This protocol is for women with hirsutism in the setting of nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency (NCCAH) whose initial oral contraceptive therapy has not produced adequate improvement by approximately six months.
The patient has hirsutism alongside nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency. The treatment approach in this population follows the same principles applied in other hyperandrogenic causes of hirsutism.
An oral contraceptive was used as first-line therapy. After approximately 6 months, the expected clinical goal — a meaningful reduction in the Ferriman–Gallwey hirsutism score — was not achieved. This unmet target is the trigger for advancing to the next step.
The structured protocol at this stage involves augmenting the oral contraceptive with an additional agent that directly targets androgen activity. The specific selection within this class, and how it integrates with the contraceptive, are laid out in the full protocol.
Improvement of hirsutism, detectable as a reduction in the Ferriman–Gallwey hirsutism score.
DOI: 10.1210/jc.2018-00241
Our approach to treating hirsutism in women with NCCAH is the same as for women with PCOS.
We suggest starting with an OC and adding an antiandrogen after 6 months if necessary.
The addition of antiandrogen therapy to OCs was slightly more effective for hirsutism than OC therapy alone (five trials) and was associated with incremental reduction of hirsutism scores—weighted mean difference, 21.73 [95% CI (23.32 to 20.13)].
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