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Hirsutism - Management
Basis for recommendation

Hirsutism that has failed to respond to treatment in primary care may respond to systemic treatments such as anti-androgens, insulin-sensitizing drugs, and gonadotrophin-releasing hormone agonists [Lavery et al, 2005; Martin et al, 2008; Koulouri and Conway, 2009].

  • Because these drugs are not licensed for the treatment of hirsutism and have potentially serious adverse effects, CKS recommends that they should only be used under specialist supervision.
  • Weak evidence from a systematic review and meta-analysis (12 randomized controlled trials [RCTs]) suggests that anti-androgens are effective for the treatment of hirsutism [Swiglo et al, 2008].
    • Compared with placebo, anti-androgens reduced Ferriman–Gallwey scores by 3.9 points (95% CI 2.3 to 5.4).
  • Weak evidence from a systematic review and meta-analysis (16 RCTs) suggests that insulin-sensitizing drugs have limited efficacy in the treatment of hirsutism [Cosma et al, 2008].
    • Compared with placebo, insulin sensitizers reduced Ferriman–Gallwey scores by 1.5 points (95% CI 0.3 to 2.8).
    • There was no evidence of a significant difference between insulin sensitizers and oral contraceptives (weighted mean difference [WMD] 0.5 points; 95% CI 3.9 to 5.0).
    • Metformin was less effective than both spironolactone (WMD 1.3; 95% CI 0.03 to 2.6) and flutamide (WMD 5.0; 95% CI 3.0 to 7.0).

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