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Run npx skillmds@latest add dromlakhani/endo-hirsutism-avoid-topical-antiandrogen 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 Avoid Topical Antiandrogen by dromlakhani

Name: Endo Hirsutism Avoid Topical Antiandrogen
Rating: 4.2 (5 reviews)
Author: dromlakhani

Endo Hirsutism Avoid Topical Antiandrogen

The skill advises clinicians to avoid prescribing topical antiandrogen agents (e.g., spironolactone or finasteride cream) for hirsutism in premenopausal women. Trigger phrases include “patient wants a topical cream for facial hair,” “considering eflornithine for hirsutism,” or “requests antiandrogen topical therapy.”

dromlakhani Updated Sep 8, 2026 10 repo stars

File contents

Avoid topical antiandrogen therapy for hirsutism

STEP 1 — Gather Information

Confirm hirsutism diagnosis (Ferriman–Gallwey score ≥8 in US White/Black women, ≥9 in Mediterranean/Hispanic/Middle Eastern, ≥6 in South Asian, ≥2–7 in East Asian), assess menstrual regularity, pregnancy/contraception status, prior cosmetic or pharmacologic treatments, and patient’s specific interest in topical antiandrogen preparations.

STEP 2 — Rule In / Rule Out

Is the patient requesting or considering a topical antiandrogen agent for hirsutism?

Yes → proceed to Step 3.
No → no further action needed for this skill.

STEP 3 — Classify or Stratify

Stratify by hirsutism severity (mild: FG 8‑15; moderate/severe: >15) and patient fertility intentions to guide overall management, but note that the recommendation against topical antiandrogen applies regardless of stratum.

STEP 4 — Decide

Do not prescribe topical antiandrogen therapy. Instead, initiate first‑line pharmacologic therapy (combined estrogen–progestin oral contraceptive) or direct hair removal methods (laser/photoepilation or electrolysis) based on patient preference, contraception needs, and hair/skin type.

Clinical Guardrails / Mimics / Pitfalls

Avoid topical antiandrogens due to limited efficacy, lack of robust RCT data, potential for systemic absorption, and risk of delaying effective therapy. Do not substitute topical agents for proven oral contraceptives, antiandrogens, or hair‑removal modalities. Be aware that eflornithine is not an antiandrogen (it inhibits ornithine decarboxylase) and is only adjunctive to laser/photoepilation, not a standalone hirsutism treatment.

Concrete Clinical Example

A 24‑year‑old woman presents with mild facial hirsutism (FG score 10), regular menses, and requests a topical spironolactone cream after reading online. The clinician confirms no pregnancy risk, explains the lack of evidence for topical antiandrogens, and prescribes a combined oral contraceptive (ethinyl estradiol 20 µg + levonorgestrel) while offering laser hair removal for faster cosmetic improvement.

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

---name: endo-hirsutism-avoid-topical-antiandrogendescription: The skill advises clinicians to avoid prescribing topical antiandrogen agents (e.g., spironolactone or finasteride cream) for hirsutism in premenopausal women. Trigger phrases include “patient wants a topical cream for facial hair,” “considering eflornithine for hirsutism,” or “requests antiandrogen topical therapy.”---# Avoid topical antiandrogen therapy for hirsutism## STEP 1 — Gather InformationConfirm hirsutism diagnosis (Ferriman–Gallwey score ≥8 in US White/Black women, ≥9 in Mediterranean/Hispanic/Middle Eastern, ≥6 in South Asian, ≥2–7 in East Asian), assess menstrual regularity, pregnancy/contraception status, prior cosmetic or pharmacologic treatments, and patient’s specific interest in topical antiandrogen preparations.## STEP 2 — Rule In / Rule OutIs the patient requesting or considering a topical antiandrogen agent for hirsutism? - **Yes** → proceed to Step 3. - **No** → no further action needed for this skill.## STEP 3 — Classify or StratifyStratify by hirsutism severity (mild: FG 8‑15; moderate/severe: >15) and patient fertility intentions to guide overall management, but note that the recommendation against topical antiandrogen applies regardless of stratum.## STEP 4 — DecideDo **not** prescribe topical antiandrogen therapy. Instead, initiate first‑line pharmacologic therapy (combined estrogen–progestin oral contraceptive) or direct hair removal methods (laser/photoepilation or electrolysis) based on patient preference, contraception needs, and hair/skin type.## Clinical Guardrails / Mimics / PitfallsAvoid topical antiandrogens due to limited efficacy, lack of robust RCT data, potential for systemic absorption, and risk of delaying effective therapy. Do not substitute topical agents for proven oral contraceptives, antiandrogens, or hair‑removal modalities. Be aware that eflornithine is **not** an antiandrogen (it inhibits ornithine decarboxylase) and is only adjunctive to laser/photoepilation, not a standalone hirsutism treatment.## Concrete Clinical ExampleA 24‑year‑old woman presents with mild facial hirsutism (FG score 10), regular menses, and requests a topical spironolactone cream after reading online. The clinician confirms no pregnancy risk, explains the lack of evidence for topical antiandrogens, and prescribes a combined oral contraceptive (ethinyl estradiol 20 µg + levonorgestrel) while offering laser hair removal for faster cosmetic improvement.**Source:** Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI:10.1210/jc.2018-00241

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