Comparison of the efficacy of spironolactone versus flutamide in the treatment of hirsutism.

OBJECTIVE

To compare the efficacy of two antiandrogens, spironolactone and flutamide, in the treatment of hirsutism.

PATIENTS, PARTICIPANTS: Twenty women with idiopathic hirsutism were randomized to receive either flutamide or spironolactone.

DESIGN

Twenty hirsute women were recruited from patients presenting to the hirsutism clinic in Marmara University, Istanbul. Each patient underwent a complete medical and gynecological examination as well as endocrine profile, hematologic, hepatic, and renal function analyses. Hirsutism scores were determined according to the Ferriman-Gallwey scoring system. These tests were then repeated at 3, 6, and 9 months of therapy. Ten patients received 250 mg of flutamide two times per day, and 10 patients received 100 mg of spironolactone for 9 months.

RESULTS

Ferriman-Gallwey scores were decreased significantly in both groups at the end of 9 months. The percent of change in hirsutism scores in flutamide and spironolactone group were as follows: 26.4% and 20.9% at 3 months; 39.5% and 32.9% at 6 months; and 46.4% and 39.6% at 9 months, respectively. There was a trend toward a better response with flutamide that did not achieve significance. None of the hormonal parameters changed significantly during this period of time. Irregular bleeding was observed in five patients (50%) of the spironolactone group, whereas none of the patients in the flutamide group experienced menstrual irregularity. Conversely, dry skin and increased appetite were experienced by two patients (20%) in the flutamide group but not in the spironolactone group.

CONCLUSION

These data suggest that both spironolactone and flutamide were similarly effective in treatment of hirsutism, and the pure antiandrogen flutamide is a safe and effective alternative in treatment.