Ketoconazole works by blocking the production of hormones by the ovaries and the adrenal glands. As with other antiandrogen drugs, there are several different research reports that claim a reduction in hirsutism with different drug use protocols. The intake of ketoconazole may range from 200mg to 400mg a day. Although the list of references below might seem to suggest that ketoconazole is a popular treatment for hirsutism, most dermatologists are wary of using it on a regular basis. Because it is such a powerful anti androgen, some dermatologists believe the risk of side effects is greater than with other antiandrogen drugs.
Dermatologists are particularly concerned with the risk of hepatotoxicity when using ketoconazole.
Most dermatologists only use ketoconazole when the hirsutism is particularly pronounced and even then the drug is only prescribed for a brief period of time before switching to other antiandrogen drugs. Flamigni C. A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. J Clin Endocrinol Metab. Low dose ketoconazole is an effective and a relatively safe alternative in the treatment of hirsutism. Eur J Endocrinol.