Encyclopedia · antiandrogen
Oral contraceptives and antiandrogenic progestins
Some birth-control pills lower androgens or block their receptor, but almost no trial shows that any pill regrows scalp hair.
What it is
Combined pills pair an estrogen with a progestin, and the progestin matters. Antiandrogenic progestins include cyproterone acetate, chlormadinone acetate, drospirenone and dienogest. All are prescription-only. No contraceptive is approved for hair loss in the US. European combined pills are licensed for contraception and, for some cyproterone/ethinyl estradiol products, for androgen-related acne and excess hair, but not for alopecia. Bitzer 2017
How it works
Estrogen raises sex-hormone-binding globulin and suppresses ovarian androgen output, and the progestin can add antiandrogen action at the receptor. Hair-specific proof is lacking, and the follicle's role in women's pattern loss is only partly androgen-driven. See DHT and pattern hair loss.
What the studies show
- Cyproterone/EE versus minoxidil (66 women, 12 months): the cyproterone group lost hairs (-2.4 per 0.36 cm²) while the minoxidil group gained (+6.5); the cyproterone group did better on oily skin, acne and excess hair. Vexiau 2002
- Four-way comparison (48 women, 1 year, unmasked): cyproterone plus ethinyl estradiol was not significantly better than no treatment. Carmina 2003
- Chlormadinone acetate (review): limited data from small subgroups in contraceptive trials suggested improved female pattern hair loss, while the evidence for acne is much stronger. Guerra-Tapia 2011
- Cyproterone 2 mg/EE 35 mcg (review of 78 studies): good efficacy for severe acne and excess hair, with no hair-loss result highlighted. Bitzer 2017
- Gap: the 2016 Cochrane review called for larger trials of spironolactone, finasteride, dutasteride, cyproterone and lasers in women. van Zuuren 2016 We found no placebo-controlled trial of a modern antiandrogenic pill for hair loss.
Side effects and safety
- Combined pills raise the risk of blood clots and are unsuitable with migraine with aura, smoking over 35 and some other conditions (general contraceptive labelling).
- Meningioma: high-dose cyproterone shows a clear dose-related excess (see cyproterone acetate). A 2024 French case-control study of other progestogens found excess meningioma risk with medrogestone, injectable medroxyprogesterone acetate and promegestone, driven by use of a year or more. Roland 2024
Bottom line
The evidence is mostly indirect and mixed. A pill is a reasonable choice for a woman who already needs contraception and has acne or excess hair along with her hair loss, ideally with a lower-androgenicity progestin. It should not be taken for hair alone and is not a substitute for minoxidil or spironolactone. If pregnancy is possible, reliable contraception is also what makes oral antiandrogens like spironolactone safe to use. Discuss with a doctor.
Studies 6
Vexiau P et al. Effects of minoxidil 2% vs cyproterone acetate treatment on female androgenetic alopecia: a controlled, 12-month randomized trial. Br J Dermatol. 2002
Tested: cyproterone acetate 52 mg plus ethinyl estradiol 35 mcg vs minoxidil 2% plus an oral contraceptive
Result: Hairs over 40 micrometres fell on cyproterone (-2.4 per 0.36 cm2) and rose on minoxidil (+6.5); cyproterone did better for seborrhoea, acne and hirsutism.
Read the study ↗Carmina E, Lobo RA. Treatment of hyperandrogenic alopecia in women. Fertil Steril. 2003
Tested: flutamide 250 mg, cyproterone acetate 50 mg plus ethinyl estradiol, finasteride 5 mg, or no treatment
Result: Only flutamide moved the Ludwig score (21% reduction); the other treatments were not significant.
Read the study ↗Guerra-Tapia A, Sancho Perez B. Ethinylestradiol/chlormadinone acetate: dermatological benefits. Am J Clin Dermatol. 2011
Tested: ethinyl estradiol plus chlormadinone acetate
Result: Limited data from small subgroups suggested improved female pattern hair loss; evidence for acne is much stronger.
Read the study ↗Bitzer J et al. Cyproterone acetate/ethinyl estradiol in hyperandrogenic skin symptoms: review. Eur J Contracept Reprod Health Care. 2017
Tested: cyproterone acetate 2 mg plus ethinyl estradiol 35 mcg
Result: Good efficacy for severe acne and hirsutism; no hair-loss result highlighted.
Read the study ↗van Zuuren EJ et al. Interventions for female pattern hair loss. Cochrane Database Syst Rev. 2016
Tested: topical minoxidil and other treatments vs placebo
Result: Minoxidil gave about 13.2 more hairs/cm2 than placebo; there was no difference between 2% and 5% in women.
Read the study ↗Roland N et al. Use of progestogens and the risk of intracranial meningioma: national case-control study. BMJ. 2024
Tested: progestogen use
Result: Excess meningioma risk with medrogestone, injectable medroxyprogesterone acetate and promegestone, driven by use of a year or more (only part of the abstract was read).
Read the study ↗Related
- SpironolactoneA cheap blood-pressure pill that blocks androgen receptors and is the most widely used off-label hormonal treatment for women's pattern hair loss.
- Cyproterone acetateA steroid antiandrogen used in Europe for women's hair loss and excess hair, with mixed trial results and a dose-related risk of meningioma.
- BicalutamideA prostate-cancer drug that blocks the androgen receptor and is used off-label by some specialists for women's hair loss, with liver-monitoring and pregnancy rules.
- FinasterideA prescription pill (and in some countries a scalp spray) that lowers DHT and is the best-proven drug for stopping male pattern hair loss.
- Antiandrogen comparison for hair lossA side-by-side of the drugs, topicals and supplements that work on the androgen pathway, with who they were studied in and how strong the evidence is.