Table 3.

Different therapies and their mechanism of action and possible side effects

	COC	Spironolactone	Cyproterone acetate	Flutamide
Mechanism of action	Decreases 5α-reductase activity Decreases free testosterone Decreases sebaceous gland size and activity	Decreases 5α-reductase activity Decreases Free testosterone Decreases Sebaceous gland size and activity	Blocks testosterone receptors Decreases secretion of gonadotropins	Blocks nuclear binding of androgens
Side effects	GI disorders Spotting Headache Breast tenderness Fluid retention Depression	Hypercalcemia Breast tenderness Menstrual irregularities Hypotension Reduced libido Hyperkalemia	Headache Breast tenderness Menstrual irregularities Fluid retention Liver dysfunction Blood clotting disorders	Hematological disorders Muscle cramps Gynecomastia Acute liver failure
Contraindications	Smoking in age >35 years CVS diseases Hematological disorders BMI ≥35 Migraine Risk of estrogen-dependent malignancy	Risk of estrogen-dependent malignancy	History of meningioma Liver disease Hematological disorders Severe diabetes Sickle cell anemia Severe depression	Liver disease

Abbreviations: COC, combined oral contraceptives; GI, gastrointestinal; CVS, cardiovascular; BMI, body mass index.