse sequential regime was more effective and better tolerated but much more expensive than the combination of spironolactone and the oral contraceptive pill (OCP).

Topics: Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Retrospective Studies; Spironolactone; Trinidad and Tobago

Sixty-nine patients who had Ferriman/Gallwey hirsutism scores (FG) of greater than or equal to 8 were treated with Diane, an anovulant containing cyproterone acetate, 2 mg, an anti-androgenic progesterone and ethinyl oestradiol, 5.0 micrograms. Twenty-one of these had been previously treated with dexamethasone (DEX) and did not respond, i.e. FG greater than 50% of pre-treatment value. Prior to Diane treatment, plasma total testosterone (T) values, 1.4 +/- 0.5 nmol/l, mean +/- S.D., were similar to those in 43 normal women, 1.23 +/- 0.3 nmol/l, as were plasma androstenedione levels, 6.8 +/- 2.5 and 6.0 +/- 1.7 nmol/l respectively. However, plasma sex hormone-binding globulin (SHBG) values were suppressed being 36.2 +/- 16 nmol/l in hirsute women and 45.8 +/- 15 nmol/l in normal women, p less than 0.01. The T/SHBG ratio, an index of free testosterone, was elevated in hirsute women, 4.8 +/- 4.1, compared to values in normal women, 2.9 +/- 1.0, p less than 0.001. Following Diane therapy (2-24 months), 73% of patients responded clinically. There was no change in T, but SHBG was increased to 181 +/- 54 nmol/l, p less than 0.001 and T/SHBG was decreased markedly to 0.9 +/- 0.4, p less than 0.001. Androstenedione fell also to 4.8 +/- 1.7 nmol/l, p less than 0.001. The clinical and hormone response to Diane was similar in both DEX-resistant and previously untreated groups. We conclude that Diane is an effective agent in the treatment of hirsutism while it avoids the adverse effects of androgenic progesterone and of high dose cyproterone acetate therapy.

Topics: Androgen Antagonists; Androstenedione; Cyproterone; Cyproterone Acetate; Dexamethasone; Drug Combinations; Ethinyl Estradiol; Female; Follow-Up Studies; Hirsutism; Humans; Testosterone

Twenty-four hirsute women were treated with an inversal sequential scheme of cyproterone acetate, 50 mg/d by oral route from the 1st to the 15th day of the menstrual cycle, along with 100 micrograms/24 h of 17 beta-estradiol transdermally administered from days 1 to 21, for nine cycles at weekly intervals. The acne and seborrhea as well as hirsutism showed a significant improvement in all subjects studied. The plasma testosterone and dehydroepiandrosterone sulfate decrease from 1.5 +/- 1.3 ng/mL and 6.9 +/- 1.3 micrograms/mL to 0.5 +/- 0.03 ng/mL and 2.7 +/- 1.7 micrograms/mL, respectively. Similar values were observed in subjects with idiopathic hirsutism during the treatment. The metabolic parameters, as well as the plasma levels of sex hormone-binding globulin, appeared unaffected by the therapy. Furthermore, the luteinizing hormone and follicle-stimulating hormone secretion was strongly inhibited from the first cycle of treatment. In conclusion, considering the good clinical results and the avoidance of any hepatic effect, this association should be taken into account in the treatment of hirsutism, especially in case of oral estrogen intolerance.

Topics: Administration, Cutaneous; Administration, Oral; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Estradiol; Female; Hirsutism; Humans; Middle Aged; Sex Hormone-Binding Globulin; Testosterone

Serum 5 alpha-androstane-3 alpha,17 beta-diolglucuronide (3 alpha-AdiolG) levels were measured and the degree of hirsutism was scored in female outpatients complaining of excessive hair growth before and during treatment with cyproterone acetate. In a group of 16 patients with idiopathic hirsutism and in a group of 9 patients with either polycystic ovary syndrome and hirsutism or 21-hydroxylase deficiency and hirsutism, the serum 3 alpha-AdiolG levels were significantly increased (p less than 0.01) as compared with the serum 3 alpha-AdiolG level in a control group of 13 apparently healthy women: 3 alpha-AdiolG levels, median (range), being 5.3 (2.3-7.8) nmol/l, 8.5 (4.1-10.4) nmol/l, and 2.9 (1.5-5.2) nmol/l, respectively. In contrast to a previous report, no correlation was found between the serum 3 alpha-AdiolG levels and the Quetelet Index (N = 18, R = 0.42, p greater than 0.05), indicating an apparent ineffectiveness of the excessive androgen turnover in fat tissue. The use of the anti-androgen drug cyproterone acetate alone or in combination with ethinylestradiol in reverse sequential therapy did lower the 3 alpha-AdiolG levels significantly (p less than 0.01) together with a significant decrease (p less than 0.01) in hirsutism score. From the results of this study we therefore conclude that 3 alpha-AdiolG can be used as a parameter for peripheral androgen action before and during treatment with anti-androgens.

Topics: Androgen Antagonists; Androgens; Androstane-3,17-diol; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Polycystic Ovary Syndrome

We investigated whether plasma androstanediol glucuronide (ADG) levels reflect the increased androgenicity in women with idiopathic hirsutism (n = 24) or hirsutism associated with polycystic ovary syndrome (n = 10). We also evaluated whether ADG levels parallel the clinical evolution of the hirsutism during a combined treatment, with cyproteroneacetate (2 mg) and ethinylestradiol (35 micrograms), of women with moderate idiopathic hirsutism. Finally, we investigated if there is evidence for increased conversion of precursors to ADG in hirsutism, by comparing the ADG levels, measured by RIA, to ADG levels obtained by applying the conversion rates of precursors obtained in non-hirsute women. ADG levels were increased in less than half of the patients with mild hirsutism. The clinical cure of hirsutism, which was obtained by the treatment in majority of patients, was accompanied by a significant decrease of plasma ADG levels, but a similar decrease was also observed in the 5 patients who did not respond to treatment. The data show that, although there is evidence for increased conversion of precursors to plasma ADG in mildly hirsute women, the latter is not a reliable parameter of androgenicity. Our data suggest, moreover, that treatment with cyproterone acetate and ethinylestradiol decreases 5 alpha-reductase activity, as indicated by the more important decrease in ADG levels than in the precursors.

Topics: Adult; Androgen Antagonists; Androstane-3,17-diol; Biomarkers; Cyproterone; Cyproterone Acetate; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged; Polycystic Ovary Syndrome

The usefulness of antiandrogenic therapy with cyproterone acetate for androgenisation signs and symptoms in women, when tumours are definitely not the cause, has now been confirmed world-wide in about 100,000,000 therapy cycles using the hormonal contraceptive Diane and its follow-up preparation Diane-35, which contains a lower level of oestrogen. Nowadays, low-dose hormonal contraceptives are preferred in order to minimise the so-called "internal" risk by reducing the level of the oestrogen component and, by careful selection of the progestin, minimising the residual androgenic effect. In an open study on 150 women with moderately severe symptoms of androgenisation, we assessed, for treatment periods of up to 36 cycles, the effect of the only oestrogen-reduced hormonal contraceptive with anti-androgenic activity (Diane-35), and also monitored biochemical parameters, which are indicative of high risk metabolic activity and permit an accurate characterisation of the hormonal contraceptive, especially with long-term use. Although the parameters of liver and fat metabolism occasionally yielded values close to the limit of the normal range, it was particularly favourable to note, that the lipoprotein fraction HDL exhibited a slightly rising tendency, whereas, at the same time, the LDL fraction dropped. Special attention has been paid to ultrasonographic monitoring of the liver, since the influence on the function of this organ has been frequently discussed in conjunction with prolonged use of 17-alpha-alkylated steroidal compounds, and because a possible connection between sex steroids and the development of liver tumours has been a point of discussions.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Acne Vulgaris; Adolescent; Adult; Androgen Antagonists; Cholesterol, HDL; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Female; Follow-Up Studies; Hirsutism; Humans; Lipids; Liver Function Tests; Long-Term Care; Menstrual Cycle; Middle Aged

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Administration Schedule; Female; Hirsutism; Humans

Cyproterone acetate given as a single intramuscular dose of 300 mg monthly for 6 months resulted in significant reduction of hirsutism without appreciable side effects. This regimen resulted in decreased levels of luteinizing hormone (LH) and estradiol in the eight women studied. No significant changes were observed in total serum testosterone (T) levels, however, there was a reduction in sex hormone binding globulin (SHBG), resulting in lowered SHBG-bound T, and an increase in non-SHBG-T over this time. Serum androstanediol glucuronide levels decreased in three of four women, although not to normal levels.

Topics: Adolescent; Adult; Albumins; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dose-Response Relationship, Drug; Female; Hirsutism; Humans; Sex Hormone-Binding Globulin; Testosterone

In the syndrome of familial virilization, insulin resistance, and acanthosis nigricans, the interrelationships are not understood. Twin sisters were studied, along with a lesser affected sister and mother. They manifested amenorrhea, hirsutism, masculinization, hypertension, hyperinsulinemia, hypertriglyceridemia, and hyperprolactinemia. Medical therapy with a gonadotropin-releasing hormone agonist plus an antiandrogen resulted in reversal of the hirsutism, yet with preservation of potential fertility. In response to luteinizing hormone (LH) and follicle-stimulating hormone suppression, there was normalization of the serum androgens, but not of the hyperinsulinemia, hypertriglyceridemia, hyperprolactinemia, hypertension, or acanthosis nigricans.. (1) This syndrome may be familial. (2) Medical therapy for the virilization is successful. (3) The hyperandrogenemia is primarily LH dependent and not primarily insulin dependent, although insulin may have an amplification effect. (4) Hyperinsulinemia, hypertriglyceridemia, hyperprolactinemia, and the hypertension are not androgen dependent.

Topics: Acanthosis Nigricans; Adult; Androgen Antagonists; Antineoplastic Agents; Cyproterone; Cyproterone Acetate; Dexamethasone; Diseases in Twins; Family Health; Female; Follicle Stimulating Hormone; Gonadotropin-Releasing Hormone; Hirsutism; Humans; Hyperinsulinism; Hyperlipidemias; Hyperprolactinemia; Hypertension; Insulin Resistance; Leuprolide; Luteinizing Hormone; Male; Pituitary Hormone-Releasing Hormones; Syndrome; Virilism

Forty hyperandrogenemic women were investigated in order to determine whether the source of androgen excess could be attached to a dysfunction of the ovary or the adrenal cortex with a higher degree of accuracy when both steroid-producing organs were subjected to a supposedly specific suppression test. Dexamethasone (DXM) was administered at a dose of 2 mg for 2 days. The ovary-suppression test (OST) was carried out after a combined preparation containing 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (EE-CPA) had been taken for 2-3 weeks. Before and after the tests, the serum levels of testosterone (T), free testosterone (fT), DHEA-S and SHBG were determined. Serum T was lowered by DXM and EE-CPA to the same degree: the latter was more effective with respect to fT. DHEA-S responded much better to DXM than to EE-CPA. The basal level of SHBG was below the lower limit of the norm in 45% of the women. This indicates that hyperandrogenemia can be associated with normal and subnormal levels of SHBG. T and/or fT were elevated in all 40 women. DHEA-S was higher than normal in only 22 of the 40. DXM normalized the DHEA-S level in all but 1 case. In another 18 women, serum T and fT remained unaffected by DXM. This indicates an ovarian source of androgen excess in these cases. The number of cases was reduced from 18 to 4 when the OST was carried out. Even though DXM and EE-CPA are not completely organ-specific in action, the combination of both suppression tests seems to allow a higher degree of discrimination to be made between an ovarian and an adrenal component of hyperandrogenemia than is possible with either test alone.

Topics: Adolescent; Adrenal Glands; Adult; Androgens; Body Mass Index; Body Weight; Cyproterone; Cyproterone Acetate; Dexamethasone; Ethinyl Estradiol; Female; Hirsutism; Humans; Oligomenorrhea; Ovary; Progesterone; Regression Analysis; Sex Hormone-Binding Globulin; Testosterone

Topics: Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Sexual Behavior

This study evaluates the effect of therapy over a long period of time (36 cycles without interruption) with the monophasic combination containing 0.035 mg of ethinylestradiol and 2 mg of cyproterone acetate (EE35-CPA) on hormonal and clinical parameters of 66 patients with polycystic ovary syndrome (PCOS). During the administration of the pill a significant decrease in the LH/FSH ratio and in adrenal and ovarian androgens has been observed, as well as a significant increase of the Sex Hormone Binding Globulin (SHBG). The progressive decrease of the total androgenic activity explains the clinical results that have been obtained: at the 36th cycle of therapy acne disappeared in 100% of the cases, seborrea in 76.4% and hirsutism in 75%. Our results underline the need for a continuous administration without interruption of the pill with CPA in patients with clinical hyperandrogenic symptoms.. This study evaluated the effect of therapy over a long period of time (36 cycles without interruption) with the monophasic combination containing 0.035 mg ethinyl estradiol and 2 mg cyproterone acetate (EE35-CPA) on hormonal and clinical parameters of 66 patients with polycystic ovary syndrome. During the administration of the pill, a significant decrease in the LH/FSH ratio and in adrenal and ovarian androgens has been observed, as well as a significant increase in sex hormone binding globulin. The progressive decrease in total androgenic activity explains the clinical results that have been obtained--at the 36th cycle of therapy, acne disappeared in 100% of the cases, seborrhea in 76.4%, and hirsutism in 75%. These results underline the need for continuous administration of the pill with CPA without interruption in patients with clinical hyperandrogenic symptoms.

