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Treatment – Hormonal Therapies

By Editorial Team · October 20, 2020

Hidradenitis suppurativa (HS) is a chronic, painful inflammatory skin disease that begins when clogged hair follicles cause bumps. Treatments are available to help manage the condition, but there is no cure for HS. Since there is no cure, the goals of HS treatment are to reduce symptoms, relieve pain, and heal wounds to prevent infection.1

Increased androgens (male hormones) may contribute to the development of hidradenitis suppurativa (HS) in some people. For that reason, hormonal therapies are sometimes used to relieve HS symptoms, including pain and lesions.2

Signs of high levels of androgens in people with HS include:3

  • Acne
  • Excess male-pattern hair growth in women (hirsutism)
  • Irregular menstrual periods
  • High level of androgen in the blood
  • Infertility

Some studies have found no difference in levels of androgen in women with HS compared to a matched sample of women without HS. However, changing hormone levels appear to affect the course of the disease. Studies show that HS flares before menstrual periods, after childbirth, and as menopause approaches. Nearly half of women with HS report that the disease decreases after menopause.3-7

How do hormone therapies work?

Androgens are hormones that are present in both young men and women during puberty. Testosterone is one of the most well-known androgens. Androgens are also the precursors of estrogen. This means androgens are converted to estrogens by chemicals in the body.8

In HS, clogged hair follicles cause bumps that lead to symptoms like lesions, abscesses, and sinus tracts. The hair follicles in the armpits, groin, and buttocks area are surrounded by sweat and sebaceous (a gland that secretes sebum, an oily matter that lubricates the skin and hair) glands. These glands have 2 kinds of androgen-converting enzymes that turn testosterone into a stronger androgen hormone, 5-dihydrotestosterone (5-DHT). Testosterone and 5-DHT stick to androgen receptors on the sebaceous glands. This causes the glands to secrete more sebum, which increases inflammation and HS symptoms. Hormone therapy can help to keep testosterone and 5-DHT levels balanced, thus reducing HS symptoms and flares.8

What kinds are used for HS?

Several different hormonal therapies are recommended for people with mild to moderate HS or in combination with other drugs for severe disease. These hormone therapies include:9

  • Ethinyl estradiol
  • Norgestrel
  • Cyproterone acetate
  • Spironolactone (Aldactone)
  • Finasteride (Propecia, Proscar)

Ethinyl estradiol, norgestrel, and cyproterone acetate for HS treatment

Ethinyl estradiol, norgestrel, and cyproterone acetate (CypA) hormones are often used in birth control pills. Ethinyl estradiol and norgestrel are forms of the female hormones estrogen and progestin. CypA is not available in the United States.10

In 1 study, researchers studied women with HS taking birth control pills containing ethinyl estradiol and norgestrel (forms of the female hormones estrogen and progestin) with pills containing ethinyl estradiol and the anti-androgen cyproterone acetate (CypA). HS improved or completely cleared in half the women using either treatment.9,10

Spironolactone for HS treatment

Spironolactone is an androgen blocker that was developed for the treatment of high blood pressure. Researchers in 1 study found that just over half of women treated with a combination of ethinyl estradiol, CypA, and spironolactone experienced an improvement in their HS symptoms.9,11

In women treated with spironolactone alone, nearly 90 percent showed improvement. More than half had complete remission of their HS.9

Researchers recommend spironolactone as a first-line treatment for women with mild to moderate HS.11

Finasteride for HS treatment

Finasteride is an anti-androgen that is used for treating enlargement of the prostate gland and male-pattern hair loss in men. It is used to treat hirsutism (excessive hair growth) in women.10

Studies have found that finasteride is effective for treating HS when used alone or with other drugs, regardless of the duration or extent of disease. It reduces the frequency and severity of flares in adults, teens, and children. It is cost-effective and well-tolerated.10

More research is needed to find out the best timing, dosage, and duration of treatment, as well as any complications of long-term use in younger people.10

What are the possible side effects?

Side effects of hormone therapies vary depending on the drug and its dosage. Some of the common side effects of certain hormone therapies include:2,9,10,12-15

  • Breast pain in women and enlargement of breasts in men
  • Decreased sex drive (libido)
  • Dizziness
  • Flu-like symptoms
  • Hot flashes
  • Headaches
  • Mood swings
  • Nausea, abdominal pain, and diarrhea
  • Weight gain

These are not all the possible side effects of hormone therapies. Talk to your doctor about what to expect or if you experience any changes that worry you.

