The DOI matches its Crossref record; 35 of the 36 references it cites were found in a registry or an index.
Insulin Sensitizers for the Treatment of Hirsutism: A Systematic Review and Metaanalyses of Randomized Controlled Trials
Abstract
CONTEXT: Insulin sensitizers, including metformin and thiazolidinediones (TZDs), improve hyperinsulinemia and reproductive dysfunctions in some women with hyperandrogenism. The extent to which these agents improve hirsutism remains unclear. OBJECTIVE: Our objective was to conduct a systematic review and metaanalyses of randomized controlled trials of metformin or TZDs for the treatment of hirsutism. DATA SOURCES: We searched the following databases: MEDLINE, EMBASE, and Cochrane CENTRAL (up to May 2006). Review of reference lists and contact with hirsutism experts further identified candidate trials. STUDY SELECTION: Reviewers working independently and in duplicate, with acceptable chance-adjusted agreement (kappa = 0.72), determined trial eligibility. Eligible trials randomly assigned women with hirsutism to at least 6 months of insulin sensitizers or control and measured hirsutism outcomes. DATA EXTRACTION: Reviewers working independently and in duplicate determined the methodological quality of trials and collected data on patient characteristics, interventions, and outcomes. DATA SYNTHESIS: Of 348 candidate studies, 16 trials (22 comparisons) were eligible. The methodological quality of these trials was low. Random-effects metaanalyses showed a small decrease in Ferriman-Gallwey scores in women treated with insulin sensitizers compared with placebo [pooled weighted mean difference (WMD) of -1.5; 95% confidence interval (CI), -2.8 to -0.2; inconsistency (I(2)) = 75%]. There was no significant difference between insulin sensitizers and oral contraceptives (WMD of -0.5; CI, -5.0, 3.9; I(2) = 79%). Metformin was inferior to both spironolactone (WMD of 1.3; CI, 0.03, 2.6) and flutamide (WMD of 5.0; CI, 3.0, 7.0; I(2) = 0%). CONCLUSIONS: Imprecise and inconsistent evidence of low to very low quality suggests that insulin sensitizers provide limited or no important benefit for women with hirsutism.
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“Meta-analyses including larger number of RCTs in women with PCOS showed limited or no benefit of insulin sensitizers on hirsutism [185, 186].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [185]
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Evidence‐Based Treatment of Hirsutism
Blume‐Peytavi, U., & Bartels, N. G. (2008) · doi:10.1002/9781444300161.ch53 · Cited by 1
Russo, J. A., & Nelson, A. L. (2011) · Contraception · doi:10.1002/9781444342642.ch22 · Cited by 1
Bruk av metformin ved polycystisk ovarie-syndrom
Carlsen, S. M. (2009) · Tidsskrift for Den norske legeforening · doi:10.4045/tidsskr.08.0663 · Cited by 1
Surgical Management Options for Patients with Infertility and Endometriosis
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Duran, J. M. (2019) · Digital Access to Scholarship at Harvard (DASH) (Harvard University) · Cited by 1
Bright, T. M. (2013) · Elsevier eBooks · doi:10.1016/b978-1-4557-4975-1.00057-7
Metformin for the Treatment of Polycystic Ovary Syndrome (PCOS)
Patel, S. S., Beshay, V. E., & Carr, B. R. (2009) · Humana Press eBooks · doi:10.1007/978-1-60327-392-3_2
How effective are pharmacologic treatments for women with hirsutism?
Yialamas, M. A. (2008) · Nature Clinical Practice Endocrinology & Metabolism · doi:10.1038/ncpendmet0922
A clinical approach to women with hirsutism
Karunasena, T., & Bulugahapitiya, D. (2013) · Sri Lanka Journal of Diabetes Endocrinology and Metabolism · doi:10.4038/sjdem.v3i1.5497
For information on reprint requests of more than 101 and commercial reprints contact
Barbour, L. A., Cobin, R. H., DeGroot, L. J., Glinoer, D., Mandel, S. J., & Edwards, H. A. (2008)
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Act, A. (2010)
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Glintborg, D., Rungby, J., Eskildsen, P. C., Hermann, A. P., Stecher, C. W., Andersen, M., & Selskab, E. A. N. A. D. E. (2010) · Ugeskrift for Læger
Treatment of Hirsutism in a Woman With Familial Partial Lipodystrophy of Dunnigan Type
Foth, D., & Rahimi, G. (2010) · The Endocrinologist · doi:10.1097/ten.0b013e3181fd0409
Barth, J. H. (2011) · Elsevier eBooks · doi:10.1016/b978-0-7020-3120-5.00026-6
Gay, S. (2021) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000603
Role of Insulin-Sensitizing Drugs in PCOS Management
Kojok, D., Ghazeeri, G. S., & Awwad, J. T. (2022) · Springer eBooks · doi:10.1007/978-3-030-92589-5_12 · Cited by 1
Evidence‐Based Treatment of Hirsutism
Blume‐Peytavi, U., & Bartels, N. G. (2014) · doi:10.1002/9781118357606.ch58
Yildiz, B. O., & Azziz, R. (2011) · doi:10.1093/med/9780199235292.003.0865
Hyperandrogenism: Acne and Hirsutism
Evans, M. B., & Hill, M. J. (2016) · Springer eBooks · doi:10.1007/978-3-319-17002-2_40-2
Rodrigues, T. D. C., & Spritzer, P. M. (2013) · Springer eBooks · doi:10.1007/978-3-642-34029-1_5
Russo, J. A., & Nelson, A. L. (2011) · Wiley-Blackwell eBooks · doi:10.1002/9780387978598.ch22
Wolff, H., Hoffmann, R., Kunte, C., Trüeb, R. M., & Blume‐Peytavi, U. (2009) · Fortschritte der praktischen Dermatologie und Venerologie · doi:10.1007/978-3-540-77148-7_88
(2012) · Elsevier eBooks · doi:10.1016/b978-3-437-41797-9.16001-7
Directive clinique n° 444 : Hirsutisme : Évaluation et traitement
Elliott, J., Liu, K. E., & Motan, T. (2023) · Journal of Obstetrics and Gynaecology Canada · doi:10.1016/j.jogc.2023.102273
Trüeb, R. M. (2025) · Springer eBooks · doi:10.1007/978-3-031-64083-4_10
Metadata
- Authors
- Cosma, M., Swiglo, B. A., Flynn, D. N., Kurtz, D. M., LaBella, M. L., Mullan, R. J., Elamin, M. B., Erwin, P. J., & Montori, V. M.
- Affiliations
- Mayo Clinic (US)
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2008-04
- Volume
- 93
- Issue
- 4
- Pages
- 1135-1142
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2103374510
- Cited by
- 129
- References
- 36
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 3 · 2019: 5 · 2018: 7 · 2017: 10 · 2016: 11 · 2015: 9 · 2014: 12 · 2013: 13 · 2012: 8
- FWCI
- 1.65
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Reproductive Medicine › Ovarian function and disorders
- Health Sciences › Medicine › Dermatology › Acne and Rosacea Treatments and Effects
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Keywords
- hirsutism, insulin sensitizers, metformin, thiazolidinediones, hyperandrogenism, Ferriman-Gallwey score, oral contraceptives, spironolactone, flutamide, treatment efficacy
- MeSH terms
- Androgen Antagonists, Drug Therapy, Combination, Hirsutism, Humans, Hypoglycemic Agents, Metformin, Randomized Controlled Trials as Topic
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