News, Views, and Reviews. Cutaneous Hyperandrogenism: Role of AntiandrogenTherapy in Acne, Hirsutism, and Androgenetic Alopecia

November 2013 | Volume 12 | Issue 11 | Features | 1297 | Copyright © November 2013

Aimee Krausz BA and Adam J. Friedman MD


The authors have no relevant conflicts to disclose.
Aimee Krausz BAa and Adam J. Friedman MDa,b
aDepartment of Medicine (Division of Dermatology) and
bDepartment of Physiology and Biophysics, Albert Einstein
College of Medicine, Bronx, NY


  1. Zouboulis CC. The human skin as a hormone target and an endocrine gland.Hormones (Athens, Greece). Jan-Mar 2004;3(1):9-26.
  2. Thiboutot D, Jabara S, McAllister JM, et al. Human skin is a steroidogenic tissue: steroidogenic enzymes and cofactors are expressed in epidermis, normal sebocytes, and an immortalized sebocyte cell line (SEB-1). J Investig Dermatol. 2003;120(6):905-914.
  3. Zouboulis CC. The skin as an endocrine organ.Dermatoendocrinol. Sep 2009;1(5):250-252.
  4. Zouboulis C, Chen W-C, Thornton M, Qin K, Rosenfield R. Sexual hormones in human skin.Hormone and metabolic research. 2007;39(02):85-95.
  5. Chen W-C, Zouboulis CC. Hormones and the pilosebaceous unit.Dermatoendocrinol. 2009;1(2):81-86.
  6. Zouboulis CC, Degitz K. Androgen action on human skin -- from basic research to clinical significance.Exp Dermatol. 2004;13 Suppl 4:5-10.
  7. Chen W, Thiboutot D, Zouboulis CC. Cutaneous androgen metabolism: basic research and clinical perspectives.J Investig Dermatol. 2002;119(5):992-1007.
  8. Lai JJ, Chang P, Lai KP, Chen L, Chang C. The role of androgen and androgen receptor in skin-related disorders.Archives of dermatological research. Sep 2012;304(7):499-510.
  9. Fritsch M, Orfanos CE, Zouboulis CC. Sebocytes are the key regulators of androgen homeostasis in human skin.J Investig Dermatol. 2001;116(5):793-800.
  10. Zouboulis CC, Baron JM, Bohm M, et al. Frontiers in sebaceous gland biology and pathology. Exp Dermatol. Jun 2008;17(6):542-551.
  11. Chen W, Zouboulis CC, Orfanos CE. The 5 alpha-reductase system and its inhibitors. Recent development and its perspective in treating androgen-dependent skin disorders.Dermatology (Basel, Switzerland). 1996;193(3):177-184.
  12. Samson M, Labrie F, Zouboulis CC, Luu-The V. Biosynthesis of dihydrotestosterone by a pathway that does not require testosterone as an intermediate in the SZ95 sebaceous gland cell line.J Investig Dermatol. Feb 2010;130(2):602-604.
  13. Rosenfield RL. Hirsutism and the variable response of the pilosebaceous unit to androgen.J Investig Dermatol. Symposium proceedings / the Society for Investigative Dermatology, Inc. [and] European Society for Dermatological Research. Dec 2005;10(3):205-208.
  14. Rosenfield RL. Clinical practice. Hirsutism. N Engl J Med. Dec 15 2005;353(24):2578-2588.
  15. Nordstrom RE. Synchronous balding of scalp and hair-bearing grafts of scalp transplanted to the skin of the arm in male pattern baldness. Acta dermatovenereologica. 1979;59(3):266-268.
  16. Orentreich N. Autografts in alopecias and other selected dermatological conditions. Annals of the New York Academy of Sciences. Nov 20 1959;83:463-479.
  17. Itami S, Inui S. Role of androgen in mesenchymal epithelial interactions in human hair follicle. J Investig Dermatol. Symposium proceedings / the Society for Investigative Dermatology, Inc. [and] European Society for Dermatological Research. Dec 2005;10(3):209-211.
  18. Kurokawa I, Danby FW, Ju Q, et al. New developments in our understanding of acne pathogenesis and treatment. Exp Dermatol. Oct 2009;18(10):821-832.
  19. Lucky AW, Biro FM, Huster GA, Leach AD, Morrison JA, Ratterman J. Acne vulgaris in premenarchal girls. An early sign of puberty associated with rising levels of dehydroepiandrosterone. Arch Dermatol Res. Mar 1994;130(3):308-314.
  20. Thiboutot D, Harris G, Iles V, Cimis G, Gilliland K, Hagari S. Activity of the type 1 5 alpha-reductase exhibits regional differences in isolated sebaceous glands and whole skin. J Investig Dermatol. Aug 1995;105(2):209-214.
  21. Janiczek-Dolphin N, Cook J, Thiboutot D, Harness J, Clucas A. Can sebum reduction predict acne outcome? Br J Dermatol. Oct 2010;163(4):683-688.
  22. Lee WJ, Jung HD, Chi SG, et al. Effect of dihydrotestosterone on the upregulation of inflammatory cytokines in cultured sebocytes. Arch Dermatol Res. Aug 2010;302(6):429-433.
  23. Smith TM, Gilliland K, Clawson GA, Thiboutot D. IGF-1 induces SREBP-1 expression and lipogenesis in SEB-1 sebocytes via activation of the phosphoinositide 3-kinase/Akt pathway. J investig dermatol. May 2008;128(5):1286-1293.
  24. Fan W, Yanase T, Morinaga H, et al. Insulin-like growth factor 1/insulin signaling activates androgen signaling through direct interactions of Foxo1 with androgen receptor. J biol chem. Mar 9 2007;282(10):7329-7338.
