Treatment with flutamide improves hyperinsulinemia in women with idiopathic hirsutism

Objective: To investigate insulin metabolism and its modifications induced by the administration of flutamide, a specific antiandrogen compound, in wo men with idiopathic hirsutism (IH) and in nonobese women with polycystic ov ary syndrome (PCOS). Design: Prospective, randomized trial. Setting: Endocrinological Centre of the Department of Obsterics and Gynecol ogy, University of Caligari, Caligari, Italy. Patient(s): Thirty-two women with normal body mass index participated in th e study: 11 with clinical and hormonal features of PCOS and 21 age- and wei ght-matched normally cycling women with IH (n = 11) and without IH (n = 10, controls). Intervention(s): Each subject with PCOS or IH was assigned randomly to rece ive either flutamide tablets (250 mg twice a day) or placebo for greater th an or equal to 5 months. Twelve subjects (6 with PCOS, 6 with IH) received flutamide and 10 (5 with PCOS, 5 with IH) received placebo. All subjects in gested 75 g of glucose and then underwent an oral glucose tolerance test (O GTT), 3-7 days after spontaneous or medroxyprogesterone acetate (5 mg daily for 5 days)-induced menses. Tn women with PCOS or IH, the OGTT was treated at the fourth month of treatment. Main Outcome Measure(s): Easting and OGTT-stimulated levels of glucose, ins ulin, and C peptide. Result(s): Both fasting and OGTT; stimulated levels of insulin and C peptid e were significantly higher in women with PCOS and in those with IH than in controls. Placebo did not modify parameters of glucose metabolism. Flutami de was capable of significantly blunting fasting and OGTT-stimulated secret ion of insulin only in women with III. Conclusion(s): Hyperinsulinemia exists in women with TH as well as in nonob ese women with PCOS. Treatment with flutamide can completely reverse hyperi nsulinemia only in women with IH, which suggests that the efficacy of the d rug is dependent on peripheral androgen hyperactivity. (Fertil Steril(R) 19 99;72: 448-53. (C) 1999 by American Society for Reproductive Medicine.)