PREVENTING THE PHYSICAL EFFECTS OF TOO MANY MALE HORMONES
Thankfully, it is now possible to prevent and reverse the masculine changes that result from excessive androgen production or activity. In years gone by, acne and facial hair have caused many women of all ages’ considerable stress and embarrassment in their social and professional lives. Uncontrolled acne in particular may lead to permanent scarring and disfigurement if allowed to continue but such women can now be promised near to perfect skin. I myself remember the extreme self-consciousness caused by my own adolescent acne and only wish that the doctor I had consulted way back then had known of the value of hormonal therapy in suppressing acne.
Overcoming Acne and Facial/Body Hair
For women with moderate to severe acne or facial hair, it is usually necessary to use drugs with a hormonal action that will either reduce the body's production of male hormones and/or block the action of male hormones upon the hair follicles and sebaceous glands in the skin. These drugs are extremely effective and, under strict medical supervision, are safe. They need to be
given for a long time and you need to feel that the improvement in your appearance warrants the expense and slight risk in taking this long-term medication.
Because I am a naturopathic doctor as well as a medical doctor, I am often asked if nutritional supplements can cure acne, facial hair or thinning of scalp hair. Unfortunately, they will not cure these problems and although they may help, particularly with thinning of the scalp hair hormonal therapy is the most effective strategy.
Let us take a look at some of the hormonal drugs that reduce the production and action of male hormones in our bodies.
Androcur
The chemical name for Androcur is cyproterone acetate and this remarkable drug acts like an anti-male hormone. It is the most powerful anti-male hormone available providing an almost 100% cure of acne after three to nine months of use and reverses hirsutism in 80% of women after nine to twelve months of use. Approximately one in every two women with androgenic alopecia will obtain a regrowth or thickening of the scalp hair after using Androcur for nine to twelve months.
Androcur has been used overseas since 1974 and indeed in Europe it is a component of the oral contraceptive pill called "Dianette" which is commonly prescribed as a contraceptive in acne sufferers. Androcur is really a hormone with a dual action, being not only an anti-male hormone but also a progestogen and so it can be used with oestrogen in an oral contraceptive pill. Hopefully, Australian and New Zealand women will soon have an oral contraceptive pill such as Dianette.
Androcur is given with the female hormone oestrogen on a cyclical basis in much the same way as the oral contraceptive pill is taken and this can be tailor-made for you to suppress acne and/or facial hair and to provide contraception. This is important as women taking Androcur must avoid pregnancy because its anti-male hormone properties may stop the sexual development in a male foetus.
In post-menopausal women, or women who have had a hysterectomy, pregnancy is not a concern and so Androcur can be taken without regard to contraception.
Generally speaking, Androcur is well tolerated by most women and when it is given along with oestrogen, the side effects are similar to those of being on the oral contraceptive pill.
Most women are overjoyed to have clear feminine skin which makes it easier to put up with any annoying side effects. Because Androcur is a potent anti-male hormone, high doses of it may cause a reduction in sex drive, reduced concentration, fatigue and mild depression.
Side effects can usually be avoided if the dosage of Androcur is reduced. Once your skin is looking good, the dose can be reduced way down to say 2.5 to 5mg daily when side effects should disappear. In the long term the lowest possible dose that can keep your skin looking good should be used and your own doctor can guide you on this. Androcur is available on an authority prescription for women suffering with the effects of excessive male hormones and in such cases, is not expensive.
Aldactone
The chemical name for Aldactone is spironolactone and, like Androcur, this is a drug with a dual action being not only a diuretic but also an effective anti-male hormone. Aldactone is not as powerful in its anti-male hormone effect as Androcur, but may be sufficient for some women with facial hair, acne or balding. It is often preferable to use Aldactone rather than Androcur in women with obesity, high blood pressure, fluid retention, severe depression, or in older women who smoke or who are unable to tolerate the oral contraceptive pill.
The amount needed to control acne and facial hair varies between different women. If breakthrough bleeding occurs or if contraception is required, Aldactone can be taken with the oral contraceptive pill. You must not become pregnant while taking Aldactone as, like Androcur, it may cause feminisation of the developing male foetus.
Aldactone may cause minor side effects such as breakthrough bleeding, slight breast enlargement, nausea, muscle cramps and an imbalance in potassium levels, but these may be avoided by reducing the dose.
Other Hormonal Treatments
In some women with mild acne and/or facial hair, a very good result can be obtained simply by taking the female hormone oestrogen. This will reduce the production of male hormones from the ovary and reduce production of oily secretions from the skin's sebaceous glands. In women with a uterus it is also necessary to give progestogen to regulate menstrual bleeding and only progestogens without male (androgenic) properties should be used. Many of today's oral contraceptive pills contain androgenic progestogens and these should be avoided as they may worsen acne and facial hair. Your doctor can tailor-make an oral contraceptive pill for you containing oestrogen and a non-androgenic progestogen such as Provera, Duphaston, or ideally, Androcur.
