The addition of dexamethasone to antiandrogen therapy for hirsutism prolongs the duration of remission

Objective: To determine whether the addition of dexamethasone to antiandrogen therapy prolongs the duration of remission in women with hirsutism. Design: Follow-up study of patients treated with one of four regimens: spironolactone (100 mg/d) for 1 year, dexamethasone (0.37 mg/d) for 1 year, dexamethasone (0.37 mg/d) plus spironolactone (100 mg/d) for 1 year, or dexamethasone (0.37 mg/d) plus spironolactone (100 mg/d) for 2 years. Setting: Academic medical practice in reproductive endocrinology. Patient(s): Fifty-four women with hirsutism and hyperandrogenism. Intervention(s): Ferriman-Gallwey-Lorenzo scores were obtained and serum levels of testosterone, unbound testosterone, and dehydroepiandrosterone sulfate were measured before therapy, every 6 months during therapy, and for 1 year after the withdrawal of therapy. Main Outcome Measure(s): Hirsutism scores and serum indices of hormonal changes were monitored. Result(s): Ferriman-Gallwey-Lorenzo scores and androgen levels remained low 1 year after the withdrawal of therapy in patients who were treated with dexamethasone, either alone or in combination with spironolactone. In patients who were treated with spironolactone alone, hirsutism scores had returned to baseline values after 1 year. Conclusion(s): The addition of an agent that suppresses androgen levels may be useful to prolong the duration of remission of hirsutism in women with hyperandrogenism who are treated with antiandrogens.