The influence of combined cyproterone acetate-ethinyl oestradiol therapy on serum levels of dehydroepiandrosterone, androstenedione, and testosterone in hirsute women.

Serum levels of dehydroepiandrosterone, androstenedione, and testosterone in hirsute women suffering from either idiopathic hirsutism or the polycystic ovary syndrome were determined before and during treatment with cyproterone acetate combined with ethinyl oestradiol. During this treatment the hirsutism decreased markedly. In untreated hirsute women serum dehydroepiandrosterone levels do not differ from those in normal women and do not change during therapy; androstenedione levels are higher than normal and decrease markedly during treatment, and the testosterone levels are elevated compared to normals, with a considerable overlap, and show only a tendency to decrease. There is no correlation between dehydroepiandrosterone and androstenedione levels or between androstenedione and testosterone levels in the serum of untreated hirsute women. After 12-14 months of cyproterone acetate-ethinyl oestradiol therapy a linear correlation is found between dehydroepiandrosterone and androstenedione levels. This can be explained by the relatively higher contribution of the peripheral conversion of dehydroepiandrosterone to androstenedione to the occurrence of lower androstenedione levels. The linear correlation between androstenedione and testosterone after treatment, also found in normal women, indicates the restoration of the role of androstenedione as the major peripheral precursor of testosterone.

PIP: 25 hirsute women (16-54 years), 20 suffering from idiopathic hirsutism and 5 with polysystic ovary syndrome, were investigated to determine the influence of combined cyproterone acetate-ethinyl estradiol therapy on sera levels of dehydroepiandrosterone (DHEA), androstenedione, and testosterone. The severity of hirsutism was recorded photographically. Serum values of DHEA, androstenedione and testosterone were measured before and during treatment by radioimmunoassay. Starting on the 5th day after the onset of menstrual bleeding, 100 mg cyproterone acetate was given daily for 10 days and starting on the same day 50 mcg of ethinyl estradiol for 21 days. This was followed by a 7-day interval without treatment. After 6-8 months of therapy classification of hirsutism was repeated and steroid levels determined in 15 patients. Of these, 10 patients were treated for 12-14 months after which evaluation was repeated. Normal values were determine in 14 healthy women (23-39 years) without contraceptive medication. DHEA levels of hirsute women are similar to those in normal women and are unchanged by therapy. Androstenedione levels are also elevated but show only a tendency to decrease with therapy. DHEA and androstenedione levels and androstenedione and testosterone levels are uncorrelated in the serum of hirsute women. However, after 12-14 months of therapy a linear correlation between DHEA and androstenedione levels was seen indicating a restoration of serum androstenedione as the major peripheral precursor of testosterone.