| Oral contraceptives | Ethinyl estradiol with norgestimate, desogestrel, norethindrone, ethynodiol diacetate | One tablet per day for 21 days, followed by seven-day pill-free interval | GI distress, breast tenderness, headache, intolerance to contact lenses | Pregnancy category X | $31.00 per month |
| No FDA labeling for treatment of hirsutism |
| Least androgenic progestin component preferred |
| Ethinyl estradiol with drospirenone | Hyperkalemia may occur. Contraindicated with hepatic dysfunction, renal insufficiency, adrenal disease | Monitor serum potassium during first cycle with concurrent use of NSAIDs, ACE inhibitors, angiotensin-II receptor blockers, heparin, potassium supplements, potassium sparing diuretics. | 29.00 per month |
| Antiandrogens (no FDA labeling for treatment of hirsutism) | Spironolactone (Aldactone) | 50 to 200 mg per day | Hyperkalemia (rare), theoretic feminization of male fetus, gynecomastia | Pregnancy category D | 29.00 per month (22.00 to 25.00) |
| Irregular bleeding may occur, monitor electrolytes. |
| Flutamide (Eulexin) | 250 mg two to three times daily | Monitor liver function. | Combine with other method of contraception. | 144.00 per month (125.00) |
| Pregnancy category D |
| Finasteride (Proscar) | 5 mg daily | Monitor liver function. | Pregnancy category X | 70.00 per month |
| Glucocorticoids (no FDA labeling for treatment of hirsutism) | Dexamethasone | 0.5 mg nightly | Weight gain, hypokalemia, decreased bone density, immune suppression | Pregnancy category C. May be combined with oral contraceptives or Gn-RH agonists for severe hirsutism. | 20.00 per month (2.00 to 10.00) |
| Prednisone | 5 to 10 mg daily | Pregnancy category C | 1.50 per month (2.00 to 3.00) |
| Gn-RH agonists (no FDA labeling for treatment of hirsutism) | Leuprolide (Lupron) | 3.75 mg IM per month for up to six months | Hot flushes, decreased bone mineral density, atrophic vaginitis | Pregnancy category X. Use with caution for short periods because of hypoestrogenic effect. | 535.00 per month |
| 11.25 mg IM every three months (depot form) | May need add-back HT. | Use nonhormonal contraception during treatment. | 1,605.00 for three months |
| Antifungal agents (no FDA labeling for treatment of hirsutism) | Ketoconazole (Nizoral) | 400 mg daily | Scalp hair loss, dry skin, abdominal pain, fatigue, headache, vaginal spotting, hepatotoxicity | Pregnancy category C Use as last resort. | 231.00 per month (182.00 to 190.00) |
| Monitoring of hepatic function necessary |
| Topical hair growth retardant | Eflornithine HCI (Vaniqa) | Apply to face twice daily at least eight hours apart. | Skin adverse effects include acne, erythema, stinging/burning, dry skin. | Pregnancy category C | 42.00 for 30-g tube |
| May cause mild elevations in transaminase levels. |
| FDA approval for reduction of unwanted facial hair | No significant drug interaction known |
| Insulin-sensitizing agents (not FDA approved for treatment of hirsutism) | Metformin (Glucophage) | 500 mg twice daily | GI distress, lactic acidosis (rare with mortality nearly 50 percent), numerous drug interactions | Pregnancy category B | 47.00 per month (42.00) |
| 1,000 mg twice daily (maximal dosage 2.0 to 2.5 g per day) | Resumption of ovulation may occur. |
| No FDA labeling for treatment of PCOS |
| Monitor liver function, confirm normal renal function before starting, and monitor. |
| 850 mg three times daily |