Women with severe
hirsutism resulting from
hyperandrogenism often respond poorly to suppressive
therapy aimed at decreasing adrenal or ovarian
androgen production.
Antiandrogens, such as
cyproterone acetate, prevent
androgens from expressing their activity at target sites by inhibiting the formation of the
androgen/cytosol
binding protein complex. Seven severely hirsute hyperandrogenic women were treated for six months with the reverse sequential
cyproterone acetate regimen. Pretreatment plasma
testosterone (T) levels were elevated in all subjects, and
sex hormone binding globulin (SHBG) binding capacity was depressed. A free
testosterone index, as assessed by the T/SHBG ratio, was markedly elevated. A marked and significant decrease in T levels and the T/SHBG ratio occurred during the first two cycles of treatment (p less than 0.01).
Hirsutism grading assessed by the semiquantitative method of Ferriman and Gallwey did not change significantly until four months after the beginning of
therapy but improved by six months of treatment. There was a marked antigonadotropic effect in terms of suppression of LH and FSH. The reverse sequential
cyproterone acetate regimen produces rapid normalization of the plasma T, SHBG and free
testosterone index, but resolution of the
hirsutism is slower and requires several months of
therapy.