In Europe and New Zealand, women have the benefit of commercially available oral contraceptive pills containing oestrogen and non-androgenic progestogens such as Desogestrel or Androcur. Hopefully, Australian and American women will soon have these types of feminine oral contraceptive pills.
Menopausal and post-menopausal women with facial hair often find that the natural oestrogen in their hormone replacement therapy greatly reduces this problem, especially if a small dose of Androcur or Aldactone is added.
Excessive male hormone production from the adrenal glands can be suppressed by taking a very small dose of a cortisone-type preparation such as dexamethasone once a night upon retiring. One should use only the smallest possible dose of cortisone-type drugs as an impaired response to stress may occur.
The Story of Julia
Timely hormonal therapy may help to avoid unnecessary surgery as was the case for Julia, a 32-year-old woman who came to see me complaining of symptoms typical of polycystic ovarian disorder. Since the birth of her son eight years ago, she had developed PMT, facial hair and acne. Julia had bouts of sharp pelvic pains and an ultrasound scan of her pelvis revealed enlarged ovaries with many small cysts around their periphery. She had consulted a surgeon who told her that the only option was to remove her left ovary and take a wedge of tissue out of her right ovary. Julia was alarmed at this prospect because she did not want to lose an ovary this early in life. She consulted another doctor who prescribed a low-dose oral contraceptive pill, but unfortunately it contained an androgenic progestogen and did not help her facial hair and acne. We discussed the possibility of suppressing her androgen producing ovarian cysts with oestrogen and Androcur and she was delighted to learn that Androcur would cure her acne and facial hair. I prescribed Estigyn .05mg daily and Androcur 50mg for two weeks every month and advised her to avoid surgery as her ovarian cysts were typical of polycystic ovaries and not a tumour or cancer. After six months of Estigyn and Androcur, Julia's ovaries had returned to their normal size, their cysts had become much smaller and her skin was clear and much more feminine in appearance. Julia also found the treatment very convenient as it provided her with reliable contraception.
The Story of Barbara
Excessive secretion of male hormones associated with polycystic ovaries is quite common and can be responsible for much suffering and confusion which was exactly the case for 34-year-old Barbara who had been trying to become pregnant for more than two years. Barbara's menstrual cycle had always been infrequent and irregular and every three to four months she would have a menstrual flow that was heralded by PMT, large blind pimples and depression. Since the age of 18, she had developed facial hair and gradually gained excessive weight. Her mother said it was all the fault of her diet
and that if she gave up fats and sugars her pimples would clear. Barbara's mother's surprise was only surpassed by Barbara's relief when I explained that her problems were due to excessive levels of male hormones.
I referred Barbara to an infertility specialist so that she could receive fertility drugs to stimulate regular ovulation in her polycystic ovaries. Barbara became pregnant with the fertility drugs and nine months after the birth of her daughter, came to see me as her polycystic ovaries were once again over-producing male hormones. Subsequently, Barbara's facial hair and acne were very well controlled with Estigyn and Androcur and a weight-loss programme.
The Story of Susan
Susan, an actress, comedienne and singer was understandably very concerned with keeping her skin at its best. In her early 30s her hormonal balance changed after having had three children, and she developed "mature aged acne"
She became quite obsessed when every month before her period several blind pimples would appear on her chin and forehead and her husband and children complained to me that she sounded like a broken record. In her eyes, the pimples were like volcanos and she resorted to wearing bandaids on her face to conceal them. Her family and friends could hardly see these few pimples and told her that she was being overly anxious.
I referred Susan to a hormone specialist (endocrinologist) who began her on Aldactone tablets. These helped her acne but caused annoying breakthrough bleeding. Her specialist then tried Androcur and oestrogen tablets, but Susan was not able to tolerate oestrogen in oral (tablet) form as it caused nausea.
Her endocrinologist was by this time understanding that actresses are highly strung and sensitive creatures and racked his brains for an alternative to facial bandaids.
He suggested to Susan that she try oestrogen in injection form and so she began a course of monthly Primogyn Depot injections, each one being given at the end of her menstrual bleeding. Much to the relief of the doctor and Susan's family, this stopped the mild acne and she stopped wearing band-aids on her beautiful face.
It may seem minor to you but it is another example of how only a minor imbalance in the ratio of female to male hormones can cause small or large physical changes that in an individual can have ruinous effects.
For women who over-produce male hormones, therapy with oestrogen and anti-male hormones can be dramatically effective. These treatments are slow acting with nine to twelve months of therapy being needed for a total relief of symptoms. However, it is not a cure and symptoms such as acne, hirsutism or balding usually return if hormonal therapy is stopped. For permanent control, it is usually necessary to continue treatment on a long-term basis with interruption if pregnancy is desired.
These hormonal treatments should not be started before the sexual development and longitudinal growth spurt of adolescence is completed, otherwise a reduction in the attainment of height may occur. Furthermore, therapy needs to be guided under strict medical supervision and regular blood tests.
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