How do I install the Endo Hirsutism Add Antiandrogen After 6months skill?

Run npx skillmds@latest add dromlakhani/endo-hirsutism-add-antiandrogen-after-6months in your terminal (requires Node.js), paste this page's agent-chat prompt into Claude, Cursor, or any MCP-connected agent, or download the SKILL.md file and copy it into your agent's skills directory.

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dromlakhani (@dromlakhani) published this skill. Their other Agent Skills are listed on their SkillMD profile.

Endo Hirsutism Add Antiandrogen After 6months by dromlakhani

Name: Endo Hirsutism Add Antiandrogen After 6months
Rating: 4.5 (4 reviews)
Author: dromlakhani

Endo Hirsutism Add Antiandrogen After 6months

This skill guides clinicians to add an antiandrogen after six months of monotherapy with an oral contraceptive when patient‑important hirsutism shows an inadequate response. Trigger phrases include “patient‑important hirsutism”, “6 months of OC monotherapy”, and “suboptimal hirsutism response”.

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Add an antiandrogen after six months of inadequate OC response

STEP 1 — Gather Information

Document baseline Ferriman–Gallwey (FG) score, current OC formulation and dose, duration of OC monotherapy, patient‑reported hirsutism distress, menstrual regularity, and contraceptive use. Action: Record these data and proceed to step 2.

STEP 2 — Rule In / Rule Out

Is the patient on OC monotherapy for at least 6 months with inadequate or suboptimal hirsutism improvement?

Yes: Proceed to step 3.
No: Continue OC monotherapy and reassess response in 3 months. Decision: End of algorithm for now.

STEP 3 — Classify or Stratify

Classify hirsutism severity using FG score (mild 8‑15, moderate 16‑25, severe >25) and patient‑important distress level. Also confirm need for effective contraception if of child‑bearing potential. Action: Assign severity tier and contraception status, then move to step 4.

STEP 4 — Decide

Add an antiandrogen (e.g., spironolactone 100‑200 mg daily in divided doses, finasteride 2.5‑5 mg daily, or dutasteride) while ensuring effective contraception; avoid flutamide due to hepatotoxicity risk. Decision: Prescribe selected antiandrogen and schedule follow‑up in 3 months to assess response.

Clinical Guardrails / Mimics / Pitfalls

Do not initiate antiandrogen monotherapy without reliable contraception because of teratogenic risk; avoid flutamide unless hepatotoxicity monitoring is in place; do not add antiandrogen before 6 months of OC monotherapy unless there is rapid progression or virilization; monitor liver enzymes if flutamide is ever considered.

Concrete Clinical Example

A 24‑year‑old woman with PCOS has been on EE 20 mcg + levonorgestrel OC for 8 months, FG score 18, reports persistent facial hair distress despite shaving. She uses condoms for contraception. According to the guideline, add spironolactone 100 mg BID and continue OC; reassess FG score and symptoms in 3 months.

Source: Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI:10.1210/jc.2018-00241

TODO: consider adding scripts/calc.py for the endo-hirsutism-add-antiandrogen-after-6months calculator

---name: endo-hirsutism-add-antiandrogen-after-6monthsdescription: This skill guides clinicians to add an antiandrogen after six months of monotherapy with an oral contraceptive when patient‑important hirsutism shows an inadequate response. Trigger phrases include “patient‑important hirsutism”, “6 months of OC monotherapy”, and “suboptimal hirsutism response”.---# Add an antiandrogen after six months of inadequate OC response## STEP 1 — Gather InformationDocument baseline Ferriman–Gallwey (FG) score, current OC formulation and dose, duration of OC monotherapy, patient‑reported hirsutism distress, menstrual regularity, and contraceptive use. **Action:** Record these data and proceed to step 2.## STEP 2 — Rule In / Rule OutIs the patient on OC monotherapy for at least 6 months with inadequate or suboptimal hirsutism improvement? - **Yes:** Proceed to step 3. - **No:** Continue OC monotherapy and reassess response in 3 months. **Decision:** End of algorithm for now.## STEP 3 — Classify or StratifyClassify hirsutism severity using FG score (mild 8‑15, moderate 16‑25, severe >25) and patient‑important distress level. Also confirm need for effective contraception if of child‑bearing potential. **Action:** Assign severity tier and contraception status, then move to step 4.## STEP 4 — DecideAdd an antiandrogen (e.g., spironolactone 100‑200 mg daily in divided doses, finasteride 2.5‑5 mg daily, or dutasteride) while ensuring effective contraception; avoid flutamide due to hepatotoxicity risk. **Decision:** Prescribe selected antiandrogen and schedule follow‑up in 3 months to assess response.## Clinical Guardrails / Mimics / PitfallsDo not initiate antiandrogen monotherapy without reliable contraception because of teratogenic risk; avoid flutamide unless hepatotoxicity monitoring is in place; do not add antiandrogen before 6 months of OC monotherapy unless there is rapid progression or virilization; monitor liver enzymes if flutamide is ever considered.## Concrete Clinical ExampleA 24‑year‑old woman with PCOS has been on EE 20 mcg + levonorgestrel OC for 8 months, FG score 18, reports persistent facial hair distress despite shaving. She uses condoms for contraception. According to the guideline, add spironolactone 100 mg BID and continue OC; reassess FG score and symptoms in 3 months.**Source:** Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI:10.1210/jc.2018-00241> **TODO:** consider adding scripts/calc.py for the endo-hirsutism-add-antiandrogen-after-6months calculator

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