Topics: Acne Vulgaris; Adult; Alanine Transaminase; Alkaline Phosphatase; Analysis of Variance; Androgen Antagonists; Androstenedione; Aspartate Aminotransferases; Bilirubin; Blood Glucose; Cholesterol; Contraceptives, Oral, Combined; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Liver; Luteinizing Hormone; Ovary; Polycystic Ovary Syndrome; Prolactin; Sex Hormone-Binding Globulin; Testosterone; Triglycerides

Two young girls with hirsutism and premature pubarche showed nonclassical 3 beta-hydroxysteroid dehydrogenase (3 beta-HSD) deficiency. Post-ACTH increased serum delta 5-17-hydroxypregnenolone and increased ratio of delta 5-17-hydroxypregnenolone/17-hydroxyprogesterone are the most sensitive indicators of nonclassical 3 beta-HSD deficiency. Nonclassical 3 beta-HSD deficiency may not be uncommon, but most cases may have gone unrecognized. Routine assay of delta 5-17-hydroxypregnenolone should be made generally available.

Topics: 17-alpha-Hydroxypregnenolone; 17-alpha-Hydroxyprogesterone; 3-Hydroxysteroid Dehydrogenases; Androstenedione; Child; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Female; Hirsutism; Humans; Hydroxyprogesterones; Paramethasone; Puberty, Precocious

22 female patients suffering from idiopathic hirsutism were treated according to Hammerstein's reversed sequential scheme over 12 months. During each treatment cycle of 21 days, the daily medication consisted of 1 coated tablet containing 0.035 mg ethinyl estradiol and 2 mg cyproterone acetate (Diane-35); in addition, the patients received one i.m. injection of 300 mg cyproterone acetate (Androcur-Depot) on the first day of each cycle. This therapy resulted in improvement of the disease in 19 of our patients (86.4%). The transitory, mild side effects observed did not require interruption of the treatment. The reversed sequential scheme making use of the depot form of CPA can successfully be administered in patients with hirsutism.

Topics: Administration, Oral; Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Administration Schedule; Drug Combinations; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Injections, Intramuscular

Topics: Cyproterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Polycystic Ovary Syndrome

Topics: Androgen Antagonists; Cyproterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans

This study evaluates the effect of an oral contraceptive containing 35 micrograms of ethinyl estradiol and 2 mg of cyproterone acetate (Diane-35) on hormone dynamics, clinical signs of androgenization and ovarian size in patients with polycystic ovary syndrome (PCOS). Forty-six patients with PCOS were treated with Diane-35 for between 9 and 30 cycles without interruption (a total of 688 cycles). Clinical and hormonal evaluations were performed before treatment and every 3rd cycle during the treatment period while ultrasonographic assessment of ovaries was carried out every 6th cycle. A highly significant decrease in the LH/FSH ratio (p less than 0.001) as well as testosterone levels (p less than 0.001) was noticed after the 3rd cycle of Diane-35 administration. The mean serum androstenedione level decreased significantly (p less than 0.025) after the 3rd cycle, and showed a lowering trend thereafter. A significant reduction in serum DHEA-S levels was observed after the 6th cycle of treatment and they also showed a subsequent lowering trend. A highly significant increase in SHBG concentrations (p less than 0.001) was noticed after the 3rd cycle. Most of the patients noticed improvement in hirsutism between the 8th and 12th cycles of treatment. Mean ovarian size decreased significantly (p less than 0.001) after the 6th cycle, the normal size being reached after the 12th cycle of treatment. After the 4th cycle treatment was discontinued in 1 patient due to secondary amenorrhea, and in another 3 patients because of an increase in diastolic blood pressure. In a few patients side-effects such as weight gain, breast tenderness and mood changes in mild form were reported. Three out of 7 patients conceived in the 2nd or 3rd cycle after discontinuing Diane-35 therapy. The results of this study show that a combination of low-dose estrogen and cyproterone acetate (Diane-35) successfully reduces the hormonal disturbances which characterize PCOS. Apart from the normalization of the hormonal profile and the decrease in ovarian size, beneficial effects of Diane-35 were also observed on acne, hirsutism and regulation of the menstrual cycle. Favourable effects were also seen in terms of the pregnancy rate after discontinuation of Diane-35 therapy.

Topics: Adolescent; Adult; Androgen Antagonists; Androgens; Cyproterone; Cyproterone Acetate; Drug Combinations; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Ovary; Polycystic Ovary Syndrome; Sex Hormone-Binding Globulin

To investigate a possible relationship between lymphocyte H-Y antigen expression and plasma androgen concentrations in hirsute women, 27 hirsute women were studied. A significant increase in the percentage of H-Y-positive lymphocytes was found in both hirsute women with idiopathic hirsutism [13.4 +/- 2.9% (+/- SD); n = 15] and hirsute women with the polycystic ovary syndrome (13.0 +/- 2.8%; n = 12) compared to that in normal women (10.0 +/- 1.9%; n = 30; P less than 0.0005). Plasma testosterone and androstenedione concentrations, % H-Y+ lymphocytes, and hirsutism scores diminished during oral cyproterone acetate (50 mg/day) and percutaneous estradiol (3 mg/day) treatment. Significant correlations between % H-Y+ lymphocytes and hirsutism scores (P less than 0.001), % H-Y+ lymphocytes and plasma T concentrations (P less than 0.01) were found. We conclude that 1) women can produce H-Y antigen in the same way as men; 2) hirsutism is associated with an increase in H-Y antigen; and 3) the antiandrogen cyproterone acetate reduces H-Y antigen expression on lymphocytes.

Topics: Adult; Androstenedione; Animals; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Estradiol; Female; H-Y Antigen; Hirsutism; Humans; Lymphocytes; Mice; Testosterone

Topics: Androgen Antagonists; Androgens; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Menstrual Cycle

Testosterone-estradiol binding globulin (TeBG) was studied in 50 hirsute women, before and after 6-month treatment with cyproterone acetate (CPA). 50 mg CPA was administered orally from the 5th to the 25th day of the menstrual cycle and combined with 3 mg 17 beta-estradiol (E2) administered percutaneously from days 16-25 of the cycle. TeBG was evaluated by a filter assay measuring [3H]-DHT binding capacity. Before treatment, the mean plasma TeBG level was 40 +/- 12 nM in hirsute patients, which is significantly lower than TeBG value in normal women (60 +/- 9 nM, n = 20, P less than 0.01) and intermediate between normal women and normal men (30 +/- 8 nM, n = 20). After a 6-month treatment, TeBG strikingly decreased to 22 +/- 8 nM, which is significantly lower than pretreatment values (P less than 0.01) and even less than TeBG level in normal men. Parallel TeBG assay by immunoelectrodiffusion in 8 of these hirsute patients provided similar results. With this treatment, plasma testosterone and delta 4-androstenedione, measured between the 20th and 25th days of the cycle, decreased from 68 +/- 21 to 25 +/- 8 ng/dl, and 210 +/- 95 to 98 +/- 31 ng/dl respectively. Plasma estradiol decreased from 150 +/- 62 pg/ml to 75 +/- 25 pg/ml. In contrast, urinary 3 alpha-androstanediol glucuronide remained high: 112 +/- 51 and 123 +/- 55 micrograms/24 h respectively before and with CPA treatment. Three mechanisms have been proposed to explain TeBG decrease under CPA + E2perc. treatment (1) relative competition of CPA with labelled DHT in the TeBG-binding capacity assay, (2) relative hypoestrogenism with this treatment, (3) a progestagen or even a partial agonistic androgen effect of CPA on TeBG synthesis in the liver. The third mechanism appears to be predominant. In any case. TeBG decrease combined with the partial enzymatic induction effect of CPA on the liver contributes to the increase in the metabolic clearance rate of T and the high urinary Adiol levels previously reported with CPA treatment.

Topics: Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estradiol; Female; Hirsutism; Humans; Sex Hormone-Binding Globulin

Topics: Adolescent; Adult; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Sex Hormone-Binding Globulin; Testosterone

Sexual activity was evaluated in 51 women with hirsutism associated with increased levels of circulating androgens before and while on combined treatment with the antiandrogen cyproterone acetate (CA) and ethinyl estradiol (EE2) and compared to a reference group of 52 subjects. The percentage of unbound testosterone (T) was higher (p less than 0.001), the coital frequency lower (p less than 0.05), and the masturbation frequency higher (p less than 0.04) in hirsute women. Mean frequency of total activity (coitus plus masturbation) was similar in the two groups. Treatment with combination of CA and EE2 resulted in a decline of unbound T (p less than 0.001). There was no change of total sexual activity, but coital frequency increased (p less than 0.05) and masturbation frequency declined (p less than 0.04). It is concluded that raised levels of circulating androgens, as judged by free T concentration, are not of crucial importance in the expression of sexual behavior in hirsute women.

Topics: Adolescent; Adult; Coitus; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Masturbation; Sex Hormone-Binding Globulin; Sexual Behavior; Testosterone

Hematological parameters were studied in female patients receiving reverse-sequential anti-androgen therapy for hirsutism and acne. A significant fall in hemoglobin, total red cell count and packed cell volume occurred after 3-month treatment in 30 patients during the 10-day cyproterone acetate and ethinyl estradiol phase; this change was sustained in 14 patients studied to 12 months. A fall in hemoglobin and packed cell volume alone occurred after 3 months in 31 patients in the ethinyl estradiol phase. Reverse-sequential therapy may influence hemopoiesis by its anti-androgenic action on erythropoiesis, although we found no relationship between changes in hematological parameters and total testosterone levels.

Topics: Acne Vulgaris; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Erythrocyte Count; Ethinyl Estradiol; Hematocrit; Hemoglobins; Hirsutism; Humans; Prospective Studies; Testosterone

Eighteen hirsute women (8 with polycystic ovarian syndrome, 10 with idiopathic hirsutism) were treated for up to 12 months with cyproterone acetate, 150 mg daily, and ethinyl oestradiol, 50 micrograms on days 5-25 of the menstrual cycle. Hair growth rate and density were measured from standardized serial photographs of a shaved skin area. A significant reduction was seen in mean hair growth rate, total plasma testosterone, free testosterone index, plasma dehydroepiandrosterone, and plasma androstenedione. LH and FSH also fell and sex hormone binding globulin level increased. No significant changes occurred in hair density or in serum PRL levels. A significant correlation was observed between hair growth rate and total plasma testosterone for the pooled results (r = 0.35, P less than 0.005). No significant correlations were seen between hair density and the endocrine parameters studied.

Topics: Adult; Androgens; Androstenedione; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hair; Hirsutism; Humans; Luteinizing Hormone; Sex Hormone-Binding Globulin; Testosterone; Time Factors

Topics: Acne Vulgaris; Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans

Topics: Androgen Antagonists; Cyproterone; Estrogens; Female; Glucocorticoids; Hirsutism; Humans; Spironolactone

A comparative study has been performed in order to evaluate the relative potency of Diane and Aldactone in reducing hair growth as well as the effect on blood hormone concentrations. Thirty-six women participated in the study and depending on the desire for contraception, 22 were treated with Diane and 14 with Aldactone. The results show that Aldactone (50 mg per day) had little effect on hormone concentrations, only LH was significantly reduced after 12 months of treatment. Despite the lack of effect on hormone levels, all 14 women reported reduced hair growth and after 5 months of treatment, 58% also reported a decrease in the formation in new hair growth. In contrast to the Aldactone treated group, the women on Diane medication demonstrated a marked decrease in circulating hormone levels with a subsequent effect on the hair parameters. The clinical effects were, however, not quite of the same degree as those seen with Aldactone treatment. Approximately 20% exhibited no response for any of the 3 hair-parameters (reduced hair growth, formation of new hair and a change to softer hair). The response time before any effect was observed was also longer than that seen with the Aldactone group. The data suggest that, at the dosages employed, Aldactone has a better clinical effect on the hair parameters despite a lack of effect on circulating hormone levels. One should, however, be aware that Diane contains only 2 mg cyproterone acetate (CPA) and a better effect would most probably have been obtained using a higher dosage of CPA.

Topics: Adolescent; Adult; Cyproterone; Cyproterone Acetate; Drug Combinations; Drug Evaluation; Ethinyl Estradiol; Female; Gonadal Steroid Hormones; Hirsutism; Humans; Pituitary Hormones, Anterior; Sex Hormone-Binding Globulin; Spironolactone

In the present study a parenteral treatment regimen with cyproterone acetate was compared with the high dose peroral administration in patients with severe hirsutism. Two groups consisting of 10 patients each performed treatment with either 100 mg cyproterone acetate perorally for the first 10 days of the menstrual cycle or received a monthly implant of 300 mg cyproterone acetate intramuscularly applied on the first day of each cycle. In addition, contraception was performed with Diane in both patient groups. 9 treatment cycles were followed by a posttreatment period of 3 months. Hair parameters and serum androgens were monitored regularly. No significant differences of testosterone, androstenedione, dehydroepiandrosterone-sulfate and prolactin serum levels became evident between both cyproterone acetate regimens. Measurements of facial hair diameters revealed a better reduction for the parenteral application. Also the improvement of dermatological parameters was more prominent in the parenteral treatment group. The good effects of a medium dose parenteral application against higher dose peroral treatment thus was documented. The lack of significant differences of androgenic suppression in both regimens turns up the question if different metabolism at the cellular level may be responsible for that phenomenon.

