This protocol addresses virilization in patients whose hirsutism has not responded adequately to combined medical therapy. Despite a sustained course of treatment, clinically meaningful improvement in hirsutism has not been achieved, and escalation to a next-line approach is warranted.
The prior treatment step paired a combined hormonal contraceptive with an antiandrogen agent — spironolactone, cyproterone acetate, finasteride, or flutamide. The criterion for adequate response was significant improvement in hirsutism after at least 6 months of therapy. When this threshold is not met, escalation to this protocol is indicated.
When first-line antiandrogen combinations prove insufficient, management at this stage centres on a gonadotropin-releasing hormone (GnRH) analog, which targets ovarian hyperandrogenism as the underlying driver of refractory hirsutism. Add-back therapy is incorporated to address associated side effects. The complete clinical pathway — including sequencing and the full scope of the regimen — is available in the structured protocol.