Effects of various combined oral contraceptives on sex steroids, gonadotropins and SHBG.

In women with preexisting virilization it is advisable to prescribe contraceptive agents that do not provoke a further increase in free circulating androgens. This study evaluated the influence of 3 gestagens without androgenic effects on the endogenous sex hormone equilibrium and sex hormone-binding globulin (SHBG) concentrations. 122 women were administered 4 different combined contraceptives for up to 6 cycles. The estrogen component of each of the 4 preparations was estradiol estrogen (EE) while the gestagens were desogestrel (in 2 formulations in 2 different dosages) cyproterone acetate and chlormadinone acetate. Most subjects had irregular cycles before treatment and exhibited seborrhea acne and hirsutism. Luteinizing hormone follicle-stimulating hormone estrone estradiol progesterone free testosterone and dehydropeiandrosterone-sulfate levels were significantly reduced in all 4 treatment groups during tablet intake. However SHBG concentrations increased in a highly significant manner during treatment. The elevation of SHBG is an expression of increased hepatic synthesis induced by EE. Concentrations of circulating SHBG determine the balance between estrogens and androgens. Since SHBG binds androgens better than estrogens it effectively monitors androgenic activity. Because of their role in significantly lowering the active fraction of androgens the preparations studied are considered appropriate contraceptives for androgenized women.