Topics: Administration, Oral; Adult; Androgens; Cyproterone; Dose-Response Relationship, Drug; Drug Implants; Female; Hair; Hirsutism; Humans; Prolactin; Time Factors

Extended hormonal diagnosis allows causative treatment in hirsutism. By means of inhibition of the pituitary/gonadal axis and the androgenic metabolism at the cellular level, the androgenic action in hirsutism is extensively treated. Cyproterone acetate allows differentiated treatment according to the various grades of hirsutism by modification of dosage and application. Individual treatment according to the specific grade of hirsutism is also possible by different modes of application of medroxyprogesterone acetate. Intralesional application is a new interesting aspect of treatment. There have also been reported good results with spironalactone. Cimetidine may be another helpful alternative in cases of contraindicated hormonal treatment.

Topics: Cimetidine; Cyproterone; Cyproterone Acetate; Hirsutism; Humans; Medroxyprogesterone; Medroxyprogesterone Acetate; Receptors, Androgen; Spironolactone

The effects on fasting serum lipids of the potent anti-androgen, cyproterone acetate (CA) and the oestrogen, ethinyl oestradiol (EO) given both alone and in combination were examined in women acting as their own controls. Cyproterone acetate alone caused significant reductions in total cholesterol, high density lipoprotein subfraction 2 cholesterol (HDL2) and low density lipoprotein cholesterol (LDL). Ethinyl oestradiol alone significantly increased triglycerides, HDL and HDL2 and reduced LDL, and there was also a significant increase in the HDL/LDL and HDL2/LDL ratios. The two steroids were administered in combination according to a reverse sequential regime. The 28-day treatment cycle thus included Phase A during which both drugs were given followed by Phase B when EO alone was given. Triglycerides rose significantly in Phases A and B to the same extent as for the group taking EO alone. High density lipoprotein cholesterol was unchanged but HDL2 was reduced in both phases and this effect could not be overcome by increasing the dose of oestrogen. Low density lipoprotein cholesterol fell and the HDL/LDL ratio rose during the two Phases and these changes were significant during Phase A. The effects of EO demonstrated in this study are consistent with previous reports. Cyproterone acetate, however, has properties conventionally ascribed to both synthetic androgens (e.g. lowering of HDL2) and oestrogens (e.g. lowering of LDL). The limitations of the terms androgenic and oestrogenic activity in relation to their conventional associations with changes in lipid and lipoprotein levels are discussed.

Topics: Acne Vulgaris; Adult; Cholesterol; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Lipid Metabolism; Lipoproteins; Lipoproteins, HDL; Lipoproteins, LDL; Triglycerides

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Androgen Antagonists; Androgens; Cyproterone; Cyproterone Acetate; Drug Combinations; Drug Evaluation; Ethinyl Estradiol; Female; Follow-Up Studies; Hirsutism; Humans

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans

A prolonged-action Synacthen (R) test (1 mg.i.m. was performed in 14 hirsute women before and 6 months after instituting combined treatment with cyproterone acetate (50 mg/day/21 days) and percutaneous estradiol (3 mg during the last 10 days of cyproterone acetate administration). Determination of blood cortisol and precursors of cortisol--plasma androgens--was carried out to evaluate possible modification of adrenal enzymatic activity. At the used doses, cyproterone acetate failed to influence adrenal reactivity to synthetic ACTH or the enzymatic activities of 21-hydroxylase and 17-beta-reductase in vivo.

Topics: Administration, Cutaneous; Adrenal Cortex; Adrenocorticotropic Hormone; Cyproterone; Delayed-Action Preparations; Drug Therapy, Combination; Estradiol; Female; Hirsutism; Humans

Women with the polycystic ovary syndrome were treated cyclically for two years with an oral oestrogen/progestogen combination of 50 mg of cyproterone acetate and 0.05 mg of ethinyloestradiol. Ovarian volume, ovarian texture and uterine size were monitored by ultrasound before, during and after treatment. Menstrual rhythm, ovulation and the degree of hirsutism were also studied clinically. A significant decrease in the ovarian volume and in the number of cystic areas was observed during treatment. Hirsutism was also markedly improved. Some of these beneficial effects persisted after treatment was stopped. The number of subjects who had regular, ovulatory cycles increased after stopping treatment. Growth of uterine muscle occurred during treatment.

Topics: Adolescent; Adult; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Menstrual Cycle; Ovary; Ovulation; Polycystic Ovary Syndrome; Time Factors; Ultrasonography; Uterus

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Spironolactone; Time Factors

Topics: Androgens; Cyproterone; Cyproterone Acetate; Diethylstilbestrol; Drug Evaluation; Drug Therapy, Combination; Female; Hirsutism; Humans; Menstruation Disturbances

A simple photographic technique was used to assess the objective response of hirsute women to treatment with cyproterone acetate (CA). The skin in front of the left ear was shaved and photographs taken immediately and after 1 week, and hair growth per week estimated by averaging the length of 20 hairs in the magnified photographs. The precision, repeatability and patient acceptance of the method were found to be satisfactory. Basal hair growth rates were 2.28 +/- 0.4 mm/week (mean +/- SD, n = 34) and showed a significant correlation with hirsutism scores derived from a standard physician-rated scale. During therapy with CA the mean (+/- SD) improvement in hair growth rate was 19 +/- 13%, whereas physician-rated hirsutism scores improved by 33 +/- 20%. The reduction in hair growth rate showed no significant correlation with improvement assessed using subjective rating by either physician or patient. The greater improvement in physician-rated scores compared with hair growth rate assessment suggests that hair shaft width, colour and other factors may be as important as hair length when assessing treatment response.

Topics: Adolescent; Adult; Cyproterone; Cyproterone Acetate; Ear, External; Female; Hair; Hirsutism; Humans; Middle Aged; Photography

Two groups of patients affected by idiopathic androgenization have been treated with ethinylestradiol (EE) associated with two different (high and low) dosages of cyproterone acetate (CA); the aim of this study was to evaluate the possible endocrine side effects at the pituitary level. After three and six months of treatment gonadotropins secretion appeared significantly inhibited with higher evidence for LH than for FSH and especially in the patients on high dose of CA. Nevertheless the most impressive finding was represented by the increase in PRL responses to TRH documented when higher doses of CA were employed without significant change in TSH secretion. The Authors suggest that such PRL hyperresponsiveness cannot be completely disregarded in the management of idiopathic androgenization.

Topics: Adult; Cyproterone; Cyproterone Acetate; Estradiol; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Pituitary Gland; Prolactin; Testosterone; Thyroxine; Triiodothyronine

Topics: Cyproterone; Drug Evaluation; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Testosterone

Topics: Adult; Clomiphene; Cyproterone; Cyproterone Acetate; Estrogens, Conjugated (USP); Ethinyl Estradiol; Female; Hirsutism; Humans; Polycystic Ovary Syndrome

Modes of action of antiandrogens, their side effects as well as indications for their application to androgen-dependent skin conditions. Particular attention is paid to the possibilities for topical medication with antiandrogenic active substances.

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Chlormadinone Acetate; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Therapy, Combination; Female; Hirsutism; Humans; Male; Skin Diseases; Spironolactone

The low-dose oral standard antiandrogen treatment with cyproterone acetate (CPA), Diane, is frequently associated with unsatisfactory results regarding moderate to severe seborrhoea/acne/acne and/or mild to moderate hirsutism. This multicenter double-blind study (n = 164) was, therefore, initiated to analyze the effectiveness of a medium dose oral regimen, i.e. the addition of 10 mg of CPA during the first 15 days of the Diane-treatment cycle. Good or satisfactory results after 3, 6, 9 and 12 months were observed in 61, 81, 95 and 97% of patients with moderate to severe seborrhoea (n = 79); in 53, 95, 98 and 100% of patients with moderate to severe acne (n = 62); and in 10, 28, 45 and 55% of patients with mild to moderate hirsutism (n = 89), respectively. The regression of moderate facial hirsutism and severe facial acne occurred faster and was more complete under the medium-dose than with the low-dose regimen. Side effects corresponded to those of conventional oral contraceptives except for a higher frequency of mastodynia. Both regimens caused a significant suppression of plasma dehydroepiandrosterone sulfate, while testosterone, triiodothyronine and thyroxine were lowered insignificantly. In contrast, cortisol, prolactin and insulin increased significantly. The extent of these changes did not differ in both modes of treatment. The medium-dose regimen (total dosage per cycle: 192 mg of CPA) is more effective than the low-dose regimen (42 mg of CPA per cycle) in the treatment of patients with moderate hyperandrogenism who do not require the high-dose oral standard antiandrogen therapy (1000 mg of CP A per cycle).

Topics: Acne Vulgaris; Cyproterone; Dehydroepiandrosterone; Dermatitis, Seborrheic; Double-Blind Method; Ethinyl Estradiol; Female; Hirsutism; Humans; Hydrocortisone; Insulin; Placebos; Prolactin; Testosterone; Thyroxine; Triiodothyronine

Women with severe hirsutism resulting from hyperandrogenism often respond poorly to suppressive therapy aimed at decreasing adrenal or ovarian androgen production. Antiandrogens, such as cyproterone acetate, prevent androgens from expressing their activity at target sites by inhibiting the formation of the androgen/cytosol binding protein complex. Seven severely hirsute hyperandrogenic women were treated for six months with the reverse sequential cyproterone acetate regimen. Pretreatment plasma testosterone (T) levels were elevated in all subjects, and sex hormone binding globulin (SHBG) binding capacity was depressed. A free testosterone index, as assessed by the T/SHBG ratio, was markedly elevated. A marked and significant decrease in T levels and the T/SHBG ratio occurred during the first two cycles of treatment (p less than 0.01). Hirsutism grading assessed by the semiquantitative method of Ferriman and Gallwey did not change significantly until four months after the beginning of therapy but improved by six months of treatment. There was a marked antigonadotropic effect in terms of suppression of LH and FSH. The reverse sequential cyproterone acetate regimen produces rapid normalization of the plasma T, SHBG and free testosterone index, but resolution of the hirsutism is slower and requires several months of therapy.

Topics: Adult; Androgen Antagonists; Androgens; Chronic Disease; Cyproterone; Cyproterone Acetate; Drug Evaluation; Ethinyl Estradiol; Female; Hirsutism; Humans; Sex Hormone-Binding Globulin; Testosterone; Time Factors

Androgen levels were measured before and during 12 months of treatment with cyproterone acetate (50 mg 5th to 16th day of cycle) and ethinyl oestradiol (50 micrograms 5th to 26th day of cycle) in 26 patients suffering from dysfunctional hirsutism. Patients were included in whom androgen levels after a dexamethasone suppression test fell above the range found in normal non-hirsute women on dexamethasone. Eighty percent of patients showed a substantial improvement of their Ferriman and Gallwey score after 12 months of treatment. During the treatment the mean level of testosterone was 64%, androstenedione 55%, testosterone oestradiol binding globulin 365%, apparent free testosterone 30%, dihydrotestosterone 74%, 5-androstanediol 43%, dehydroepiandrosterone 44%, 5-androstenediol 67% and dehydroepiandrosterone sulphate 74% of basal levels. From the results it is concluded that this treatment is effective both clinically and biochemically in reducing hyperandrogenism.

Topics: Adolescent; Adult; Androgens; Androstane-3,17-diol; Androstenediol; Androstenedione; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Dihydrotestosterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Sex Hormone-Binding Globulin; Testosterone

Carbohydrate metabolism was studied in a group of 66 women, taking cyproterone acetate (CA) and ethinyloestradiol (EO) as anti-androgen therapy for the treatment of hirsutism and/or acne. A reverse sequential treatment cycle was used and women were studied in two groups: the first when taking the combination of CA and EO during the first 12 days of the treatment cycle, and the second taking EO alone during days 13 to 22. The combination reduced fasting plasma glucose and raised fasting plasma insulin concentrations. There was deterioration of glucose tolerance with increased plasma insulin concentrations and these effects were progressive with time. The plasma insulin response to intravenous tolbutamide was increased by 50% but there was no accompanying change in the glucose nadir as compared with controls. These results show that the combination of CA and EO causes insulin resistance. Plasma C-peptide concentrations following oral glucose were unchanged compared with controls. This shows that the observed hyperinsulinaemia was due to a reduction of hepatic uptake of insulin rather than its increased secretion. We propose that these effects are due to a CA-induced elevation of fasting plasma insulin resulting in downregulation of hepatic insulin receptors with subsequent induction of insulin resistance and impairment of hepatic insulin uptake. C-peptide concentrations following i.v. tolbutamide were significantly higher on treatment with CA and EO than in controls indicating increased pancreatic secretion of insulin. Tests carried out while patients were taking EO alone showed impairment of glucose tolerance only with no change in insulin levels. There was an increase in plasma insulin in response to tolbutamide but this was not significant. We conclude that these results are explained by a reduced but persisting effect of CA.

