Anti-androgen birth control refers to hormonal contraceptives that contain a progestin with properties that counteract the effects of androgens, often referred to as male hormones. These medications are primarily used for contraception, preventing pregnancy by altering a woman’s hormonal balance. Beyond their contraceptive action, they also address conditions linked to excess androgen activity in the body.
Understanding Anti-Androgens and Their Mechanism
Androgens are a group of sex hormones present in both males and females, though in lower concentrations in females. The most well-known androgen is testosterone. In females, androgens are produced by the ovaries and adrenal glands, and they can be converted into estrogens.
Anti-androgen birth control reduces the impact of these hormones. A primary way is by blocking androgen receptors, proteins on cells that androgens bind to. By occupying these receptors, anti-androgens prevent natural androgens like testosterone from attaching and activating the cell’s response. This competitive inhibition effectively reduces androgenic activity in various tissues.
Beyond blocking receptors, these contraceptives can also inhibit androgen production. Combined oral contraceptives, often with an anti-androgen component, decrease androgen production in the ovaries and adrenal glands. This reduction in ovarian androgen is related to their ability to suppress ovulation. Some anti-androgens also increase levels of sex hormone-binding globulin (SHBG), a protein that binds to testosterone in the bloodstream, reducing “free,” active testosterone. These actions contribute to their contraceptive effect.
Therapeutic Applications Beyond Contraception
Anti-androgen birth control is used for medical conditions resulting from elevated androgen levels or increased sensitivity to androgens. A common application is in the management of acne, particularly hormonal acne. Anti-androgenic components reduce sebum production and comedone formation, key factors in acne development. Improvements in acne are observed within three months, with full effects seen around six months.
Hirsutism, characterized by excessive hair growth in areas associated with male hair patterns, is another condition effectively treated by these medications. The anti-androgenic action helps slow hair growth, lighten hair color, and make hair finer over time. While physical hair removal methods can be used concurrently, anti-androgen therapy addresses the underlying hormonal cause.
Polycystic ovary syndrome (PCOS), a common hormonal imbalance, involves high androgen levels, leading to symptoms like irregular periods, acne, and hirsutism. Anti-androgen birth control helps regulate menstrual cycles, reduce androgen-related symptoms, and can decrease the size and number of ovarian cysts. This treatment also improves insulin sensitivity, a concern in individuals with PCOS.
Commonly Prescribed Anti-Androgen Birth Control Options
Several anti-androgen birth control options are widely available as combined oral contraceptives containing both an estrogen and a progestin with anti-androgenic properties. Drospirenone is a well-known synthetic progestin with anti-androgenic and anti-mineralocorticoid effects. Pills containing drospirenone, such as Yasmin and Yaz, are prescribed for their anti-androgen benefits, including the treatment of moderate acne and premenstrual dysphoric disorder.
Another progestin with strong anti-androgenic action is cyproterone acetate (CPA). In some regions, combined oral contraceptives containing cyproterone acetate and ethinyl estradiol, such as Diane-35, treat severe acne, hirsutism, and symptoms of hyperandrogenism associated with PCOS. While highly effective, CPA is associated with a higher risk profile compared to other options. Other low-dose combined oral contraceptives with minimal androgenic effects, containing progestins like desogestrel, gestodene, or norgestimate, are also available and can be helpful for managing androgen-related conditions.
Important Considerations and Side Effects
Before starting anti-androgen birth control, a thorough medical consultation is advisable to ensure it is the appropriate choice and to discuss any pre-existing health conditions. Adherence to the prescribed dosage is important for maintaining both contraceptive efficacy and therapeutic benefits. Other medications can interfere with the effectiveness of these contraceptives, so discuss all current medications with a healthcare provider.
Common side effects associated with anti-androgen birth control can include changes in menstrual bleeding patterns, such as spotting between periods or, rarely, missed periods. Some individuals may experience mood changes, including a reduced libido or an increased risk of depression. Other potential effects are breast tenderness or enlargement, nausea, headaches, and sometimes an increase in appetite or weight.
While generally safe, there are less common but more serious risks to be aware of, such as an increased risk of blood clots, including deep vein thrombosis (DVT) and pulmonary embolism (PE). This risk is generally low but can be higher with certain formulations, such as those containing drospirenone, compared to other birth control pills. The risk of blood clots is also influenced by factors like age, smoking, and certain clotting disorders. This elevated risk typically decreases within a few weeks of stopping the medication.