  25. Katsambas AD, Dessinioti C. Hormonal therapy for acne: why not as first line therapy? Facts and controversies. Clinics in dermatology. 2010;28(1):17-23.
  26. Thiboutot D. Acne: hormonal concepts and therapy. Clinics in dermatology. Sep-Oct 2004;22(5):419-428.
  27. George R, Clarke S, Thiboutot D. Hormonal therapy for acne. Semin Cutan Med Surg. Sep 2008;27(3):188-196.
  28. Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev (Online). 2012;7:CD004425.
  29. Tyler KH, Zirwas MJ. Contraception and the dermatologist. J Am Acad Dermatol. Jun 2013;68(6):1022-1029.
  30. Muhlemann MF, Carter GD, Cream JJ, Wise P. Oral spironolactone: an effective treatment for acne vulgaris in women.Br J Dermatol. Aug 1986;115(2):227-232.
  31. Leyden J, Bergfeld W, Drake L, et al. A systemic type I 5 alpha-reductase inhibitor is ineffective in the treatment of acne vulgaris. J Am Acad Dermatol. Mar 2004;50(3):443-447.
  32. Blume-Peytavi U. How to diagnose and treat medically women with excessive hair. Dermatologic clinics. Jan 2013;31(1):57-65.
  33. Atanaskova Mesinkovska N, Bergfeld WF. Hair: what is new in diagnosis and management? Female pattern hair loss update: diagnosis and treatment. Dermatologic clinics. Jan 2013;31(1):119-127.
  34. Brown J, Farquhar C, Lee O, Toomath R, Jepson RG. Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne. Cochrane Database Syst Rev (Online). 2009(2):CD000194.
  35. Van der Spuy ZM, le Roux PA. Cyproterone acetate for hirsutism. Cochrane Database Syst Rev (Online). 2003(4):CD001125.
  36. Raudrant D, Rabe T. Progestogens with antiandrogenic properties. Drugs. 2003;63(5):463-492.
  37. Wang HS, Wang TH, Soong YK. Low dose flutamide in the treatment of acne vulgaris in women with or without oligomenorrhea or amenorrhea. Changgeng Yi Xue Za Zhi. Sep 1999;22(3):423-432.
  38. Muderris, II, Bayram F, Guven M. Treatment of hirsutism with lowest-dose flutamide (62.5 mg/day). Gynecol Endocrinol. Feb 2000;14(1):38-41.
  39. Muderris, II, Bayram F, Ozcelik B, Guven M. New alternative treatment in hirsutism: bicalutamide 25 mg/day. Gynecol Endocrinol. Feb 2002;16(1):63-66.
  40. Yazdabadi A, Sinclair R. Treatment of female pattern hair loss with the androgen receptor antagonist flutamide. Australas J Dermatol. May 2011;52(2):132-134.
  41. Lakryc EM, Motta EL, Soares JM, Jr., Haidar MA, de Lima GR, Baracat EC. The benefits of finasteride for hirsute women with polycystic ovary syndrome or idiopathic hirsutism. Gynecol Endocrinol. Feb 2003;17(1):57-63.
  42. Olszewska M, Rudnicka L. Effective treatment of female androgenic alopecia with dutasteride. J Drugs Dermatol. Sep-Oct 2005;4(5):637-640.
  43. Swiglo BA, Cosma M, Flynn DN, et al. Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol and Metab. Apr 2008;93(4):1153-1160.
  44. Sahin Y, Bayram F, Kelestimur F, Muderris I. Comparison of cyproterone acetate plus ethinyl estradiol and finasteride in the treatment of hirsutism. J Endocrinol Invest. Jun 1998;21(6):348-352.
  45. Yip L, Rufaut N, Sinclair R. Role of genetics and sex steroid hormones in male androgenetic alopecia and female pattern hair loss: an update of what we now know. Australas J Dermatol. May 2011;52(2):81-88.
  46. Imperato-McGinley J, Guerrero L, Gautier T, Peterson RE. Steroid 5alphareductase deficiency in man: an inherited form of male pseudohermaphroditism. Science (New York, NY). Dec 27 1974;186(4170):1213-1215.
  47. Hibberts NA, Howell AE, Randall VA. Balding hair follicle dermal papilla cells contain higher levels of androgen receptors than those from non-balding scalp. J Endocrinol. Jan 1998;156(1):59-65.
  48. Schweiger ES, Boychenko O, Bernstein RM. Update on the pathogenesis, genetics and medical treatment of patterned hair loss. J Drugs Dermatol. Nov 2010;9(11):1412-1419.
  49. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am Acad Dermatol. Oct 2008;59(4):547-566; quiz 567-548.
  50. Niiyama S, Happle R, Hoffmann R. Influence of estrogens on the androgen metabolism in different subunits of human hair follicles. Eur J Dermatol. May-Jun 2001;11(3):195-198.
  51. Georgala S, Katoulis AC, Georgala C, Moussatou V, Bozi E, Stavrianeas NG. Topical estrogen therapy for androgenetic alopecia in menopausal females. Dermatology (Basel, Switzerland). 2004;208(2):178-179.
  52. Price VH, Roberts JL, Hordinsky M, et al. Lack of efficacy of finasteride in postmenopausal women with androgenetic alopecia. J Am Acad Dermatol. Nov 2000;43(5 Pt 1):768-776.
  53. Scheinfeld N. A review of hormonal therapy for female pattern (androgenic) alopecia. Dermatology online journal. 2008;14(3):1.
  54. Hajheydari Z, Akbari J, Saeedi M, Shokoohi L. Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia. Indian J Dermatol Venereol Leprol. Jan-Feb 2009;75(1):47-51.