Hormonal OCPs with Antiandrogenic Effects

Introduction to Antiandrogenic OCPs

The American Academy of Dermatology notes that FDA-approved combined oral contraceptive pills (COCs) with antiandrogenic effects include Yaz/Yasmin (ethinyl estradiol/drospirenone), Ortho Tri-Cyclen (ethinyl estradiol/norgestimate), Estrostep Fe (ethinyl estradiol/norethindrone acetate/ferrous fumarate), and Beyaz (ethinyl estradiol/drospirenone/levomefolate) 1, 2

Drospirenone-containing pills, such as Yaz and Yasmin, have specific antiandrogenic properties, with 3mg drospirenone and 20μg ethinyl estradiol in a 24/4 day regimen, and are FDA-approved for acne treatment 3, 2, 4
Norgestimate-containing pills, like Ortho Tri-Cyclen, are second-generation progestins with antiandrogenic effects and are FDA-approved for acne treatment 1, 2, 4
Norethindrone acetate-containing pills, such as Estrostep Fe, are first-generation progestins with moderate antiandrogenic effects and are FDA-approved for acne treatment 1, 2, 4

All FDA-approved antiandrogenic OCPs demonstrate significant reduction in both inflammatory and comedonal acne lesions 4

The American Academy of Dermatology states that OCPs with antiandrogenic effects carry the same contraindications as other combined hormonal contraceptives, including history of deep vein thrombosis or pulmonary embolism, uncontrolled hypertension, smoking in women over 35 years of age, history of breast cancer or other estrogen/progestin-sensitive cancers, active liver disease, and migraine with aura 1, 3, 6
Drospirenone-containing pills may have a slightly higher VTE risk compared to other combined oral contraceptives 5
When prescribing OCPs for antiandrogenic effects, the benefits must be weighed against the risks, particularly in women with risk factors for venous thromboembolism 4, 6