The clinical use of antiandrogens by women
1980
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 317-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.
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