Prospective randomized study comparing the long-acting gonadotropin-releasing hormone agonist triptorelin, flutamide, and cyproterone acetate, used in combination with an oral contraceptive, in the treatment of hirsutism

Objective: To compare triptorelin, cyproterone acetate (CPA), and flutamide , in combination with an oral contraceptive, in the treatment of hirsutism. Design: Prospective randomized study. Setting(s): Tertiary care hospital. Patient(s): Thirty-nine hirsute women with idiopathic or functional ovarian hyperandrogenism. Intervention(s): Patients were randomly assigned to receive triptorelin (3. 75 mg IM every 28 days), CPA (100 mg/d orally on days 1-10 of the menstrual cycle), or flutamide (250 mg orally twice daily). All the patients also re ceived a triphasic oral contraceptive. Main Outcome Measure(s): Before and after 3 and 9 months of treatment, the Ferriman-Gallwey score, hepatic function, and gonadal and adrenal steroid p rofiles were evaluated. Results: Thirty-three patients completed the 9-month study period. The Ferr iman-Gallwey score decreased in all the groups. In the patients treated wit h CPA or flutamide, a decrease in the hirsutism score was noted as soon as after 3 months of treatment. This decrease was more pronounced after 9 mont hs of treatment, especially in the patients who received flutamide, who had lower hirsutism scores compared with the other treatment groups. None of t he patients had abnormal liver function test results. There was a mild incr ease in serum lipid concentrations, mostly in the group treated with tripto relin. Conclusion(s): Triptorelin, CPA, and flutamide are effective drugs for thr treatment of hirsutism. Flutamide results in a greater reduction in the hir sutism score, but CPA also offers satisfactory results at a much lower cost . Triptorelin has no advantages over flutamide and CPA, and is the most exp ensive of the three drugs tested. (C) 1998 by American Society for Reproduc tive Medicine.