Which AI agents work with Endo Hirsutism No Preference Antiandrogen Avoid Flutamide?

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Who published Endo Hirsutism No Preference Antiandrogen Avoid Flutamide?

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

Endo Hirsutism No Preference Antiandrogen Avoid Flutamide by dromlakhani

Name: Endo Hirsutism No Preference Antiandrogen Avoid Flutamide
Rating: 4.666666666666667 (3 reviews)
Author: dromlakhani

Endo Hirsutism No Preference Antiandrogen Avoid Flutamide

For women with patient-important hirsutism despite cosmetic measures who have suboptimal response after ≥6 months of oral contraceptive monotherapy, consider adding an antiandrogen; no preference among antiandrogens but avoid flutamide due to its hepatotoxicity risk.

dromlakhani Updated Sep 8, 2026 10 repo stars

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No Preference Among Antiandrogens but Avoid Flutamide Due to Hepatotoxicity

STEP 1 — Gather Information

Collect Ferriman–Gallwey score, menstrual history, signs of hyperandrogenism (acne, alopecia), current contraception use, fertility desires, and prior treatment response (especially OC monotherapy duration and effectiveness). End with: proceed to rule in/out for antiandrogen addition.

STEP 2 — Rule In / Rule Out

Rule in if patient has patient-important hirsutism despite cosmetic measures, is not seeking pregnancy (or uses reliable contraception), and shows suboptimal response after ≥6 months of oral contraceptive monotherapy; otherwise rule out and continue OC, consider direct hair removal, or reassess adherence.

STEP 3 — Classify or Stratify

Select an antiandrogen (spironolactone, finasteride, or flutamide) but exclude flutamide due to hepatotoxicity; no preference between spironolactone and finasteride based on efficacy and safety profiles.

STEP 4 — Decide

Prescribe chosen antiandrogen (e.g., spironolactone 100–200 mg daily or finasteride 2.5–5 mg daily) while continuing oral contraceptive; ensure effective contraception if teratogenic risk applies; schedule follow‑up in 6 months to evaluate hirsutism improvement and adverse effects.

Clinical Guardrails / Mimics / Pitfalls

Avoid flutamide entirely due to risk of hepatotoxicity and liver failure; do not use antiandrogen monotherapy without reliable contraception because of teratogenic potential; monitor for menstrual irregularities or hyperkalemia with spironolactone; do not initiate antiandrogen in pregnancy or breastfeeding; consider drug interactions (e.g., spironolactone with ACE inhibitors).

Concrete Clinical Example

A 28‑year‑old woman with PCOS‑related hirsutism (FG score 12) tried OC monotherapy for 8 months with minimal improvement; she desires contraception and is not seeking pregnancy. Flutamide is avoided; spironolactone 100 mg BID is added to her OC. At 6‑month follow‑up, her FG score decreased to 6 and she reports satisfactory hair growth control.

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

---name: endo-hirsutism-no-preference-antiandrogen-avoid-flutamidedescription: For women with patient-important hirsutism despite cosmetic measures who have suboptimal response after ≥6 months of oral contraceptive monotherapy, consider adding an antiandrogen; no preference among antiandrogens but avoid flutamide due to its hepatotoxicity risk.---# No Preference Among Antiandrogens but Avoid Flutamide Due to Hepatotoxicity## STEP 1 — Gather InformationCollect Ferriman–Gallwey score, menstrual history, signs of hyperandrogenism (acne, alopecia), current contraception use, fertility desires, and prior treatment response (especially OC monotherapy duration and effectiveness). End with: proceed to rule in/out for antiandrogen addition.## STEP 2 — Rule In / Rule OutRule in if patient has patient-important hirsutism despite cosmetic measures, is not seeking pregnancy (or uses reliable contraception), and shows suboptimal response after ≥6 months of oral contraceptive monotherapy; otherwise rule out and continue OC, consider direct hair removal, or reassess adherence.## STEP 3 — Classify or StratifySelect an antiandrogen (spironolactone, finasteride, or flutamide) but exclude flutamide due to hepatotoxicity; no preference between spironolactone and finasteride based on efficacy and safety profiles.## STEP 4 — DecidePrescribe chosen antiandrogen (e.g., spironolactone 100–200 mg daily or finasteride 2.5–5 mg daily) while continuing oral contraceptive; ensure effective contraception if teratogenic risk applies; schedule follow‑up in 6 months to evaluate hirsutism improvement and adverse effects.## Clinical Guardrails / Mimics / PitfallsAvoid flutamide entirely due to risk of hepatotoxicity and liver failure; do not use antiandrogen monotherapy without reliable contraception because of teratogenic potential; monitor for menstrual irregularities or hyperkalemia with spironolactone; do not initiate antiandrogen in pregnancy or breastfeeding; consider drug interactions (e.g., spironolactone with ACE inhibitors).## Concrete Clinical ExampleA 28‑year‑old woman with PCOS‑related hirsutism (FG score 12) tried OC monotherapy for 8 months with minimal improvement; she desires contraception and is not seeking pregnancy. Flutamide is avoided; spironolactone 100 mg BID is added to her OC. At 6‑month follow‑up, her FG score decreased to 6 and she reports satisfactory hair growth control.**Source:** Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, https://doi.org/10.1210/jc.2018-00241

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