Topics: Acne Vulgaris; Adolescent; Adult; Blood Glucose; C-Peptide; Carbohydrate Metabolism; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Fasting; Female; Glucose Tolerance Test; Hirsutism; Humans; Insulin; Insulin Resistance; Tolbutamide

Although one can reasonably infer that antiandrogens are likely to have a marked negative impact on female sexual responsiveness, the side effects of cyproterone acetate (CPA) treatment in hirsute women have been neglected in previous studies. The purpose of this study was to investigate the psychosexual situation of 61 hirsute women before and under hormonal treatment. 21% of the hirsute women were diagnosed as having been sexually dysfunctional before starting hormonal treatment. 44% of the women under antiandrogen treatment reported that their sexual enjoyment was impaired due to the hormonal treatment. Taking into account only those women living in a stable partnership, the percentage goes up to 61%. The conclusion from these results is to give a more detailed account of the possible side effects to the women involved in CPA treatment.

Topics: Acne Vulgaris; Adult; Alopecia; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Libido; Sexual Behavior

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dexamethasone; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Spironolactone

Topics: Cyproterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Hypertrichosis

Topics: Acne Vulgaris; Contraceptives, Oral; Contraceptives, Oral, Combined; Cyproterone; Female; Hirsutism; Humans

One-hundred and fifty hirsute women (68 with type I or II polycystic ovary syndrome and 82 with idiopathic hirsutism) were treated for periods of 6 to 48 months with oral cyproterone (CPA), a drug with peripheral antiandrogenic, antigonadotrophic and progestative properties, and 17 beta-estradiol given percutaneously to ensure estrogenic impregnation. CPA was administered in daily doses of 50 mg from day 5 to day 25 of the menstrual cycle, and E 2 (3 mg/day) from day 16 to day 25. The dramatic regression of hirsutism observed after 3 to 6 months of treatment was paralleled by a marked decrease of plasma testosterone and delta 4-androstenedione levels and a decrease of the androgen-dependent skin testosterone 5 alpha-reductase. The CPA-percutaneous E 2 combination also has contraceptive properties. Beside its remarkable therapeutic effectiveness, it has the advantages of avoiding the adverse reactions reported with higher doses of CPA and the metabolic and vascular effects of synthetic estrogen administered orally.

Topics: Administration, Oral; Adolescent; Adult; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estradiol; Female; Hirsutism; Humans; Skin Absorption

Topics: Adrenal Cortex Hormones; Adrenal Hyperplasia, Congenital; Androgen Antagonists; Androgens; Bromocriptine; Cimetidine; Cyproterone; Cyproterone Acetate; Drug Combinations; Estradiol Congeners; Female; Hirsutism; Humans; Polycystic Ovary Syndrome; Progesterone Congeners; Spironolactone; Thyronines; Time Factors

Topics: Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dihydrotestosterone; Drug Evaluation; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Spironolactone; Testosterone; Time Factors

Sensitive radioimmunoassays (RIA) have been developed to measure salivary and plasma androstenedione and dihydrotestosterone levels in normal women, women with polycystic ovaries (PCO) and idiopathic hirsutism, and patients on antiandrogen therapy. There was a highly significant correlation (r = 0.92, P less than 0.001) between the concentration of androstenedione in saliva and the unbound concentration in plasma. The unbound plasma androstenedione was measured in the dialysate by RIA and ranged from 6.0-10.4% of the total concentration. Salivary and plasma androstenedione levels in patients with PCO (185 +/- 72 pg/ml (n = 11) and 3262 +/- 814 pg/ml (n = 12) respectively) and in those with hirsutism (151 +/- 110 pg/ml (n = 25) and 2177 +/- 1096 pg/ml (n = 25) were significantly higher than levels in normal women (78 +/- 30 pg/ml (n = 18) and 787 +/- 355 pg/ml (n = 18). A good correlation (r = 0.82, P less than 0.001) was also found between salivary and unbound plasma dihydrotestosterone concentrations. Salivary and plasma dihydrotestosterone levels in patients with PCO (8.2 +/- 3.3 pg/ml (n = 9) and 167 +/- 45 pg/ml (n = 11) respectively and hirsutism (6.0 +/- 2.1 pg/ml (n = 14) and 176 +/- 69 pg/ml (n = 17) were significantly higher than levels in normal women (4.5 +/- 1.3 pg/ml (n = 17) and 90 +/- 44 pg/ml (n = 16), although there was a large overlap between groups. A similar decrease was observed in salivary and plasma androstenedione levels after treatment with cyproterone acetate (CA) and ethinyl oestradiol (EE) for 3 months. Plasma dihydrotestosterone levels remained elevated in 47% of treated women whereas only 21% of cases had raised salivary dihydrotestosterone levels. It is concluded that, as with testosterone salivary androstenedione and dihydrotestosterone measurements give a good reflection of their biologically active levels in normal, hyperandrogenic and CA + EE treated women.

Topics: Adolescent; Adult; Androgen Antagonists; Androstenedione; Cyproterone; Cyproterone Acetate; Dihydrotestosterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Polycystic Ovary Syndrome; Radioimmunoassay; Saliva

Management of hirsutism with high-dose oral cyproterone acetate (CPA) is associated with a failure rate of about 30%. The present investigation analyses the efficacy of parenteral CPA administration in non-tumorous hyperandrogenism. Medium-dose CPA (300 mg) was injected intramuscularly once per month, followed by oral ethinylestradiol (40 micrograms daily) for 21 days in 42 patients (total of 293 treatment cycles). The onset of withdrawal bleeding was 3 to 8 days later. This regimen was used as primary therapy (group A; n = 18) as well as follow-up therapy in low-dose (group B; n = 10) and high-dose oral standard CPA failures (group C; n = 14). The following satisfactory or good response rates were observed in regard to hirsutism: group A 83,5%, group B 100%, group C 57%; seborrhea A and B 100%, C 89%; acne and androgenetic alopecia A and B and C 100%. Clinical side effects occurred in 20 patients; they corresponded in type and frequency to those elicited by the high-dose oral standard medication and resulted in termination of treatment in only 3 patients. Pilot studies regarding the pharmacokinetics of CPA as well as the effects on plasma total and free testosterone and prolactin failed to explain the therapeutic superiority of parenteral CPA (n = 7 women). Still, it may be concluded that intramuscular CPA administration represents a new and highly effective means of managing hirsute females.

Topics: Acne Vulgaris; Adult; Alopecia; Cyproterone; Delayed-Action Preparations; Dermatitis, Seborrheic; Female; Hirsutism; Humans; Injections, Intramuscular; Prolactin; Testosterone

We report on 20 female patients suffering from acne, seborrhea, hirsutism, and androgenic alopecia during the years 1980-1982 who have been treated with 1 tablet of Androcur 10 (10 mg cyproteronacetate) daily, in the first 15 days applied together with Diane (0,05 mg ethinylestradiol and 2 mg cyproteronacetate). The results achieved after 2 years show an improvement of acne in 80 per cent of the cases, of seborrhea in 95 per cent, and of both hirsutism and androgenic alopecia in 45 per cent each. So this therapy takes its important place between the therapy with Diane alone and the usual supplementary dosis of 50 mg cyproteronacetate (Androcur) daily.

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Combinations; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged; Virilism

Hyperandrogenic states have to be treated according to their etiology. But, idiopathic hirsutism represents the majority of observed cases. Its pathophysiology is still under discussion. The ovary and/or adrenal origin has led to various treatments with corticoids or combined estrogen-progestogen preparations. However, practical problems are different. After ruling out a tumoral process or mild congenital adrenal hyperplasia, a rational and efficient treatment must be proposed. It has now become possible with the use of both antiandrogen and antigonadotropin drugs. Cyproterone acetate is the best therapeutic agent because of its antiandrogen, antigonadotropin and progestogen properties. Because of its antiestrogen effects, cyproterone acetate must be used in combination with estrogens as a substitutive therapy to permit regular bleeding.

Topics: Androgens; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estrogens; Female; Hirsutism; Humans; Ovarian Cysts; Testosterone

Antiandrogens, such as cyproterone acetate, and oestrogens both inhibit sebaceous secretion in rats and have a potentiality for the treatment of hirsutism and acne in the human female. However, they act at different points. In castrated rats treated with testosterone, 3 micrograms/day oestradiol produced a greater decrease in sebum secretion than a dose of cyproterone acetate over 1000 times larger; moreover the antiandrogen reduced the incidence of sebaceous mitoses whereas the oestradiol did not. In hirsute women, oral administration of 100 mg of cyproterone acetate daily caused a 40% reduction in sebum secretion within 10 days; a further 20% was subsequently produced by combined therapy with cyproterone acetate and ethinyloestradiol. Significant decreases in the diameter and rate of growth of thigh hairs were not established until around the fourth monthly cycle of treatment. The actions were believed to be mainly peripheral, though contributory factors could also have been the small but significant reductions in plasma androgens produced by the antiandrogen, and the marked rise in sex hormone binding globulin produced by the oestrogen. That it is theoretically possible for cyproterone acetate or oestradiol to act locally follows from an unequivocal demonstration that either compound produced a local depression of sebum secretion when applied topically to rats.

Topics: Androgen Antagonists; Animals; Castration; Cyproterone; Cyproterone Acetate; Estradiol; Female; Hirsutism; Humans; Male; Rats; Sebaceous Glands; Skin; Skin Physiological Phenomena; Testosterone

Forty-two women with hirsutism completed 12 months of treatment with cyproterone acetate and ethinyl oestradiol given in a reverse sequential regimen. A highly significant improvement was recorded in the whole group using the Ferriman and Gallwey scoring system. Ten patients recorded a poor response whereas 19 recorded a good or very good result. Patients from groups with polycystic ovarian disease and idiopathic hirsutism recorded equally beneficial responses. Fasting plasma triglycerides rose significantly after 12 months. Other lipids were largely unaffected although a small fall in high density lipoprotein-cholesterol was detected at mid-cycle. No other biochemical abnormalities were found. Circulating levels of testosterone and 17 hydroxyprogesterone were suppressed during treatment. Side-effects were not prominent. This appears to be a very useful medication for a clinical problem which hitherto has been difficult to treat.

Topics: Androgen Antagonists; Androgens; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Lipids

The effect of cyproterone acetate (CA) on adrenal glucocorticoid secretion was studied in 35 women with hirsutism. Patients were treated for 9 months with 100 mg CA orally 10 days each month, administered in reverse sequence with 21 days of a combination oral contraceptive containing 50 micrograms ethinyloestradiol and 2 mg CA. During treatment one patient had a mildly impaired plasma cortisol response to insulin-induced hypoglycaemia and 2 patients showed slight reduction of the plasma cortisol response to ACTH. Responses to metyrapone were normal in all patients tested. Overall, the mean response to these tests was significantly greater during CA treatment compared with pre-treatment measurements, probably due to effects of oestrogen on cortisol-binding globulin. In all patients urinary cortisol excretion remained normal and no patient demonstrated any features of steroid insufficiency. Thus it appears that CA has no untoward effect upon glucocorticoid secretion when given in high dosage for prolonged periods to hirsute women.

Topics: 17-Hydroxycorticosteroids; Contraceptives, Oral, Combined; Cortodoxone; Cosyntropin; Cyproterone; Cyproterone Acetate; Ethinyl Estradiol; Female; Hirsutism; Humans; Hydrocortisone

Cyproterone acetate (CPA) in association with percutaneously offinistered estradiol has been used for the treatment of 150 hirsute patients for periods ranging from 6 months to 3 years. A spectacular clinical improvement ensued. Plasma testosterone (T) and androstenedione (A) fell from 69 +/- 24 to 33 +/- 8 and 210 +/- 103 to 119 +/- 25 ng/dl (mean +/- SD) respectively after 3 months of treatment and remained low thereafter. In contrast, T glucuronide (Tg) and 3 alpha-androstanediol (Adiol) remained high during the whole course of treatment: 37 +/- 9 and 115 +/- 43 micrograms/24 h respectively. In vitro T 5 alpha-reductase activity (5 alpha-R) in pubic skin decreased from 147 +/- 34 to 79 +/- 17 fmol/mg skin after 1 year of treatment. To elucidate the discrepancy between plasma and urinary androgens levels, T production rate (PR) and metabolic clearance rate (MCR) were measured with the constant infusion technique in 6 patients before and after 6 months of treatment. PR decreased from 988 +/- 205 to 380 +/- 140 micrograms/24 h (mean +/- SD). In contrast MCRT increased from 1275 +/- 200 to 1632 +/- 360 1/24 h; this increase in MCRT explains the striking plasma T concentration fall and the high TG and Adiol excretion relative to the decrease in PR. Antipyrine clearance rate (n = 8) increased from 36.3 +/- 5.2 to 51.5 +/- 7.4 ml/min whereas urinary/6 beta hydroxycortisol remained unchanged. In conclusion, CPA acts through several mechanisms:(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adolescent; Adult; Androgen Antagonists; Androstenedione; Cyproterone; Cyproterone Acetate; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Testosterone

Topics: Acne Vulgaris; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Male

Fifteen women with idiopathic hirsutism (N = 11) or hirsutism with androgen excess (N = 4) were treated by Cyproterone acetate orally (50 mg from the 5 th to the 25 th day of the menstrual cycle) and Ethinyl Estradiol (day 15-25). Hirsutism was improved in 86% of cases with progressive improvement at 3, 6, 12 months. At 12 months, the clinical score for hirsutism was 56% of the original score. Disturbance of menstrual cycles was more frequent than reported with Hammerstein's pattern of treatment. Clinical and biological tolerance was good. delta 4 androstenedione decreased significantly at 6 months (respectively 2,26 ng/ml - 1,25 ng/ml). There was no significant decrease of plasma testosterone. Result of B 1-24 corticotropin test remained normal after 12 months of treatment.

