Symptoms of male hormone excess or androgen excess such as excessive hair growth (hirsutism), acne or scalp hair loss (alopecia) can be treated by either:

• Reducing the amount of androgens that circulate throughout the body (hormonal contraception, using medications such as metformin that act through reducing insulin resistance or reducing insulin resistance through lifestyle changes such as weight loss)
• Reducing the action of the androgens on the body tissues through drugs with an anti-androgen action (cyproterone acetate, spironolactone, finasteride – these are only used in more severe cases)

Weight loss

Improving lifestyle factors such as diet or physical activity is associated with improving androgen excess. This is through both reducing the amount of total androgens and reducing the signs of androgen excess such as excess hair growth. Read more…

Hormonal contraception

The oral contraceptive pill is also a useful treatment for reducing symptoms of androgen excess. Some oral contraceptive pills (Diane/Brenda/Juliet) also contain small amounts of anti-androgens (cyproterone acetate); however, they also have higher doses of oestrogen, which may increase insulin resistance. In general, most oral contraceptives have similar effects on androgen excess.

Insulin sensitising drugs

Metformin

A drug used to treat insulin resistance and diabetes which reduces circulating insulin levels and androgens. Metformin treatment reduces hirsutism and acne to a similar extent as the Pill.

Rosiglitazone and pioglitazone

Other insulin sensitising medications include rosiglitazone (Avandia) or pioglitazone (Actos) which are drugs used to treat diabetes. These drugs have been trialled in PCOS but are not recommended for use. They work through reducing insulin resistance. While they have been shown to lead to greater reductions in androgen excess compared to metformin, they are generally as effective as metformin for other symptoms such as fertility, blood fats and insulin levels. Rosiglitazone has been associated with a higher number of cardiovascular events than pioglitazone and has been recommended to be removed from the New Zealand, European and United Kingdom markets.

Anti-androgens

Cyproterone acetate (Androcur)

Cyproterone acetate (sold as e.g. Androcur) is an effective anti-androgen that must only be used with the hormonal contraceptive pill. Side effects may include:

• Weight gain
• Depression
• Reduced libido
• Tiredness

Cyproterone acetate is usually used 10 days of each cycle.

Spironolactone (Aldactone)

Spironolactone (sold as Aldactone) is a diuretic (fluid reducing) tablet that also reduces androgen production and blocks androgen activity in the body. It is an effective anti-androgen and should be used only in women who are not trying to conceive due to the possibility of foetal abnormalities (birth defects). It must be used with some form of contraception to avoid pregnancy and prevent irregular bleeding. Side effects may include:

• Menstrual irregularities
• Stomach upsets
• Headaches
• Dizziness

These treatments typically take a couple of months to reduce symptoms. 

Finasteride (Proscar, Propecia)

Finasteride (sold as Proscar or Propecia) reduces the binding of androgens to the target tissues. It is a treatment for acne, hirsutism and alopecia, but is not used commonly in Australia.

Other medications

Other medical treatments that reduce excess androgens include:

• Glucocorticoids (dexamethasone) also lower the level of androgens in the blood, however these increase insulin resistance and have a range of other side effects such as osteoporosis, weight gain and gastrointestinal problems (nausea, bloating, vomiting etc).
• Isotretinoin (sold as Roaccutane) can be prescribed by a dermatologist (skin specialist) for severe acne. This works by shrinking the sebaceous glands (glands that secrete substances onto the skin surface) and by reducing sebum production (sebum (made from cholesterol and fats) is one component of the oil on the skin’s surface). This should be used only in women who are not trying to conceive as there is a possibility of foetal abnormalities (birth defects). Side effects include dry skin and eczema.
• Minoxidil (sold as e.g. Rogaine, Regaine, Avacor) is a cream that is massaged into the scalp and helps to prevent hair loss. Side effects include scalp dryness and itchiness.
• Local treatments - such as creams or gels which reduce pore blocking, oil production by the skin and inflammation can be used to treat acne.
• Waxing, laser therapies and electrolysis - can be useful measures for reducing hair growth.

Content updated 25 August 2011