Treatment of HirsutismEstrogen-Progestin Contraceptives AntiandrogensMechanism of actionAndrogen production in hirsuite women usually is an LH-dependent processEstrogen-progestin contraceptives suppress pituitary LH secretion and thus suppress ovarian androgen productionThe high level of estrogen in oral contraceptives stimulates hepatic SHBG production, which decreases the amount of free/active androgen Directly or indirectly, estrogen-progestin contraceptives decrease adrenal DHEA-S secretion Contraceptive progestins inhibit 5 alfa-reductase activity in the skin, which decreases the production of dihydrotestosterone (DHT), the major nuclear androgen in hair follicles and sebaceous glands. Treatment with estrogen-progestin contraceptives induces regular, predictable menses and attenuates endometrial growth, thereby eliminating the risk for developing endometrial hyperplasia and neoplasia Current oral contraceptives contain ethinyl estradiol, in doses ranging from 20 mcg to 50 mcg daily, and one of a variety of progestins All low-dose oral contraceptives (containing 20–35 µg ethinyl estradiol) have similar effectiveness in the treatment of acne and hirsutism Cyproterone is a derivative of 17a-hydroxyprogesterone (17OHP), has potent progestational activity that inhibits gonadotropin secretion and also acts as competitive androgen receptor antagonist which inhibits enzymes involved in androgen synthesis “Dianette” or “Diane 35” contains 2 mg cyproterone acetate and 35 mg ethinyl estradiol Antiandrogens are an effective treatment for hirsutism but are best used in combination with oral contraceptives or another means of highly effective contraception, because they adversely affect sexual development in a male fetus if the patient conceives during treatment