Topics: Administration, Oral; Adolescent; Adult; Androgen Antagonists; Androstenedione; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Middle Aged; Testosterone; Time Factors

The effect of two combinations, reverse sequential and monophasic, with cyproterone-acetate, have been studied in a group of 14 women suffering from idiopathic hirsutism. The results obtained prove that both combinations have ovulation blocking properties, by decreasing the FSH, LH, progesterone and oestrogen levels, but also have favourable effects in the treatment of hirsutism. The reverse sequential combination showed an increase in the prolactin figures, although these figures were within normal limits.

Topics: Adolescent; Adult; Cyproterone; Cyproterone Acetate; Drug Combinations; Estradiol; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Kidney Function Tests; Liver Function Tests; Luteinizing Hormone; Progesterone; Prolactin; Testosterone; Time Factors

The influence of cyproterone acetate (CPA) containing drugs on the endometrium has not yet been investigated. Therefore, endometrial biopsies were obtained in 22 hirsute patients between day 14 and 28 of the cycle after 7-18 months of oral antiandrogen therapy. The effects of various regimens consisting of different doses of CPA in combination with ethinylestradiol (EE) were evaluated. The low-dose standard regimen (50 micrograms of EE plus 2 mg of CPA daily from day 5 to 25) caused regressive changes in the endometrium, i.e., sparse atrophic glands, relatively compact stroma, islands of stromal edema. These alterations correspond to those induced by conventional balanced low-dose combined oral contraceptives. High-dose reversed sequential regimen (40 micrograms of EE daily from day 5 to 25 plus 100 mg of CPA daily from day 5 to 14) resulted in pseudodeciduation and massive stromal edema. Pseudodeciduation during the early secretory phase is taken as a sign of the progestational depot effect of CPA, while the stromal edema is regarded as a result of the relatively unopposed estrogen intake during the second half of the treatment cycle. Thus, the effects of CPA containing drug on the endometrium depend essentially on their type, dosage and mode of administration.. The influence of cyproterone acetate (CPS) containing drugs on the endometrium has not yet been investigated. Therefore, endometrial biopsies were obtained in 22 hirsute patients between days 14-28 of the cycle after 7-18 months of antiandrogen oral therapy. The effects of various regimens consisting of different doses of CPA in combination with ethinyl estradiol (EE) were evaluated. The low dose standard regimen (50 mcg EE plus 2 mg CPA daily from days 5-25) caused regressive changes in the endometrium; i.e., sparse atrophic glands, relatively compact stroma, islands of stromal edema. These alterations correspond to those induced by conventional balanced low dose combined oral contraceptives. High dose reversed sequential regimen (40 mcg of EE daily from days 5-25 plus 100 mg CPA daily from days 5-14) resulted in pseudodeciduation and massive stromal edema. Pseudodeciduation during the early secretory phase is taken as a sign of the progestational depot effect of CPA, while the stromal edema is regarded as a result of the relatively unopposed estrogen intake during the 2nd 1/2 of the treatment cycle. Thus, the effects of a CPA containing drug on the endometrium depend essentially on their type, dosage, and mode of administration.

Topics: Adult; Atrophy; Biopsy; Cyproterone; Edema; Endometrium; Ethinyl Estradiol; Female; Hirsutism; Humans

A sensitive radioimmunoassay (RIA) was used to measure salivary testosterone levels in normal women, in patients with polycystic ovaries (PCO), and in women with hirsutism. There was a highly significant correlation (r = 0.79, P less than 0.001) between the concentration of testosterone in saliva [12.3 +/- 7.8 (SD) pg/ml] and the concentration of unbound testosterone in plasma (5.2 +/- 3.1 pg/ml) in matched samples collected from 56 women including normals, patients with clinical signs of hyperandrogenism, and women treated with a combination of cyproterone acetate (CA) and ethinyl oestradiol (EE). The unbound plasma testosterone was measured in the dialysate directly using a sensitive RIA. Salivary and plasma testosterone levels in patients with PCO (20.6 +/- 8.5 and 626 +/- 187 pg/ml respectively, n = 14) and in those with hirsutism (13.9 +/- 5.6 and 421 +/- 170 pg/ml, n = 30) were significantly higher (P less than 0.001) than levels in normal women (7.7 +/- 2.6 and 196 +/- 68 pg/ml, n = 36). Treatment for 3 months with CA and EE resulted in a decrease (mean 68%) in salivary testosterone levels in all patients studied (n = 15), but the suppression of plasma testosterone (mean 34%) was not observed in all cases. It is concluded that measurement of salivary testosterone gives a useful indication of levels of biologically available androgen in hyperandrogenic women, before and during CA/EE therapy.

Topics: Adolescent; Adult; Contraceptive Agents, Male; Cyproterone; Cyproterone Acetate; Ethinyl Estradiol; Female; Hirsutism; Humans; Polycystic Ovary Syndrome; Radioimmunoassay; Saliva; Testosterone

Ten hirsute women in fertile age were given 50 mg cyproterone acetate (CA) on day 5--14 and 50 micrograms ethinyl oestradiol (EE2) on day 5--21 except during the first treatment cycle when EE2 was given on day 15--21. The treatment lasted for 12 months. Clinical examination and hormone analysis were undertaken every third month. LRH tests were performed prior to treatment with CA in late follicular phase and after one week of administration of the drug. Subjective improvement of hypertrichosis was reported in 7 women, objectively a significant decrease in hair scores was observed. Short-term effects of CA alone included significantly decreased serum levels of oestrogens while FSH, LH, 4-androstene-3,17-dione and testosterone remained unaffected. Long-term administration of CA and EE2 resulted in significantly decreased serum levels of FSH, LH and oestrogens whereas 4-androstene-3,17-dione and testosterone were not affected. The gonadotrophin response to LRH did not reveal any significant difference before and after treatment. 4-Androstene-3,17-dione and testosterone did not change during the LRH tests but increased levels of oestrogens were observed at the end of the test during the CA treatment. Since CA alone causes decreased oestrogen levels without any suppression of the basal gonadorrohin levels, it is speculated that CA directly affects the ovarian steroid biosynthesis. On the other hand the adrenal androgens seem to be unaffected by the drug.

Topics: Adrenal Glands; Adult; Androstenedione; Contraceptive Agents, Male; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estrogens; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Ovary; Pituitary Gland; Testosterone

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Hirsutism; Humans; Testosterone

Function of the pituitary-adrenal axis was assessed in 16 adult female patients who had been taking cyproterone acetate for greater than 1 year. Some evidence of reduced basal cortisol output was seen in 25% of the patients, but plasma cortisol levels could be stimulated both by hypoglycaemia and by direct corticotrophin (ACTH) stimulation. The latter effect was confirmed by analysis of steroid excretion in urine although basal excreation rates indicated extensive adrenal suppression. These results suggest that cyproterone acetate does have some glucocorticoid activity which is able partially to suppress the pituitary--adrenal axis, but leaves it still responsive to stress.

Topics: Adult; Alopecia; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Hydrocortisone; Pituitary-Adrenal Function Tests; Pituitary-Adrenal System

Cyproterone acetate treatment was applied with good success by the authors to 52 patients with hirsutism. Yet, the patients' confidence in the medicament was negatively affected by recurrence of symptoms during intervals of discontinued medication. However, effective help can be given to such women to get to grips with their own psychic conflicts by disclosing to them and discussing with them those environmental factors due to which insecurity was built up in them regarding their sexual role. Such psychotherapeutic approach will back up pharmacotherapy and mitigate regression during intervals. Virile women do not accept their own female role unless they are given in parallel both gynaecological and psychotherapeutic treatment.

Topics: Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Combinations; Estrogens; Female; Gender Identity; Hirsutism; Humans; Personality; Pregnancy; Social Adjustment

It has been established that, through skin responds to circulating androgens, it can also produce androgens from precursors. Therapy can address either of the two following physiopathological steps: the secretory step can be countered by replacement or suppressive therapy which is now fairly well mastered; the target-organ step opens new possibilities concerning receptor abnormalities and receptor control. The medical literature was reviewed for data on hormonal therapy for women with acne, idiopathic hirsutism and seborrheic alopecia, three conditions which are usually only partially improved by cosmetic treatment.

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Androgens; Cyproterone; Dermatitis, Seborrheic; Estrogens; Female; Glucocorticoids; Hirsutism; Hormones; Humans; Progesterone; Skin; Spironolactone

6 women affected by hirsutism, either of idiopathic origin or due to polycystic ovary syndrome, have been treated with cyproterone acetate and ethynyl estradiol in combined therapy using, respectively, 100 mg and 50 micrograms/day, from the 5th to the 25th day of the cycle. The adrenal function was assessed before treatment and at the end of the 4th month of therapy, evaluating the peripheral plasma concentrations of pregnenolone (delta 5P), progesterone, 17-OH-progesterone, dehydro-epiandrosterone sulfate, androstenedione, testosterone, and cortisol in basal conditions and after dexamethasone suppression and an adrenocorticotropic hormone (ACTH) stimulation test. A group of healthy, untreated females were examined in the early follicular phase, as controls, Before therapy, the hirsute patient showed testosterone and androstenedione plasma levels, which were significantly higher than in the controls, and a significant reduction in pregnenolone response to ACTH. After 4 months of therapy with cyproterone acetate plus ethynyl estradiol, a significant decrease was found in testosterone and androstenedione plasma levels, and pregnenolone basal plasma levels, dexamethasone suppressibility, and response to ACTH were also markedly reduced, showing a significant difference versus the same patients before therapy and versus the control group. The existence of an impairment in adrenal function after cyproterone acetate plus ethynyl estradiol therapy at the given dose seems to be evident only in the case of directly ACTH-dependent adrenal enzymatic activities responsible for cholesterol cleavage to pregnenolone.

Topics: 17-alpha-Hydroxyprogesterone; Adolescent; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Androstenedione; Cyproterone; Cyproterone Acetate; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Hydrocortisone; Hydroxyprogesterones; Pregnenolone; Progesterone; Testosterone

Pituitary adrenal suppression has been assessed in twenty-two patients receiving cyproterone acetate (100 mg) and ethinyl oestradiol (30 micrograms) for the treatment of hirsutism. Cortisol responsiveness to ACTH and to insulin induced hypoglycaemia, and diurnal variations of plasma cortisol levels were measured before and after 6 months of treatment. There was no evidence that adrenal suppression is a significant problem in this group of patients.

Topics: Adrenocorticotropic Hormone; Adult; Circadian Rhythm; Cyproterone; Cyproterone Acetate; Depression, Chemical; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Hydrocortisone; Insulin; Pituitary-Adrenal System

Topics: Adolescent; Adult; Cyproterone; Estrogens; Female; Hirsutism; Humans; Mestranol; Polycystic Ovary Syndrome; Testosterone

Topics: Adrenal Hyperplasia, Congenital; Androgens; Contraceptives, Oral; Cyproterone; Female; Hair Removal; Hirsutism; Humans; Ovarian Cysts; Testosterone

Topics: Acne Vulgaris; Adolescent; Adrenal Hyperplasia, Congenital; Adult; Androgen Antagonists; Cyproterone; Female; Hirsutism; Humans; Polycystic Ovary Syndrome; Testosterone

Ten women with essential hirsutism were treated for one year with cyclic administration of cyproterone acetate and ethinyl estradiol. Biochemical and clinical control took place after 1, 3, 6 and 12 months of treatment. In 4 patients great improvement of hirsutism was noted, but only after 6 months of therapy. In 4 patients there was some improvement, while 2 were resistant. Side effects included reduced libido in 4 cases, mental depression in 3, dry skin and itching in 4 and transient nausea in one, but never necessitated cessation or interruption of treatment. Several changes in endocrine function took place during treatment: testosterone secretion rate diminished together with the urinary excretion of 17-KS and 17-KGS, while the serum concentration of testosterone binding globulin increased. There was a reduction in the serum concentration of total endogenous estrogens and progesterone as well as LH. No changes in hepatic, renal or hematologic parameters were found except for a slight increase in plasma prothrombin time. Clinical outcome of therapy could not be correlated with a pretreatment endocrine "profile", nor with the changes that this therapy induced in endocrine function. It is concluded that the anti-androgenic effect is probably the most important in this drug regimen, but that reversibility of hirsutism may depend upon factors not directly related to androgen influence.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Adult; Cyproterone; Cyproterone Acetate; Drug Therapy, Combination; Estrogens; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Progesterone; Testosterone

Cyproterone acetate acts as an antiandrogen through competitive inhibition of the androgens at cellular level on the peripheral effectors. Associated with ethynyl estradiol potentiates its action upon the cutaneous effectors, and at the same time has a potent ovulostatic action. Forty one women with seborrhea, acne, hirsutism and androgenic alopecia were treated. In 18 cases serum testosterone level were measured by radioimmunoassay before treatment. Most had levels above the normal range. In 7 cases testosterone level were repeated during treatment. Some did not show changes, but in most testosterone plasma increased. Most of the cases with acne and seborrhea showed a definite improvement between 3 and 6 months. Alopecia and hirsutism needed a longer treatment and the results were not so satisfactory. The tolerance was excellent and the side effects were those usually found with other oestrogens and gestagens associations. No rebound was observed when the medication was discontinued, although most of the cases showed a tendency to mild recurrence.

