GONADOTROPIN-RELEASING-HORMONE AGONIST THERAPY FOR HIRSUTISM IS AS EFFECTIVE AS HIGH-DOSE CYPROTERONE-ACETATE BUT RESULTS IN A LONGER REMISSION

Both cyproterone acetate (CPA) and the gonadotrophin-releasing hormone agonist (GnRHa) have been shown to be effective for the treatment of hirsutism, We wished to compare the effectiveness of CPA in two standa rd doses with GnRHa and add-back therapy and to compare the length of remission after these treatments, A total of 60 hirsute hyperandrogeni c women was assigned to the following treatment groups: CPA 2 mg with 35 mu g of ethinylestradiol for 21 days each month (Diane group), CPA 50 mg, days 5-15, and ethinylestradiol 50 mu g, days 5-25, each month (CPA group) or Decapeptyl 3.75 mg i.m. every 28 days with the addition of conjugated oestrogen 0.625 mg, days 1-21, and medroxyprogesterone acetate 10 mg, days 12-21 (GnRHa group), Hirsutism was graded by the F erriman-Gallwey-Lorenzo (FGL) index and anagen hair shaft diameters an d serum luteinizing hormone (LH) and testosterone were assessed before and every 3 months during and after treatment, All women were treated for 1 year with 1 year follow-up, At baseline hirsutism and endocrine patterns were similar in all groups, After one year of treatment, hir sutism decreased in all groups but the changes were greater (P <0.05) in the CPA and GnRHa groups than in the Diane group, Serum LH and test osterone were lowest in the GnRHa group, After withdrawal, hirsutism i ncreased rapidly in the Diane and CPA groups and after 6 months, FGL s cores and hair shaft diameters were similar to pretreatment values, In the GnRHa group, hirsutism increased more gradually and after 1 year of withdrawal, FGL scores and hair diameters were significantly (P <0. 05) less than pretreatment values, Serum LH and testosterone increased rapidly in all three groups reaching pretreatment values by 6 months, These data suggest equal efficacy of the GnRHa and the high dose CPA regimen for the treatment of hirsutism in hyperandrogenic women, GnRHa with add-back treatment appears to result in a longer remission of hi rsutism in comparison with CPA.