Treatment of hirsutism with spironolactone and with spironolactone plus dexamethasone

Background: Spironolactone has an anti androgenic effect, inhibiting the bi nding of androgens to their receptor. This antagonistic effect is the basis for the use of spironolactone in the treatment of hirsutism. Aim: To study the effectiveness and safety of spironolactone in the treatment of hirsute women and of the association of spironolactone plus dexamethasone in the t reatment of hirsutism with glucocorticoid sensitive hyperandrogenism. Patie nts and method: Sixteen women (group 1) with peripheral hirsutism (defined as those with normal androgens levels, normal menstrual cycles and ovulatio n) and 24 women (group 2) with glucocorticoid sensitive hyperandrogenic hir sutism were studied. Group 1 was treated with spironolactone 50 mg bid and group 2 with same spironolactone dose plus dexamethasone 0.5 mg at 23 h dur ing one month and 0.25 mg thereafter. Patients were followed during one yea r. Results: After one year of treatment, a 54% reduction in Moncada hirsuti sm escore was observed in group 1 and 52% reduction in group 2. Observed se condary effects of spironolactone were increases in diuresis, fatigability, acne aggravation and seborrhea in two patients. Two additional patients ha d spotting. No secondary effect attributable to glucocorticoid use were obs erved. Conclusions: Spironolactone is effective and safe in the treatment o f hirsutism. Androgenic supression did no increases its effectiveness, unde rscoring the peripheral anti androgenic activity os spironolactone.