SummaryBackground Hormone studies have demonstrated the androgen-dependent character of female androgenetic alopecia, but there have been few controlled studies of therapies for alopecia in women.
Objectives To compare topical minoxidil 2% and cyproterone acetate in the treatment of female alopecia.
Methods Sixty-six women with female-pattern alopecia were randomly assigned for 12 cycles into two groups, 33 received two local applications (2 mL day−1) of topical minoxidil 2% plus combined oral contraceptive and 33 received cyproterone acetate 52 mg day−1 plus ethinyl oestradiol 35 µg for 20 of every 28 days.
Results A mean reduction of 2·4 ± 6·2 per 0·36 cm2 in hairs of diameter > 40 µm was observed in the cyproterone acetate group (P = 0·05) and a mean increase of 6·5 ± 9 per 0·36 cm2 in the minoxidil group (P < 0·001). Comparison of the total number of hairs at 12 months and the body mass index (BMI) revealed a borderline positive correlation in the cyproterone acetate group (r = 0·39, P = 0·06) and a negative correlation in the minoxidil group (r = −0·42, P < 0·05). No significant difference was observed in the total number of hairs among cyproterone acetate patients according to the presence or absence of other symptoms of hyperandrogenism, whereas in the minoxidil group, the total number of new hairs was higher in patients with isolated alopecia (Δ = 8·1; P < 0·05). Variations in scalp seborrhoea were significant in both groups, but the result was better (for acne and hirsutism as well) in the cyproterone acetate group than in the minoxidil group (P < 0·001).
Conclusions Minoxidil treatment was more effective in the absence of other signs of hyperandrogenism, hyperseborrhoea, and menstrual cycle modifications when the BMI was low, and when nothing argued in favour of biochemical hyperandrogenism. Cyproterone acetate treatment was more effective when other signs were present and when the BMI was elevated, factors that favoured a diagnosis of biochemical hyperandrogenism.