Medication	Dosage	Adverse effects	Comments	FDA pregnancy category
Oral contraceptives (various)	One tablet daily	Gastrointestinal upset, headache	Recommended first-line agents; formulations containing norgestimate, desogestrel, or drospirenone are preferred	X
Metformin (Glucophage)	500 to 1,000 mg twice daily	Gastrointestinal upset	Useful for treating polycystic ovary syndrome, but no data to support primary use for hirsutism	B
Spironolactone (Aldactone)	100 to 200 mg daily	Hyperkalemia, irregular menses	Risk of pseudohermaphroditism in male fetuses if used during pregnancy	D
Finasteride (Propecia)	2.5 mg daily	Hepatotoxicity	—	X
Glucocorticoids (prednisone)	5 to 10 mg daily	Weight gain, bone density loss, adrenal suppression	Indicated in congenital adrenal hyperplasia	C
Leuprolide (Lupron)	3.75 to 7.5 mg intramuscularly monthly	Hot flashes, atrophic vaginitis, bone density loss	Consider adding back hormone therapy; expensive	X
Ketoconazole	400 mg daily	Dry skin, headache, hepatotoxicity	Typically used only after failure of other therapies	C
Eflornithine (Vaniqa)	Apply topically twice daily	Acne, erythema, burning	FDA approval is only for use for unwanted facial hair	C