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Hirsutism; Humans; Hydrocortisone; Middle Aged; Testosterone

Topics: Adrenal Gland Neoplasms; Adrenal Hyperplasia, Congenital; Androgen Antagonists; Contraceptives, Oral; Cushing Syndrome; Cyproterone; Cyproterone Acetate; Dexamethasone; Female; Hair Removal; Hirsutism; Humans; Sex Hormone-Binding Globulin; Stimulation, Chemical

The authors employed a preparation containing ethinyl estradiol and cyproterone acetate (patented as Diane) to treat 32 women showing signs of masculinization; treatment was continued for 252 cycles. The contraceptive effect of the treatment was 100%. During treatment there was a considerable reduction of seborrhoea, acne, and hirsutism, and this improvement could be measured statistically. There were very few side effects serious enough to require interruption of treatment. Because of these favorable characteristics, this drug is considered suitable for the treatment of seborrhea, acne, and hirsutism in women for whom combination contraceptives are not contraindicated.

Topics: Acne Vulgaris; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Testosterone; Virilism

76 women with virilizing features (68 women suffering from hirsutism and 8 from acne) were treated on average for 25 months according to different models of Androcur medication. Success of treatment was clinically assessed as good in 3/4 of the cases and slight in the remaining 1/4. However, treatment is more successful in cases of adrenal hirsutism than in idiopathic hirsutism. Moreover, success of treatment seems to be better in women below 35 than over 35 years of age. Side effects, mostly bleeding anomalies and fatigue, were found in 31 women; these must be attributed to the gestagenic component of cyproterone acetate. By contrast, 12 women showed positive side effects such as weight reduction, improvement in depression states and reversal of hair loss, which must be attributed to the antiandrogenic component. The selected continuation rate in all subjects was 86% and the unselected 72%, over a treatment period of 4.5 years. Furthermore, hormonal controls were carried out under treatment. These showed, on average, a depression of plasma androstendione of 17%, of total plasma testosterone of 47%, as well as an inhibition of the testosterone/sex hormone-binding globulin quotient of 58%. These inhibition effects speak in favour of alterations taking place in steroid metabolism. However, by inhibition of androgenic serum levels, the mechanism of cyproterone acetate is only assisted, while the main mechanism is based on peripheral receptor inhibition. Furthermore, as additional component in this action a slight increase in plasma binding capacity was found during combined cyproterone-oestrogen treatment.

Topics: Acne Vulgaris; Adult; Androgen Antagonists; Androstenedione; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Middle Aged; Ovarian Cysts; Testosterone; Virilism

We determined by trichometry the rate of hair growth in ten hirsute patients receiving a combination of cyproterone acetate (CA) 50 mg/daily and 'Diane' (CA 2 mg + ethinyl oestradiol 0.05 mg). In two patients there was a prompt and persistent reduction in hair growth; in three the response was less marked, and in the remaining five patients the rate of hair growth fluctuated during therapy. However, there was an overall reduction in hair growth in all but one patient during the 12 months of treatment and all patients noticed that their hair became softer, thinner and lighter in colour.

Topics: Androgen Antagonists; Cyproterone; Cyproterone Acetate; Drug Combinations; Ethinyl Estradiol; Female; Hair; Hirsutism; Humans; Reference Values

Topics: Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Middle Aged; Virilism

Five females with idiopathic hirsutism, ten with adrenogenital syndrome, four with acne vulgaris, and three with Stein-Leventhal syndrome were treated for nine months with large or small doses of cyproterone acetate (100 or 2 mg daily, respectively) in combination with oestrogen. The drug had a good effect on the acne vulgaris and moderated the hirsutism. In the various patient groups the serum testosterone level was decreased to between 58.6% (+/- 28.7% S.E.) and 10.8% (+/- 8.2% S.E.) of the basal value. No essential difference in effectiveness was observed between the large and small doses. Based on study of the side-effects, it is recommended that laboratory liver tests are used for control.

Topics: 17-Ketosteroids; Acne Vulgaris; Adolescent; Adrenal Hyperplasia, Congenital; Adult; Alanine Transaminase; Aspartate Aminotransferases; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans; Hydrocortisone; Polycystic Ovary Syndrome; Testosterone

21 female patients with pronounced, predominantly idiopathic hirsutism were treated for six month wit preparation SH B 209 AB (Diane, Schering corp.) supplemented by 10 mg Cyproterone acetate between the 5th and 20th day of the menstrual cycle. The results of this therapy were clinically assessed as excellent in 5 patients, 11 patients showed a considerable, and 4 a moderate reduction of hirsutism, 1 patient showed no improvement. The results were quantified by measurement of hair thickness. In almost all cases a reduction was found, the mean value being 18,74%. No correlation could be found between therapeutic success and menstrual cycle anamnesis.

Topics: Adolescent; Adult; Child; Cyproterone; Female; Hirsutism; Humans; Menstruation

Cyproterone acetate (100 mg daily on the 5th-14th days of the normal cycle) together with ethinyl estradiol (0.05 mg daily on the 5th-25th days) was used for the treatment of hirsutism in 23 women for six months. This treatment caused a significant decrease in the severity of the hirsutism after only three months, the effect being maximal after six months. Sixty per cent of our patients reported being subjectively satisfied with the results. A relapse occurred, however, within three months of the end of the treatment in half the patients. The serum testosterone was significantly decreased after three months of treatment, but the changes in serum testosterone did not follow the changes in the clinical picture of hirsutism, suggesting that one facet in the favorable action of cyproterone acetate is an inhibition of the action of androgen on target cells. Various side effects, such as nausea, headache, loss of libido and depression, were reported very frequently, which undoubtedly limits the large scale use of this treatment, at least with the doses used in this study.

Topics: Adult; Cyproterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Testosterone

Topics: Cyproterone; Female; Hirsutism; Humans

Hormonal influences give rise to hirsutism and may encourage the appearance of seborrhea, acne and falling hair. Androgenically active processes in the cells of the end organs (e. g. sebaceous glands, hair roots) and in the endocrine regulation center may also be responsible for androgenic manifestations in women such as excretion of androgens by suprarenals and ovaries as well as its metabolization and final elimination. The central inhibiting effects of large doses of estrogen or gestagen have been taken advantage of since the sixties with varying therapeutic success. Advances in the treatment were only brought by the development of antiandrogenic progestogens and finally the synthesis of the "antiandrogen" cyproterone acetate in particular which, when selectively applied with critical consideration of the clinical symptoms, brings about a satisfactory therapeutic result for the cosmetically sensitive woman.

Topics: Acne Vulgaris; Alopecia; Binding, Competitive; Chlormadinone Acetate; Cyproterone; Estrogens; Female; Hirsutism; Humans; Megestrol; Progesterone; Receptors, Androgen

Topics: Acne Vulgaris; Adolescent; Adrenal Cortex Function Tests; Adrenal Hyperplasia, Congenital; Child; Cyproterone; Cyproterone Acetate; Dose-Response Relationship, Drug; Female; Hirsutism; Humans; Male; Paraphilic Disorders; Puberty, Precocious

The use of antiandrogens (principally cyproterone acetate CPA) to treat women with symptoms of hypersecretion of androgens is discussed. Several therapy schemata are presented. A high dosage "reverse sequential" therapy of 100 mg CPA on the 5th-14th days of the menstrual cycle and 40 mcg ethinyl estradiol (EE) on the 5th-25th days is used in severe cases. Low dosage (2mg CPA, 50 mcg EE) preparations are used for light cases of androgen hypersecretion. Parenteral application of 300 mg CPA per cycle with supplementary EE administration has also been tested. Hirsuitism is treated with good results in 65%-80% of those who use high dosage preparations and 50% of those who use the low dosage preparations. The effects of the therapy are apparent 9-12 months after it begins; the therapy is not as successful among patients whose problems are not related to their hormonal balance. Seborrhea and endogenous acne can be effectively treated with all types of antiandrogen preparations. Androgenetic alopecia can also be treated in a majority of cases with CPA preparations. CPA treatment should not last longer than 12 months. High dosage CPA use by ovulating women causes suppression of the preovulatory LH and FSH peaks but has little effect on basal levels; in postmenopausal women, the basal LH and FSH levels are significantly reduced. Use of CPA by itself causes a significant decrease in the levels of testosterone and delta-4-andostendion 3,17-dion. Use of CPA/EE combinations causes an increase in SHBG and the blood cortisol levels. Protein metabolism, hematopoesis, blood coagulation, and liver function are not affected by CPA use. Reduced glucose utilization and an increase in triglyceride levels are observed during CPA use. Pregnant women and women over 40 or with androgen-producing tumors should not use CPA.

Topics: Acne Vulgaris; Adrenocorticotropic Hormone; Alopecia; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Dermatitis, Seborrheic; Dose-Response Relationship, Drug; Drug Therapy, Combination; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Hypertrichosis; Luteinizing Hormone; Pregnancy; Prolactin; Virilism

Cyproterone acetate, combined with ethinyl estradiol, was administered to 60 women (mean age: 25 years) suffering from hirsutism, acne and alopecia for 3--39 months. The rate of success was 94% for acne, 85% for hirsutism and 55% for alopecia. These results are comparable to those already reported. No correlation was found between the degree of the disease or plasma levels of testosterone, androstenedione, respectively urinary 17-cetosteroids, and the effectiveness of the treatment. Side effects were rare and identical in frequency and nature to those encountered during treatment with estrogen-containing contraceptives.

Topics: 17-Ketosteroids; Acne Vulgaris; Adult; Alopecia; Androstenedione; Cyproterone; Female; Hirsutism; Humans; Testosterone

Twenty hirsute women were treated with 50 mg cyproterone acetate orally, administered from the 5th to the 25th day of the menstrual cycle, along with 3 mg 17 beta-estradiol administered percutaneously from days 16-25. Percutaneously administered 17 beta-estradiol was used rather than ethinylestradiol in order to avoid the side effects of oral administration of synthetic estrogens. From a clinical point of view there was a dramatic improvement of hirsutism after 3-6 months of treatment. Biologically, plasma testosterone decreased markedly (P < 0.01) from 64.6 +/- 24.2 ng/dl (n = 20) to 25.2 +/- 11.8 (n = 20), 26.1 +/- 16.6 (n = 16), and 13.3 +/- 10.8 ng/dl (n = 14) after 3, 6, and 9 months of treatment. There was also a significant decrease in delta 4-androstenedione from 251.0 +/- 110.2 ng/dl to 129.9 +/- 66.5, 114.2 +/- 45.8, and 62.0 +/- 21.5 ng/dl after the same periods. From these results it may be assumed that this therapeutic combination has an antigonadotropic effect, as confirmed by the decrease in plasma estradiol, FSH, and LH and the absence of a significant progesterone level in all cases. Plasma and urinary cortisol, lipids, and hepatic tests remained normal. The good clinical and biological tolerance of this treatment makes it interesting to consider for use in the management of hirsutism.

Topics: Androstenedione; Cyproterone; Cyproterone Acetate; Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Hydroxyprogesterones; Luteinizing Hormone; Ovary; Testosterone

Topics: Adult; Androgens; Cyproterone; Cyproterone Acetate; Dihydrotestosterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged; Sex Hormone-Binding Globulin; Testosterone

Topics: Acne Vulgaris; Cyproterone; Dermatitis, Seborrheic; Ethinyl Estradiol; Female; Hirsutism; Humans; Virilism

Topics: Adolescent; Adult; Androgen Antagonists; Cyproterone; Cyproterone Acetate; Female; Hirsutism; Humans

The effect of oral cyproterone acetate on hair density and diameter was studied in a clinically homogeneous group of 11 women with idiopathic hirsutism. Therapy was continued for 12 cycles of treatment. Hair density and mean hair diameter on the chin and left upper leg were measured before, immediately after and 3 months after therapy. Generally, the effect of treatment consisted of a quantitative reduction of both parameters, but the effect was not permanent after termination of therapy. Concurrently, the possible influence on plasma androgen was studied. No significant differences were found between the concentrations of plasma testosterone, dehydroepiandrosterone and androstenedione before and after treatment.

Topics: Adult; Androgens; Cyproterone; Ethinyl Estradiol; Female; Hair; Hair Removal; Hirsutism; Humans; Sex Hormone-Binding Globulin

Topics: Administration, Oral; Adult; Cyproterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged

Use of the antiandrogen cyproterone acetate in the treatment of hirsutism.--25 women with hirsutism or hypertrichosis faciei were subject to a "reverse sequential therapy" with cyproterone acetate (Hammerstein's regimen) for 1 to 3 years. In 8 patients, a limited, in 14 patients a satisfactory and in one woman a good result could be recorded. Cycle irregularities and subjective side effects were within a tolerable range. Studies of the hair pattern in 15 patients revealed a higher telogen rate as well as increased diameters of the hair stalks, compared with controls, in the temporal region of the head. These alterations disappeared in the course of the treatment. In the parietal region of the head no significant differences of the hair pattern were found in comparison with the controls and during application of the steroids.

