The Effects of Flutamide on Lipid Profile, Insulin Sensitivity, Hirsutism and Gonadotropins in Women With Polycystic Ovary Syndrome Tr. J. of Medical Sciences 29 (1999) 677-681 © TÜBİTAK 677 Abstract: In this study, we evaluated metabolic changes and the effects of flutamide in 22 women with PCOS. Flutamide was administered for a 6-month period in a dose of 750 mg/day. The basal and after treatment body mass index, waist: hip ratio, blood glucose, insulin, lipids, Ferriman-Gallwey scoring (FGS), gonadotropins, testosterone, trasaminazed and glucose: insulin (G:I) ratio were measured. For comparison, ANOVA was used. The sixth month mean FGS was significantly lower than the basal values (18.5±7.4 and 12.5±4.5, P<0.01). The mean basal G:I ratio was 3.31±1.12 and 6.21±2.53 at the sixth month. The sixth month G:I ratio was significantly higher (P<0.001). The total and LDL-cholesterol were decreased by flutamide (from 144±23 to 123±23 and from 88±32 to 60±25 mg/dl respectively. P<0.02 and P<0.01), whereas, the HDL-cholesterol level was increased with flutamide (from 44.8±3.9 to 46.5±3.2 mg/dl and P<0.001). LH (from 14.7±6.7 to 8.4±3 mlU/ml), LH/FSH ratio (from 3.4±1.7 to 1.9±0.6), total testosterone (from 0.87±0.29 to 0.61±0.18 ng/ml) and free testosterone (from 4.29±1.18 to 2.14±0.9 pg/ml) were decreased by flutamide (P<0.05). Thus, we reached three conclusions:1-Flutamide may improve insulin insensitivity. 2-In PCOS, flutamide decreases total and LDL-cholesterol, and increases HDL- cholesterol. 3-Flutamide may improve the LH/FSH ratio and induce a decrease in testosterone. Key Words: insulin sensitivity, PCOS, flutamide, hirsutism and lipids. Mithat BAHÇECİ 1 Alpaslan TUZCU 1 Mehmet DURSUN 2 Melikşah ERTEM 3 Vahit YÜKSELEN 2 Received: January 25, 1999 Departments of 1 Endocrinology, 2 Internal Medicine and 3 Public Health, Faculty of Medicine, Dicle University, Diyarbakır-Turkey Introduction The most common disorder is women resulting in chronic anovulation with estrogen present is polycystic ovary syndrome (PCOS) (1). A total of 5-10% of these women are affected by PCOS (2). In addition to hirsutism, hyperandrogenism leads to metabolic aberrations such as insulin resistance, dyslipidemia and cardiovascular disease (3). Although some explanations are available, the causes of these aberrations are not clear. The roles of insulin and sex hormones in the regulation of lipid metabolism have been well defined (4). Hyperandrogenism is not only associated with increased waist: hip ratio, but also leads to increased visceral fat accumulation and decreased serum HDL levels (5, 6). Decreased insulin sensitivity in PCOS can be diagnosed using the fasting glucose: insulin ratio (G:I ratio), which is easily obtainable, safe, highly sensitive and specific (7). Legro RS et al. (7) reported that the cut-off value of this ratio is 4.5, and, below this ratio, it is accepted that there is insulin resistance in non-Hispanic white PCOS women (7). Correction of hyperandrogenism and insulin resistance in PCOS may improve lipid and other metabolic disturbances. The treatment of PCOS with flutamide, a 5 alpha-reductase inhibitor and pure antiandrogen, is associated with significant improvements in insulin resistance. The purpose of this study was to study the metabolic changes of PCOS and explain the effect of flutamide in women with PCOS Material and Methods Thirty women with PCOS were selected for study. However, 8 patients did not return for clinical checks (26.6%), and the remaining 22 patients (73.3%) were investigated. The diagnosis of PCOS was confirmed by the presence of chronic anovulation and hyperandrogenism. Hyperandrogenism was confirmed by an increased level of at least two of the following plasma androgens: total testosterone, free testosterone, androstenedione, and an