Comparison of finasteride versus flutamide in the treatment of hirsutism

Objective: To compare the effectiveness of finasteride and flutamide in the treatment of hirsutism in patients with polycystic ovary syndrome (PCOS) a nd with idiopathic hirsutism. Design: Randomized study. Patients: One hundred and ten hirsute patients were selected: 64 women with PCOS and 46 with idiopathic hirsutism. Methods: Patients were assigned randomly to receive 5 mg finasteride once d aily or 250 mg of flutamide twice daily, for 12 consecutive months. Hirsuti sm was evaluated at 12 months of therapy, with the Ferriman-Gallwey score a nd with measurement of the terminal hair diameters (mu m) taken from four d ifferent body areas. Blood samples were taken for assessment of endocrine a nd hematochemical parameters, Side effects were monitored during the treatm ent. Results: Both finasteride and flutamide induced a significant decrease in t he hirsutism scores and hair diameters at the end of 12 months. Finasteride reduced the Ferriman-Gallwey score by 31.4% in the PCOS cases and by 34.2% in the idiopathic hirsutism cases, and hair diameter by 27.0-34.1% in PCOS and by 29.6-37.9% in idiopathic hirsutism. Flutamide reduced the Ferriman- Gallwey score by 56.7% in PCOS and by 50.9% in idiopathic hirsutism, and ha ir diameter by 50.3-60.0% in PCOS and by 47.7-56.5% in idiopathic hirsutism . Flutamide did not induce hormone variations, while finasteride increased testosterone Levels by 40% in PCOS and by 60% in idiopathic hirsutism and d ecreased 3 alpha-androstanediol glucuronide (3 alpha-diolG) by 66.7% in PCO S and by 69.5% in idiopathic hirsutism. No important side effects or change s in the hematochemical parameters were observed with finasteride, while tw o patients (3.6%) in the flutamide group expressed abnormal transaminase le vels after 6 months of treatment. Dry skin also appeared significantly more with flutamide (67.3%) than with finasteride (23.6%). Conclusions: Both drugs are effective in the treatment of hirsutism but flu tamide is more effective than finasteride.