Evaluating the Standard of Care for Unwanted Hair Growth

Hirsutism, a distressing endocrine condition characterised by excessive and unwanted hair growth in women, is frequently managed with a drug called cyproterone acetate (CPA). Acting as an antiandrogen, CPA is often prescribed alongside ethinylestradiol to suppress the male hormones responsible for the growth. A newly updated Cochrane review has analysed 23 randomised controlled trials to determine if this standard treatment effectively outperforms its competitors.

The findings paint a complex picture of efficacy. When researchers compared CPA combined with ethinylestradiol against spironolactone—another medication used to block androgen effects—they found little to no difference in clinical outcomes or testosterone levels. However, the combination therapy did appear potentially more effective than finasteride at reducing hair growth scores and lowering hormone levels after six months. Against flutamide, CPA showed a slight possible advantage in improving symptoms.

Despite these insights, the review emphasises a critical lack of high-quality data. Most included studies were small, with only one involving more than 100 participants, resulting in evidence often graded as 'low-certainty'. Consequently, it remains difficult to definitively compare side effects or declare one treatment superior. While CPA remains a viable option, the current science suggests it is clinically similar to other medical therapies, highlighting the urgent need for larger, well-designed studies to guide future treatment.