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Facts about skin from the New Zealand Dermatological Society Incorporated. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Anti-androgen therapy

Anti-androgen therapy refers to medication taken by women to counteract the effect of male hormones such as testosterone on the skin. Anti-androgens are not suitable for skin problems in men.

Skin/hair conditions in women that may be caused or aggravated by local or circulating androgenic hormones include:

Hormonal regimes that may be effective for these conditions include:

Spironolactone and cyproterone may be combined with cyproterone acetate/ethinyloestradiol or other oral contraceptive agent, partly because they cause menstrual irregularities and partly to prevent pregnancy. The combined treatment is not necessary in post-menopausal women.

Antiandrogen medications suppress release of the pituitary hormone, gonadotrophin, which in turn reduces androgen production by the ovaries. They also have a direct peripheral effect on the sebaceous gland.

In acne, the effects of anti-androgens include:

They can be combined with other topical and oral treatments for acne.

In hirsutism, the results are:

Physical methods of hair removal such as waxing, shaving, electrolysis or laser epilation, can be used at the same time as anti-androgens are taken. They often work better than prior to the medication.

In female pattern hair loss, the results are:

Oral contraceptives

Progesterone-only oral contraceptives are not effective in the management of androgen-mediated skin conditions.

Combined oral contraceptives contain two hormones, ethinyloestrodiol 20-35 mcg (an oestrogen) and a progesterone. They prevent pregnancy by suppressing ovulation and changing cervical mucus. There are various kinds of progesterone, which may be androgenic in nature and thus unsuitable for those androgen-mediated skin conditions (particularly levonorgesterol). Antiandrogenic or minimally androgenic progesterones (see above) are indicated in these women.

Combined oral contraceptives are available as 21-day and 28-day packs; start on Day 1 (conventionally, day 1 is the first day of menstruation) and take one a day for 21 days. Then have a 7-day break (21-day pack) or take the placebo tablets for a week (28-day pack) before starting the cycle again. During this time, you can expect a withdrawal bleed (a period).

Combined oral contraceptives can increase the risk of thromboembolism (blood clots blocking blood vessels), especially in those with an inherited tendency ("thrombophilia"), or who smoke. Please refer to the New Zealand Ministry of Health (Medsafe) advice on the use of combined oral contraceptives.

The combined oral contraceptive may be unsuitable if the patient:

Many of these women can instead use progesterone-only contraceptive pills while they are being treated with spironolactone or cyproterone.

Oral contraceptives can sometimes aggravate migraine and are inadvisable in those with significant liver disease. They may occasionally increase the risk of certain uncommon forms of breast cancer. They must not be taken in pregnancy.

Cyproterone acetate/ethinyleodstradiol (co-pyrindiol) should be discontinued in the following circumstances:

As with other oral contraceptives, minor side effects may arise, especially in the first few weeks. These include:

Other medications can interfere with the contraceptive effectiveness.

Combined oral contraceptives with anti-androgenic components have advantages:

Studies have demonstrated that the skin condition continues to improve even after the medication has been taken for a year. Combined oral contraceptives can usually be taken safely for many years.

Unfortunately, the skin condition tends to deteriorate again within a few months after the medication has been stopped.

New forms of oral contraceptive are introduced from time to time, to increase efficacy and reduce side effects.

Please refer to the New Zealand Ministry of Health (Medsafe) advice on the use of combined oral contraceptives.

Spironolactone

Spironolactone is a potassium-sparing medication used as a diuretic medication for heart failure, liver disease and high blood pressure. However, it has also been found useful for hirsutism, acne and seborrhoea because it has anti-androgenic properties. Spironolactone works by blocking androgen receptors.

The dose of spironolactone is usually slowly increased from 25 to 200 mg daily, taken at night. It may take six or more months to see improvement in the skin condition.

Side effects include:

Cyproterone acetate

Higher doses of cyproterone acetate are indicated for more severe cases of androgenetic skin conditions. It is effective for 70% of those with hirsutism.

Several different regimes are prescribed with doses ranging from 25 to 200 mg daily. Prior to the menopause, the medication is usually combined with cyproterone acetate/ethinyloestradiol or other oral contraceptive agent:

One system is to take the high dose cyproterone for the first ten days of the cycle.

Postmenopausal women and women who have had a hysterectomy can take cyproterone every day. It may be advisable to have a 7-day break every month.

Occasional significant side effects include:

Related information

References:

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Author: Dr Amanda Oakley MB ChB FRACP, Dept of Dermatology Health Waikato

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If you have any concerns with your skin or its treatment, see a dermatologist for advice.