Relevance of Biological Properties of Progestogen of Oral Contraceptives in Treatment of Androgen Excess Symptoms

Abstract

Combined estrogen-progestogen oral contraceptives (OCs) are of proven therapeutic benefit to postpubertal females with androgen excess syndromes. Combined OCs stimulate sex hormone-binding globulin (SHBG) synthesis through their estrogen effect thereby increasing testosterone binding capacity and decreasing free testosterone concentrations. They further produce decreased ovarian and/or adrenal androgen production. The steroids with the most pronounced effects on androgenic activity are DL-norgestrel norethindrone and norethindrone acetate. Recent research suggests that the low-dose OCs and equally as effective as earlier formulations in decreasing free or total testosterone levels or androstenedione levels and increasing SHBG. Several studies of the effects of low-dose levonorgestrel-containing triphasic OCs have produced conflicting findings in terms of SHBG rises in women with acne. When androgenic progestogens are combined with estrogen at low dosages the androgenic properties of progestogen may not become expressed Clearly there is a need for more clinical and biochemical research on the efficacy and safety of treatment with low-dose OCs containing significant androgenic biopotency. It is important to keep in mind however that alleviation of androgen excess symptoms by OC use is only a temporary measure. The goal is to produce a more precise and lasting therapy through definition of the primary pathogenic mechanism of either excess androgen production or idiopathic androgenic symptoms.