Antiandrogens for Female Androgenetic Hair Loss

The treatment of female androgen-induced hair loss with finasteride is considered problematic in pre-menopausal women because if taken during a possible pregnancy, malformations of male fetuses are very likely. Other oral medications that also have an effect on hormone balance are, however, approved for women of reproductive age. These are so-called anti-androgens or androgen receptor antagonists, which block receptors for testosterone and DHT and thus protect the hair follicles from androgen-induced miniaturisation. Pregnant women are also advised not to take them for the same reasons as finasteride, but the potential effects of androgen receptor antagonists on male fetuses appear to be less pronounced.

The androgen receptor antagonists used in female androgen-induced hair loss include spironolactone (trade name Aldactone and others, plus many generics) and flutamide (trade name Flumid and others, generics), as well as several gestogens with antiandrogenic activity, which are primarily prescribed in combination with an estrogen in the form of contraceptives – even if the focus is less on contraception than on treating the effects of increased androgen levels (acne, seborrhoea, hirsutism, androgen-related hair loss). These include cyproterone acetate (trade name Androcur and others, generic, component of Diane and other combination contraceptives), chlormadinone acetate (component of many pills, including Belara, Chariva, Minette), drospirenone (also component of combination contraceptives, e.g. Yasmin, Yasminelle and Petibelle) [47].

The additional estrogen contained in the contraceptives is supposed to enhance the effect of the androgen receptor antagonist by lowering the androgen level. A further advantage of the treatment is that a contraceptive, even if the contraceptive properties are not the focus of the treatment at all, definitely avoids pregnancy (and thus the potential risk for male fetuses).
Anti-androgens are only useful in cases of elevated androgen levels!

Anti-androgens – whether alone or in combination with an estrogen – are very likely to help only women whose hair loss is actually associated with increased androgen levels (there are also female hair loss cases, following the pattern of androgen-induced alopecia, which occur despite hormone levels corresponding to the norm).

Anti-androgens are not free of side effects (depending on the active substance, these include reduced libido, low blood pressure and a certain risk of liver damage); the use of so-called third and fourth generation combination contraceptives (to which all contraceptives relevant here belong) is also associated with a very small, but thoroughly relevant and much talked about in the media, risk of life-threatening pulmonary embolisms, shag attacks, etc. caused by thromboses [48]. It is therefore urgently recommended that the decision for or against treatment with one of these drugs should not be taken lightly, but should be based on a laboratory analysis of the hormone levels in the blood.