Things to know

Pregnant women with HS should not use hormonal therapy because of risks to their unborn baby. Talk to your doctor if you are pregnant or plan to become pregnant.2

Before taking any hormone therapies, tell your doctor about any other drugs, vitamins, or supplements you are taking. This includes over-the-counter drugs.

Hormone therapies are just 1 part of HS treatment. You should discuss the risks and benefits of these drugs with your doctors, as well as any other steps you should take to avoid side effects. Other approaches may include different drugs, surgery, diet and lifestyle changes, and alternative medicine.

Written by: Ina Fried and Heather Morse | Last reviewed: December 2020
  1. Seyed Jafari SM, Hunger RE, Schlapbach C. Hidradenitis suppurativa: current understanding of pathogenic mechanisms and suggestion for treatment algorithm. Front Med (Lausanne). 2020 Mar 4;7:68. doi:10.3389/fmed.2020.00068.
  2. Nesbitt E, Clements S, Driscoll M. A concise clinician’s guide to therapy for hidradenitis suppurativa. Int J Womens Dermatol. 2020 Mar;6(2):80-84. doi:10.1016/j.ijwd.2019.11.004.
  3. Phan K, Charlton O, Smith SD. Hidradenitis suppurativa and polycystic ovarian syndrome: systematic review and meta-analysis. Australasian Journal of Dermatology. 2020;61:e28-e33. doi:10.1111/ajd.13110.
  4. Vossen AR, van Straalen KR, Prens EP, van der Zee HH. Menses and pregnancy affect symptoms in hidradenitis suppurativa: a cross-sectional study. J Am Acad Dermatol 2017;76(1):155-156.
  5. Perng P, Zampella JG, Okoye G. Management of hidradenitis suppurativa in pregnancy. J Am Acad Dermatol . 2017 May;76(5):979-989. doi:10.1016/j.jaad.2016.10.032.
  6. Riis PT, Ring HC, Themstrup L, Jemec GB. The role of androgens and estrogens in hidradenitis suppurativa - a systematic review. Acta Dermatovenerol Croat. 2016 Dec;24(4):239-249. Available at https://pubmed.ncbi.nlm.nih.gov/28128074/. Accessed 7/9/2020.
  7. Kromann CB, Deckers IE, Esmann S, et al. Risk-factors, clinical course and long-term prognosis in hidradenitis suppurativa: a cross-sectional study. Br J Dermatol. 2014 Oct;171(4):819-824. doi:10.1111/bjd.13090.
  8. Clark AK, Quinonez RL, Saric S, Sivamani RK. Hormonal therapies for hidradenitis suppurativa: Review. Dermatol Online J. 2017;23(10):13030/qt6383k0n4.
  9. Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: A publication from the United States and Canadian Hidradenitis Suppurativa Foundations: Part II: Topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91‐101.
  10. Khandalavala BN, Do MV. Finasteride in hidradenitis suppurativa: a ‘‘male’’ therapy for a predominantly ‘‘female’’ disease. J Clin Aesthet Dermatol. 2016 June;9(6):44-50. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4928456/. Accessed 8/19/2020.
  11. Lowes M, Hoffman L. Faculty opinions recommendation of [Lee A, Fischer G. A case series of 20 women with hidradenitis suppurativa treated with spironolactone. Australas J Dermatol. 2015;56(3):192-196]. In Faculty Opinions. doi:10.3410/f.726985760.793525572.
  12. Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015 Jan;29(4):619-644. doi:10.1111/jdv.12966.
  13. Ngan V. Polycystic ovarian syndrome. Topics A-Z. DermNet NZ. 2003. Available at https://www.dermnetnz.org/topics/polycystic-ovary-syndrome/. Accessed 7/17/2020.
  14. Dictionary definition: metabolic syndrome. National Institute of Diabetes and Digestive and Kidney Diseases. Available at https://www.niddk.nih.gov/Dictionary/M/metabolic-syndrome. Accessed 7/21/2020.
  15. Verdolini R, Clayton N, Smith A, et al. Metformin for the treatment of hidradenitis suppurativa: a little help along the way. J Eur Acad Dermatol Venereol. 2013;27:1101-1108. doi:10.1111/j.1468-3083.2012.04668.x.

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