RETRACTED: Comparison of finasteride versus flutamide in the treatment of hirsutism

Abstract

Objective: To compare the effectiveness of finasteride and flutamide in the treatment of hirsutism in patients with polycystic ovary syndrome (PCOS) and with idiopathic hirsutism. Design: Randomized study. Patients: One hundred and ten hirsute patients were selected: 64 women with PCOS and 46 with idiopathic hirsutism. Methods: Patients were assigned randomly to receive 5 mg finasteride once daily or 250 mg of flutamide twice daily, for 12 consecutive months. Hirsutism was evaluated at 12 months of therapy, with the Ferriman-Gallwey score and with measurement of the terminal hair diameters (mm) taken from four different body areas. Blood samples were taken for assessment of endocrine and hematochemical parameters. Side effects were monitored during the treatment. Results: Both finasteride and flutamide induced a significant decrease in the hirsutism scores and hair diameters at the end of 12 months. Finasteride reduced the Ferriman-Gallwey score by 31.4% in the PCOS cases and by 34.2% in the idiopathic hirsutism cases, and hair diameter by 27.0-34.1% in PCOS and by 29.6-37.9% in idiopathic hirsutism. Flutamide reduced the Ferriman-Gallwey score by 56.7% in PCOS and by 50.9% in idiopathic hirsutism, and hair diameter by 50.3-60.0% in PCOS and by 47.7-56.5% in idiopathic hirsutism. Flutamide did not induce hormone variations, while finasteride increased testosterone levels by 40% in PCOS and by 60% in idiopathic hirsutism and decreased 3a-androstanediol glucuronide (3a-diolG) by 66.7% in PCOS and by 69.5% in idiopathic hirsutism. No important side effects or changes in the hematochemical parameters were observed with finasteride, while two patients (3.6%) in the flutamide group expressed abnormal transaminase levels after 6 months of treatment. Dry skin also appeared significantly more with flutamide (67.3%) than with finasteride (23.6%). Conclusions: Both drugs are effective in the treatment of hirsutism but flutamide is more effective than finasteride.

Retrospective observational study on the effects and tolerability of flutamide in a large population of patients with various kinds of hirsutism over a 15-year period

“…The limited utility of the fT assay (due to its low sensitivity) did not impugn the results. The evident decrease in serum androgen levels was in agreement with ours and other previous reports (6,18,19,21,22,25,31,32,34,(36)(37)(38), and in disagreement with others (16,23,27,29,30) using different doses of Flu and smaller sizes of the subject sample enrolled. Hence, although Flu is considered a pure anti-androgen, the main action of which is attributed to its peripheral antiandrogenic properties, our data also confirm a direct inhibitory effect on androgen secretion, resulting from a blockade of the steroidogenic enzymes of androgen biosynthesis in both ovarian thecal and adrenal corticoreticular cells, as has been reported already (18,21,24).…”

“…Our study demonstrates that Flu administration causes an evident improvement in hirsutism score with an almost complete and lasting clinical resolution in the majority of patients, independent of the aetiologic diagnosis of hirsutism. In fact, we found no difference in the improvement of hirsutism between PCOS subjects and those with IH or other states of androgen excess, confirming previous data (27). Moreover, this study shows for the first time that very low doses of Flu (62.5 mg/day) are very effective in the long-term treatment of hirsutism.…”

“…Fatal and non-fatal hepatotoxicity associated with the use of Flu has been reported in male prostate cancer (46) and in female hirsutism (47). Considering that flutamide hepatotoxicity appears to be dose dependent (27,30,35,37), the use of very low doses of flutamide (62.5-125 mg/day) seems appropriate to treat hirsutism, so as to almost completely eliminate adverse events caused by the drug. In fact, a tendency to use lower doses of flutamide in the course of time both as monotherapy in the treatment of hirsutism (29,38) and as polytherapy in association with insulin sensitizers in the treatment of PCOS and related metabolic disorders (35) has been accomplished.…”

Diagnosis of Polycystic Ovary Syndrome

“…(63) Clinically, a number of antiandrogens including cyproterone acetate, flutamide, spironolacton, and finasteride have been used to treat hyperan-drogenism in women with or without PCOS. (64)(65)(66)(67)(68)(69) Despite slight worsening of glucose tolerance, a combination of estrogen and cyproterone acetate is an efficient treatment for women with hyperandrogenism and hirsutism. (64,70) As with cyproterone acetate, spironolactone is effective for improving hyperandrogenism and reducing hirsutism in PCOS patients.…”

“…(65) Finasteride is also effective in the treatment of hirsutism in patients with PCOS but it is less effective than flutamide. (68) …”