Oral contraceptives and androgenic symptoms

Dermatologic signs of androgenization can be due to hyperandrogenemia, incr eased local androgen synthesis in the skin, or increased sensitivity of the skin to androgens. The most important pathogenetic factor, apart from incr eased serum levels of total and free testosterone, is enhanced local activi ty of 5 alpha-reductase. The latter cannot be detected by measuring serum a ndrostanediol glucuronide levels. All oral contraceptives with a predominan tly estrogenic effect alleviate acne and seborhea in 60-80 % of patients. A bout half of this therapeutic effect appears to be due to a placebo effect, and participation in a study itself seems to lead to more careful skin car e and avoidance of acne-promoting factors. The favorable effect of oral con traceptives results from a reduction of ovarian and adrenal synthesis of an drogens and androgen precursors, an increase in SHBG, and local effects of ethinylestradiol and progestins. Prolonged use of oral contraceptives conta ining a progestin with antiandrogenic properties can alleviate androgenic a lopecia in many women. Oral contraceptives are less effective for hirsutism , but a favorable effect can sometimes be obtained in severe cases by using a combination of ethinylestradiol and high doses of cyproterone acetate. F ormulations containing high doses of a progestin with androgenic properties are less effective and may even produce signs of androgenization in predis posed women, Occasionally, initiation of treatment with oral contraceptives can cause a temporary slight diffuse loss of hair or a transient exacerbat ion of acne. Hair loss or acne occurring with discontinuation of an oral co ntraceptive are usually transient.