Effect of oral versus transdermal steroidal contraceptives on androgenic markers

Objective The purpose of this study was to compare biochemical androgen profiles in women treated with the contraceptive patch versus an oral contraceptive (OC). Study design Twenty-four healthy women were randomly assigned to receive 3 cycles of either the contraceptive patch (ethinyl estradiol [EE] 20 μg/d and norelgestromin 150 μg/d) or OC (EE 35 μg and norgestimate 250 μg). Blood samples were taken at baseline and end of treatment. Serum levels of sex hormone-binding globulin (SHBG), total testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEAS), dihydrotestosterone (DHT), and 3α-androstanediol glucuronide (3α-diol G) were quantified by immunoassay methods; free T was calculated. The paired t and Student t tests were used for statistical analysis. Results Nineteen women completed the study (patch, n = 10; OC, n = 9). Despite a 1.6-fold relative increase in SHBG levels with the patch versus OC (449% vs 274%, P = .03), free T decreased equally in both groups (patch 60%, P< .0001; OC 59%, P< .0001). DHEAS decreased by 26% in the patch group (P< .01) and 32% in the OC group (P< .001). 3α-diol G was reduced by 52% in the patch group (P< .0001) and 51% in the OC group (P< .0001). In addition, the OC was associated with significant decreases in A and DHT. Conclusion The contraceptive patch had an effect comparable to the OC on several key androgenic markers. Given these biochemical findings, the contraceptive patch has significant potential as a therapeutic agent for disorders of androgen excess.