Treatment options for hirsutism: a systematic review and network meta-analysis
Open accessAbstract
Background: Several pharmacologic treatments for hirsutism are used in practice; however, their relative efficacy is unclear. Methods: We searched MEDLINE, EMBASE, and CENTRAL through January 2017 for randomized controlled trials (RCTs) with follow-up of at least 6 months that evaluated antiandrogens, insulin sensitizers, and oral contraceptives in women with hirsutism. Independent pairs of reviewers selected and appraised trials. Random-effects network meta-analysis was used to compare individual drugs and classes. Results: We included 43 trials. Estrogen-progestin oral contraceptives pills (OCPs), antiandrogens, and insulin sensitizers were superior to placebo, with standardized mean reductions (95% confidence intervals) of -0.94 (-1.49 to -0.38), -1.29 (-1.80 to -0.79), and -0.62 (-1.00 to -0.23), respectively. Antiandrogen monotherapy, the combination of OCP and antiandrogen, the combination of OCPs and insulin sensitizer, and the combination of antiandrogen and insulin sensitizer were superior to insulin sensitizer monotherapy. The combination of OCPs and antiandrogen was superior to OCPs. Antiandrogen monotherapy with flutamide, finasteride, and spironolactone were each superior to placebo but similar to each other in efficacy. OCPs containing levonorgestrel, cyproterone acetate, or drospirenone were similar in effectiveness to other OCPs or had trivial differences. The certainty in comparisons with placebo was moderate and for head-to-head comparisons was low. Conclusions: Estrogen-progestin OCPs, antiandrogens, and insulin sensitizers are superior to placebo for the treatment of hirsutism.
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The combination of COCPs and antiandrogens is superior for management of hirsutism.
“The combination of COCPs and antiandrogens is superior for management of hirsutism [186].”
From Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls (2019) · cites this paper as [186]
Meta-analyses including larger number of RCTs in women with PCOS showed limited or no benefit of insulin sensitizers on hirsutism.
“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 [186]
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- Authors
- Barrionuevo, P., Nabhan, M., Altayar, O., Wang, Z., Erwin, P. J., Asi, N., Martin, K. A., & Murad, M. H.
- Affiliations
- Mayo Clinic (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Murad, M Hassan
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2018-03-07
- Volume
- 103
- Issue
- 4
- Pages
- 1258-1264
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- OpenAlex
- W2793255513
- Cited by
- 82
- References
- 27
- Citations by year
- 2026: 6 · 2025: 7 · 2024: 14 · 2023: 8 · 2022: 13 · 2021: 16 · 2020: 10 · 2019: 4 · 2018: 3
- FWCI
- 1.24
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- 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 › Urology › Hair Growth and Disorders
- Keywords
- hirsutism, androgen receptor antagonists, insulin sensitizers, oral contraceptives, flutamide, finasteride, spironolactone, cyproterone acetate, drospirenone, levonorgestrel, combination therapy, treatment efficacy
- MeSH terms
- Androgen Antagonists, Contraceptives, Oral, Combined, Drug Therapy, Combination, Female, Hirsutism, Humans, Hypoglycemic Agents, Insulin Resistance, Randomized Controlled Trials as Topic
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