Topics: Cyproterone; Female; Hair; Hirsutism; Humans; Long-Term Care

28 cases of moderate to severe hirsutism, two cases of acne and one case of axilary hidrosadenitis were tested continuously on average over 6 months by the daily administration of 100 mg cyproterone acetate. This drug was then given together with 1-2 mg oestradiol valerate over a further 6 month period by reversed sequential therapy. The effect of treatment was judged as being moderate only in 7 cases of idiopathic and one case of adrenal hirsutism and good in the remaining cases. However, this regimen caused a marked lowering of the urinary dehydroepiandrosterone sulphate and low polar oestrogen levels and also the plasma testosterone level. At the same time, according to preliminary results, the fraction of sex hormone binding globulin was raised. The plasma hydrocortisone level was depressed by about 20%. The fractions of 17-KS and 17-KGS decreased slightly at first, but then returned to normal. The side effects of continuous treatment were mainly gestagenic and of reversed sequential therapy mainly oestrogenic in nature. The continuation rate was 81% during a treatment period of two years.

Topics: 17-Ketosteroids; Acne Vulgaris; Adult; Cyproterone; Dehydroepiandrosterone; Drug Therapy, Combination; Estradiol; Estrogens; Female; Hirsutism; Humans; Hydrocortisone; Lymphadenitis; Middle Aged; Testosterone; Virilism

The most important therapeutic problems of female puberty and adolescence are discussed, including high stature, amenorrhoea, oligomenorrhea, pubertas tarda, anovulation, anorexia, anisomastia, hypermastia. Indications for treatment are given and the possibilities for a prophylactic medicine in this age group are stressed.

Topics: Acne Vulgaris; Adolescent; Amenorrhea; Anorexia Nervosa; Breast Diseases; Child; Cyproterone; Drug Combinations; Endocrine System Diseases; Estradiol Congeners; Ethinyl Estradiol; Female; Growth Disorders; Hirsutism; Humans; Menstruation Disturbances; Obesity; Oligomenorrhea; Progesterone Congeners; Puberty, Precocious

Topics: Acne Vulgaris; Adult; Breast Diseases; Cyproterone; Female; Hirsutism; Humans; Libido

Topics: Acne Vulgaris; Chronic Disease; Cyproterone; Female; Gynecology; Hirsutism; Humans

101 hirsute women received Diane, a combination of 2 mg cyproterone acetate and 50 micrograms ethinyl oestradiol per capsule, from the fifth to twenty-fifth day during a total of 1105 cycles. The treatment was satisfactory in 96% of women with acne, 84% with androgenic alopecia, 79% with seborrhoea, and 50% of those with mild or moderate hirsutism. The effectiveness of treating hirsutism or alopecia depended on its severity and duration. There was no correlation between various measures of androgen levels before and during treatment and the clinical results. Side effects were similar to those after contraceptive one-phase preparations, both in kind and incidence. None of the women became pregnant. Diane is thus the drug of choice in hormonal contraception of patients with acne, seborrhoea, androgenic alopecia or mild hirsutism. It is also suitable in the follow-up or interval management of high-dose cyproterone acetate treatment of severe hirsutism, in order to maintain the effect obtained with lower hormone doses.

Topics: Acne Vulgaris; Alopecia; Contraception; Cyproterone; Dermatitis, Seborrheic; Ethinyl Estradiol; Female; Hirsutism; Humans

Topics: Acne Vulgaris; Alopecia; Cyproterone; Dermatitis, Seborrheic; Female; Hirsutism; Humans; Virilism

Topics: Anthropometry; Cyproterone; Female; Hair; Hirsutism; Humans

Further experience in the treatment of female hirsutism with the anti-androgen cyproterone acetate is reported. Two-thirds of treated patients have shown improvement but relapse occurred within two or three months of stopping treatment. Acne also healed in two patients.

Topics: Adolescent; Adult; Cyproterone; Drug Administration Schedule; Female; Hirsutism; Humans; Middle Aged

In spite of remarkable therapeutic results obtained by gestagens with antiandrogenic activity, usually combined with estrogen, in oily seborrhea, acne, Fox-Fordyce disease, androgenetic alopecia and hirsutism many dermatologist still hesitate to treat the named disorders by hormones. The reason for their hesitation appears to be the erroneous belief, that the named disturbances represent hormonal disorders the treatment of which does not belong to dermatology. After a survey on the mechanism of action of antiandrogens the basic difference between androgen dependent skin disorders and endocrinopathies with manifestation on the skin and its appendages is explained. Androgen dependent skin disorders, like oily seborrhea and most cases of acne are not the result of endocrine disturbances in the sense of an pathologically increased or decreased production of sexual hormons. Administering sexual hormons the physician takes advantage of the sebosuppressive effect of female sexual hormons as he does of the antiallergic activity of the hormon cortisol (and related compounds) in the treatment of eczemas. The antiandrogenic treatment of androgenetic alopecia, hirsutism and androgenetic acne--with their underlying hormonal disturbance, consisting in an increased production of androgens, represents an quasi etiological therapy. As in these cases the hormonal disturbances finds its expression mainly or exclusively in disorders of the skin or hair growth, the dermatologist, preferentially in cooperation with endocrinogists and/or gynacologists remains entitled to take over the treatment. The available drugs are discussed and suggestions are made for their appropriate use.

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Chlormadinone Acetate; Cyproterone; Dermatitis, Seborrheic; Female; Hirsutism; Humans; Miliaria; Progesterone

The effectiveness of therapy with cyproterone acetate and ethinyl estradiol was studied in 103 women. Acne and seborrhea responded best with 91.7 and 93.3% respectively, including complete and partial therapeutic success. For hirsutism complete remission and partial improvement were found in 75.3% of the treated women. Under therapy, body weight did not change in 51.9%, while 24.7% of the patients gained weight and 23.4% lost weight. The cycle length remained normal after therapy in 35.8%. Normalization or improvement was found in 54.7%. In 6.3% no improvement was noted after therapy and in 3.2% cycle irregularity developed in women with previous undisturbed pattern. According to BBT, improvement of the functional capacity of the reproductive system was found in 32.9% of the patients. Only 3% of the women studied demonstrated a deterioration. The 17-ketosteroid excretion was diminished in 35.3% after therapy and remained unchanged in 64.7%. The therapeutic regimen used for the study was well tolerated and good cycle control was obtained.

Topics: 17-Ketosteroids; Acne Vulgaris; Adolescent; Adult; Body Temperature; Body Weight; Cyproterone; Dermatitis, Seborrheic; Ethinyl Estradiol; Female; Hirsutism; Humans; Menstruation; Menstruation Disturbances; Remission, Spontaneous

The functioning of the hypothalamo-pituitary-adrenal axis was assessed in 10 adult women with idiopathic hirsutism treated for 2 weeks with the anti-androgen cyproterone acetate in a dose of 50 mg b. d. daily and in 4 patients treated for at least 3 months. Basal plasma ACTH and cortisol levels and the cortisol response to 8 h ACTH infusion were comparable before and during short-term treatment. The plasma ACTH and cortisol responses to insulin induced hypoglycaemia before and during anti-androgen therapy also were of the same order of magnitude. In the 4 patients treated for at least 3 months also no suppressive effect of the anti-androgen on basal plasma cortisol levels was observed. From these data the conclusion seems warranted that short-term cyproterone acetate treatment in the given dose not significantly influences pituitary-adrenal function in adult women with idiopathic hirsutism.

Topics: Adolescent; Adrenal Glands; Adrenocorticotropic Hormone; Adult; Cyproterone; Female; Hirsutism; Humans; Hydrocortisone; Insulin; Pituitary Gland

Topics: Adrenal Hyperplasia, Congenital; Adult; Cyproterone; Estrogens; Female; Hair Removal; Hirsutism; Humans; Middle Aged; Progesterone; Racial Groups

Topics: Adult; Cyproterone; Female; Hirsutism; Humans; Middle Aged

The administration of cyproterone acetate can be effective in the treatment of 'idiopathic' hirsutism. In 5 similarly affected patients treated with ethinyloestradiol and lynoestrenol (Minilyn) the rate of hair growth was reduced in only two, even though the serum total testosterone was reduced in each instance.

Topics: Adolescent; Adult; Cyproterone; Drug Combinations; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Lynestrenol; Middle Aged; Testosterone

First clinical experiences with the anti-androgenic drug cyproterone-acetate in treatment of pachydermia laryngis are reported in eleven male and female patients. This endocrine therapy led to complete healing in four and to marked improvement in six patients. One did not respond. Evaluation of the endocrine state of these patients showed imbalance in the androgen/estrogen equilibrium. As the larynx constitutes a secondary sex characteristic and an endocrine target organ, the significance of endocrine factors for pathogenesis and therapy of epithelial changes on the vocal cords is discussed.

Topics: Androgen Antagonists; Cyproterone; Female; Hirsutism; Humans; Laryngeal Diseases; Laryngeal Edema; Laryngeal Neoplasms; Leukoplakia, Oral; Male; Middle Aged

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Child; Chlormadinone Acetate; Cyproterone; Dermatitis, Seborrheic; Female; Fertility; Hirsutism; Humans; Menstruation; Puberty, Precocious; Skin Diseases

It is reported on the possibilities of the application of anti-androgenics, especially of cyproterone acetate. The indication extends to hirsutism, sexual deviations, growth disturbances in pubertas praecox as well as diseases of the prostate. Particularly strong standard are to be applied in the treatment of fertile women, as there exists the danger of an intrauterine feminisation of male foetuses, when a pregnancy was not absolutely excluded. Side-effects and results of animal experiments are mentioned. The therapeutic mechanism of the anti-androgenics can be explained with the help of a concurrency mechanism at the androgen receptor or acceptor.

Topics: Acne Vulgaris; Animals; Cricetinae; Cyproterone; Female; Gynecomastia; Hirsutism; Humans; Libido; Male; Menstruation Disturbances; Paraphilic Disorders; Pregnancy; Prostatic Hyperplasia; Puberty, Precocious; Rats

Serum levels of dehydroepiandrosterone, androstenedione, and testosterone in hirsute women suffering from either idiopathic hirsutism or the polycystic ovary syndrome were determined before and during treatment with cyproterone acetate combined with ethinyl oestradiol. During this treatment the hirsutism decreased markedly. In untreated hirsute women serum dehydroepiandrosterone levels do not differ from those in normal women and do not change during therapy; androstenedione levels are higher than normal and decrease markedly during treatment, and the testosterone levels are elevated compared to normals, with a considerable overlap, and show only a tendency to decrease. There is no correlation between dehydroepiandrosterone and androstenedione levels or between androstenedione and testosterone levels in the serum of untreated hirsute women. After 12-14 months of cyproterone acetate-ethinyl oestradiol therapy a linear correlation is found between dehydroepiandrosterone and androstenedione levels. This can be explained by the relatively higher contribution of the peripheral conversion of dehydroepiandrosterone to androstenedione to the occurrence of lower androstenedione levels. The linear correlation between androstenedione and testosterone after treatment, also found in normal women, indicates the restoration of the role of androstenedione as the major peripheral precursor of testosterone.. 25 hirsute women (16-54 years), 20 suffering from idiopathic hirsutism and 5 with polysystic ovary syndrome, were investigated to determine the influence of combined cyproterone acetate-ethinyl estradiol therapy on sera levels of dehydroepiandrosterone (DHEA), androstenedione, and testosterone. The severity of hirsutism was recorded photographically. Serum values of DHEA, androstenedione and testosterone were measured before and during treatment by radioimmunoassay. Starting on the 5th day after the onset of menstrual bleeding, 100 mg cyproterone acetate was given daily for 10 days and starting on the same day 50 mcg of ethinyl estradiol for 21 days. This was followed by a 7-day interval without treatment. After 6-8 months of therapy classification of hirsutism was repeated and steroid levels determined in 15 patients. Of these, 10 patients were treated for 12-14 months after which evaluation was repeated. Normal values were determine in 14 healthy women (23-39 years) without contraceptive medication. DHEA levels of hirsute women are similar to those in normal women and are unchanged by therapy. Androstenedione levels are also elevated but show only a tendency to decrease with therapy. DHEA and androstenedione levels and androstenedione and testosterone levels are uncorrelated in the serum of hirsute women. However, after 12-14 months of therapy a linear correlation between DHEA and androstenedione levels was seen indicating a restoration of serum androstenedione as the major peripheral precursor of testosterone.

Topics: Adolescent; Adult; Androstenedione; Cyproterone; Dehydroepiandrosterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged; Polycystic Ovary Syndrome; Testosterone

The paper refers to 167 patients who were treated with 2 mg Cyproteronacetate and 50 mug Ethinyloestradiol because of acne, seborrhoea, hirsutism and androgenetic alopecia. The application was daily from the 5th to the 25th day of cycle over a period of 12 months. The success of treatment depended on the severity of virilisation: in cases of light acne only 77% of the patients showed improvement, while in cases of severe acne 91,4% showed improvement or healing of acne. The corresponding figures for seborrhoea were 55,7% and 89,4% respectively, and for hirsutism 37,4% and 60,9% respectively. Furthermore the success of treatment of the different virilising symptoms depended on the duration of therapy: while acne was already cured significantly after 6 months of treatment, seborrhoea and hirsutism show continuous improvement up to the 10th month thetherapy. Concerning side effects during therapy spottings and brake through bleedings were registered in 17,1 and 6% of cycles respectively. 16,2% of the patients noted breast tensions. Finally 68,7% of the patients suffered from nervousness, a very subjective symptom, which might be explained by the psychic lability accompanying virilising symptoms. The drop out rate was 7,8%, being not higher than with other oral contraceptives.

