This protocol applies to women with hirsutism who are not sexually active, have undergone permanent sterilization, or are already using long-acting reversible contraception (LARC). For women in this specific situation, clinical guidance supports a defined set of initial treatment options.
Initial therapy for women in this population involves a choice between oral contraceptives or an antiandrogen agent. The appropriate selection depends on individual patient preferences, including considerations of efficacy, side effects, and cost. The complete algorithm — including which specific agents qualify, their respective considerations, and any agents to avoid — is contained in the full structured protocol.
The primary therapeutic target is measurable improvement in hirsutism, defined as a meaningful reduction in the Ferriman–Gallwey hirsutism score. Due to the length of the hair growth cycle, response typically becomes detectable at approximately 6 months of therapy, with maximal effects appearing later.
DOI: 10.1210/jc.2018-00241
However, for women who are not sexually active, have undergone permanent sterilization, or who are using long-acting reversible contraception, we suggest using either OCs or antiandrogens as initial therapy (2 |OOO).
The choice between these options depends on patient preferences regarding efficacy, side effects, and cost.
Due to the long hair growth cycle, it takes ~6 months to detect the effects of hormonal therapy and ~9 months for these effects to become maximal.
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