Treatment of Hirsutism
Hirsutism results from excess androgen action on hair follicles, most commonly due to conditions like PCOS. Pharmacological management is aimed at suppressing androgen production, blocking androgen receptors, or inhibiting peripheral androgen activation. The correct answer is Option C (2, 3 and 4) — Oestrogen, Finasteride and Spironolactone.
Analysis of Each Option
- 1. Amiloride: This is a potassium-sparing diuretic that acts on the renal collecting duct sodium channel. It has no established role in the hormonal management of hirsutism and does not affect androgen synthesis, metabolism, or receptor action. It is therefore not included among the correct statements.
- 2. Oestrogen: Oestrogen, typically given as part of a combined oral contraceptive pill, increases hepatic synthesis of Sex Hormone Binding Globulin (SHBG). Higher SHBG binds more circulating free testosterone, lowering the biologically active (free) androgen fraction available to hair follicles. COCPs are a first-line therapy for hirsutism in women who also desire contraception, making oestrogen a useful and correct component of treatment.
- 3. Finasteride: Finasteride is a 5α-reductase inhibitor that blocks the peripheral conversion of testosterone to the more potent dihydrotestosterone (DHT), the androgen chiefly responsible for hair follicle stimulation. By lowering DHT levels at the follicle, it reduces terminal hair growth, confirming it as a useful agent.
- 4. Spironolactone: Spironolactone is an aldosterone antagonist that also acts as a competitive androgen receptor blocker, and at higher doses mildly inhibits androgen synthesis. It is one of the most commonly used anti-androgens for hirsutism, particularly in combination with a COCP, confirming it as useful.
Conclusion
Among the four agents listed, Oestrogen, Finasteride, and Spironolactone (2, 3 and 4) all have recognized, mechanism-based roles in reducing androgen effect and are used in the treatment of hirsutism, whereas Amiloride has no such role. Hence, Option C is the correct answer.