Antiandrogens for Hirsutism: What Works, What to Avoid

When antiandrogens for hirsutism, medications that block male hormones to reduce excess hair growth in women. Also known as androgen blockers, they’re often used when hormonal imbalances cause unwanted facial or body hair, acne, or scalp thinning. This isn’t just about looks—it’s about balancing hormones that are out of step, often due to PCOS or other conditions. Many women start noticing changes in their late teens or early twenties, and by the time they seek help, they’ve already tried creams, waxing, or laser treatments that only mask the problem.

Two of the most common spironolactone, a blood pressure drug repurposed to block androgen receptors and finasteride, a 5-alpha reductase inhibitor that stops testosterone from turning into its stronger form, DHT are frequently prescribed. Spironolactone works fast—some see less hair growth in 3 to 6 months. Finasteride takes longer, but it’s gentler on the kidneys and doesn’t cause the same electrolyte shifts. Both are off-label for hirsutism, meaning they’re not FDA-approved for this use, but decades of clinical use back their safety. You won’t find them in ads, but dermatologists and endocrinologists reach for them routinely.

What’s missing from most online advice? Timing. These drugs don’t work overnight. Hair grows in cycles, so it can take a full year to see real change. And they’re not magic bullets—they work best with lifestyle tweaks like managing insulin resistance, cutting back on sugar, and avoiding endocrine disruptors in plastics. Some women combine them with birth control pills to stabilize estrogen levels, but that’s not always safe or needed. The real key is consistency. Skipping doses or stopping too soon makes results disappear.

Side effects are real but often manageable. Spironolactone can cause frequent urination, breast tenderness, or low blood pressure. Finasteride rarely causes mood changes, but studies show it’s safe for long-term use in women. Neither should be used during pregnancy—this isn’t just a warning, it’s a hard rule. If you’re trying to conceive, talk to your doctor about alternatives like metformin or eflornithine cream.

What you won’t find in most guides are the real-world trade-offs. One woman might get great results with spironolactone and never need anything else. Another might need to switch to dutasteride after a year because her body adapts. Some women combine these with topical treatments, while others rely solely on oral meds. There’s no one-size-fits-all, but the pattern is clear: the right antiandrogen, taken consistently, changes outcomes more than any laser or cream ever could.

Below, you’ll find real comparisons and practical guides on how these drugs stack up against each other, what to watch for, and how to use them safely without guessing. No fluff. Just what works, what doesn’t, and what your doctor might not tell you.