Topics: Acne Vulgaris; Alopecia; Cyproterone; Dermatitis, Seborrheic; Ethinyl Estradiol; Female; Hirsutism; Humans; Menstruation Disturbances; Time Factors; Virilism

Topics: Acne Vulgaris; Adult; Androstenedione; Cyproterone; Drug Combinations; Ethinyl Estradiol; Female; Hair; Hirsutism; Humans; Sebaceous Glands; Testosterone

Topics: Acne Vulgaris; Adolescent; Adult; Cyproterone; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged

Case-report about a 56 year old white female patient with pachydermia laryngis and hirsutism, successfully treated with cyproterone-acetate, a testosterone antagonist. The significance of androgenic hormones for the development of epithelial changes in the female larynx is emphasized. The administration of antiandrogenic substances as a new therapeutic measure is discussed.

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Cyproterone; Estrogens; Female; Hirsutism; Humans; Laryngeal Neoplasms; Middle Aged; Precancerous Conditions; Testosterone; Vocal Cords

The hair root status was used to evaluate the effect of cyproterone-acetate (CA), given orally, on hair cycle in a clinically homogeneous group of 11 women with idiopathic hirsutism. The therapy was continued for 12 menstrual cycles of treatment. The hair root status on the left upper leg and chin was determined before, directly after CA-treatment and 3 months later. The absolute number of anagan hair roots in both fields was decreased directly after therapy. Three months later this value on the upper leg increased again significantly while on the chin there was no significant increase in this period. The number of catagen/telogen hair roots showed no significant differences before, directly after CA-treatment and 3 months later. The number of regrowing hairs on the upper leg showed a significant increase of dysplastic-dystrophic hair roots.

Topics: Administration, Oral; Adult; Cyproterone; Female; Hair; Hirsutism; Humans; Jaw; Leg

Topics: Cyproterone; Female; Hirsutism; Humans

Topics: Cyproterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Megestrol; Norgestrel

The rationale of anti-androgen treatment for hirsutism is explained. The results are presented of treatment with cyproterone acetate of idiopathic hirsutism or hirsutism associated with polycystic ovarian disease. Ten out of 14 patients showed a good response after six months treatment. The response was dramatic in two patients.

Topics: Adolescent; Adult; Cyproterone; Female; Hirsutism; Humans; Middle Aged; Polycystic Ovary Syndrome

Topics: Cyproterone; Female; Hirsutism; Humans

Topics: Androgen Antagonists; Cyproterone; Dexamethasone; Diagnosis, Differential; Female; Hirsutism; Humans; Polycystic Ovary Syndrome

Topics: Adult; Androgens; Cyproterone; Hirsutism; Humans; Male

Topics: Cyproterone; Female; Hirsutism; Humans; Time Factors

Topics: Androgen Antagonists; Chlormadinone Acetate; Cyproterone; Female; Hirsutism; Humans; Male; Paraphilic Disorders

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Androgen Antagonists; Cyproterone; Dermatitis, Seborrheic; Drug Combinations; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged

The different side effects of synthetic progestins used in oral contraceptives offer the possibility of avoiding undesired side effects and accentuating desired ones. Based on our clinical studies with antiandrogens (cyproterone acetate) selection of an oral contraceptive with antiandrogenic side effects for women with virilization phenomena (acne, seborrhea oleosa) is proposed. These women should at least not be treated with gestagens which have androgenic side effects, such as nortestosterone derivatives. Women suffering from severe acne, androgenic alopecia, or idiopathic hirsutism should be treated with higher doses of antiandrogens.

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Cyproterone; Female; Hirsutism; Humans; Pregnancy; Progesterone Congeners; Virilism

175 women of reproductive age, with hirsutism of differing degrees and different pathogenetic causes (ovarian, adrenal, iatrogenic) or idiopathic, and acne were treated with two different combinations of Cyprotrone acetate and ethinyl estradiol (SH 8.1041 and SH B209AB). 90 patients were given SH 8.1041 and 10 were given SH B209AB. 75 received both preparations. The total number of treatment cycles was 1534. Clinical, hormonal and biochemical assessments were made before, during and after treatment. The degrees of hirsutism and acne, and of seborrhea and hair loss when present, were scored by means of a modified version of the Ferriman and Gallway criteria. SH 8.1041 brought about a significant improvement in the majority of the patients. SH B209AB was generally used as maintenance therapy for hirsutism and severe acne. It was the initial treatment of choice in patients with milder acne. Reduction of hirsutism was usually apparent after the fourth cycle of therapy and acne regressed after the first month. Both combinations were well-tolerated biochemically. In a few patients on SH 8.1042, slight and transient increases in BSP, SGOT, SGPT and bilirubin were observed, but cessation of treatment was not necessary. Some patients on SH 8.1041 complained of transient frigidity, mild depression, breast discomfort and nausea.

Topics: Acne Vulgaris; Adult; Cyproterone; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Sex Factors

Topics: Cyproterone; Female; Hirsutism; Humans

In 44 hirsute women treated with antiandrogens, sequential administration of cyproterone acetate and ethinylestradiol produced a success rate of 87%. The mean duration of treatment was 9 months, and side effects were rare. Antiandrogens are therefore superior to conventional cosmetic methods, though prior hormonal analysis is indispensable.

Topics: Adolescent; Adult; Cyproterone; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged

Hirsutism (increased masculine-type sexual hair growth) is to be distinguished from hypertrichosis (generalized increase of body hair) and from virilism (organ changes tending towards masculinity) in which marked hormonal changes are alwasy observable. Hirsutism depends on age, race, heredity, hairfolicle sensitivity to testosterone, and on circulating testosterone and its precursors. The main source of testosterone and androstanedione formation is not the adrenal cortex, as previously assumed, but, as catheterization has demonstrated, the ovary. Mild forms can best be treated externally by plucking, shaving or electrolysis. In forms associated with amenorrhea the amenorrhea responds to corticoids but over a prolonged period of treatment the maximum regression of hirsutism is one-third. Good results are obtainable by reverse-sequence therapy with the competitive androgen antagonists cyproterone acetate and ethinyl estradiol (100 mg cyproterone acetate from 5th-14th day of menstrual cycle and 50 mug ethinyl estradiol from 5th-21st day). This therapy is however costly and not without side effects; it should therefore be used only for particularly troublesome cases.

Topics: Adrenal Cortex Hormones; Amenorrhea; Androstenedione; Cyproterone; Diagnosis, Differential; Ethinyl Estradiol; Female; Hirsutism; Humans; Hypertrichosis; Ovary; Testosterone; Virilism

Topics: Adolescent; Adult; Cushing Syndrome; Cyproterone; Female; Hirsutism; Humans; Middle Aged; Polycystic Ovary Syndrome

Topics: Acne Vulgaris; Adrenal Glands; Adrenalectomy; Adult; Cyproterone; Ethinyl Estradiol; Evaluation Studies as Topic; Female; Hirsutism; Humans; Menstruation; Ovary; Testosterone; Time Factors; Virilism

Twenty-five female patients, aged 14 to 49, and suffering from syptoms of virilization (hirsutism, acne, seborrhea and alopecia) were treated with an estrogen-progestogen combinantion, i.e. cyproterone acetate and ethinylestradiol, having antiandrogenic and antiovulatory action. Patients were submitted to monitoring by means of a series of laboratory tests in order to detect any toxic or hormonal effects that might occur. In most cases symptoms of virilization were significantly reduced, while untoward side effects were not noted.

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Cyproterone; Dermatitis, Seborrheic; Drug Combinations; Ethinyl Estradiol; Female; Hirsutism; Humans; Middle Aged; Virilism

Two female volunteers, of menstrual age, with severe idiopathic hirsutism were treated for eight cycles and fifteen cycles respectively with cyproterone acetate 50 mg twice daily on days 5-14 of the cycle. In all but one cycle, ethinyl oestradiol in a dose of 50 mug daily from day 5 to 21 was given in addition. Cyproterone acetate when given alone abolished the mid-cycle LH surge. Combined therapy with cyproterone acetate and ethinyl oestradiol produced a significant improvement in both patients' hirsutism and was accompanied by a marked reduction in the urinary excretion of LH, FSH and androgens and by a fall in plasma testosterone. However, the clinical benefit derived from this drug was due principally to its action as a peripheral antiandrogen.

Topics: Adult; Cyproterone; Drug Evaluation; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Menstruation; Middle Aged; Pregnanediol; Testosterone

Topics: Adrenal Glands; Contraceptives, Oral; Contraceptives, Oral, Hormonal; Cyproterone; Dexamethasone; Estrogens; Female; Glucocorticoids; Hirsutism; Humans; Testosterone

Topics: 17-Ketosteroids; Adrenal Gland Diseases; Adrenal Gland Neoplasms; Androgens; Cyproterone; Dexamethasone; Diethylstilbestrol; Female; Hirsutism; Humans; Ovarian Neoplasms

Topics: 17-Hydroxycorticosteroids; 17-Ketosteroids; Androgens; Cyproterone; Estrogens; Female; Gonadotropins; Hirsutism; Humans

Topics: Acne Vulgaris; Adolescent; Adult; Alopecia; Chlormadinone Acetate; Contraceptives, Oral; Cyproterone; Dermatitis, Seborrheic; Drug Combinations; Drug Evaluation; Ethinyl Estradiol; Female; Follow-Up Studies; Hirsutism; Humans; Megestrol; Mestranol; Nandrolone; Norethindrone; Norgestrel

Topics: Acetates; Acne Vulgaris; Alopecia; Cyproterone; Dermatitis, Seborrheic; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hirsutism; Humans; Time Factors

Topics: Adrenocorticotropic Hormone; Adult; Cyproterone; Drug Evaluation; Female; Hirsutism; Humans; Hydrocortisone; Hypothalamo-Hypophyseal System; Menstruation Disturbances; Middle Aged; Remission, Spontaneous

Topics: Adolescent; Adult; Age Factors; Cyproterone; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hair; Hirsutism; Hormones; Humans; Male; Methods; Middle Aged

Topics: Adult; Androstenedione; Carbon Radioisotopes; Chromatography, Gas; Cyproterone; Depression, Chemical; Disorders of Sex Development; Estrogens; Ethinyl Estradiol; Female; Fluorometry; Hirsutism; Humans; Male; Menstruation; Middle Aged; Ovulation; Pregnanediol; Testosterone; Time Factors; Tritium

Topics: Adrenal Gland Neoplasms; Aged; Cyproterone; Female; Hirsutism; Humans; Hysterectomy; Neoplasm Metastasis; Ovarian Neoplasms; Virilism

Topics: Adult; Amenorrhea; Corpus Luteum; Cyproterone; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Middle Aged; Ovulation; Pregnanediol; Testosterone

Topics: Adrenal Glands; Adult; Contraceptives, Oral; Cyproterone; Dexamethasone; Estrogens; Ethinyl Estradiol; Female; Follicle Stimulating Hormone; Hirsutism; Humans; Luteinizing Hormone; Middle Aged; Ovary; Pregnanediol; Testosterone

Topics: Acne Vulgaris; Alopecia; Androgen Antagonists; Animals; Chlormadinone Acetate; Cyproterone; Dermatitis, Seborrheic; Female; Hirsutism; Humans; Male; Progestins; Rats; Time Factors

Topics: 17-Ketosteroids; Adrenal Glands; Androgens; Cyproterone; Female; Hirsutism; Humans; Hypothalamo-Hypophyseal System; Ketosteroids; Pregnadienetriols; Receptors, Cell Surface; Time Factors

Topics: Acne Vulgaris; Adult; Alopecia; Animals; Breast Neoplasms; Chlormadinone Acetate; Contraception; Contraceptives, Oral; Contraceptives, Postcoital; Cyproterone; Delayed-Action Preparations; Dermatitis, Seborrheic; Dogs; Estrogens; Ethinyl Estradiol; Female; Hirsutism; Humans; Injections, Intramuscular; Norgestrel; Progestins

A 9-cycle study was made of 49 female patients with hirsutism and alopecia to determine the influence of antiandrogenic medication on the hair (of the head) cycle. Hair root status (HST; or percent of differentiation of the different hair root forms of epilated hair) data showed that in cases of normal telegon rate (TR; or percent of hair in the resting phase of the hair cycle) an elevation of the average TR resulted, often rising to a pathological level. In case of existing TR elevation, the tendency was toward reduced TR. A 2nd study compared growth rate measurements of body hair from hirsute women using the S35 Cystin test. Findings in this particular study did not prove a decrease in hair growth rate secondary to the hormonal therapy. Finally, an experimental study with HST data found a slight increase of the TR during antiandrogenic medication. This suggests the possibility of an androgen-induced shortening of the growing phase.

Topics: Androgen Antagonists; Cyproterone; Cystine; Drug Combinations; Ethinyl Estradiol; Female; Hair; Hirsutism; Humans; Menstruation; Pregnadienes; Sulfur Isotopes

Topics: Adult; Aged; Androgen Antagonists; Body Weight; Cyproterone; Diet; Dose-Response Relationship, Drug; Ethinyl Estradiol; Female; Hirsutism; Humans; Male; Menstruation Disturbances; Middle Aged; Nitrogen; Pregnadienes; Prostatic Neoplasms