So here we are, 6 months on Alesse and 5 more uninterrupted months on 200 mg of Spironolactone. I've been trying various medications with my endocrinologist for over a year and a half now.
A quick recap: 100 mg of Spiro was an improvement. 200 mg was better. 5 mg Finasteride did not work, as the progress I'd made visually began to reverse. Nothing changed the hair on my face enough to improve my quality of life.
So why did the endo recommend adding an oral contraceptive to what was already sorta working? Lowering the amount of androgens in your system in addition to blocking them from reaching the receptors that cause the dark hair to grow (what we've already been doing) might work even better.
And what do I think? It's working just a little better than anything else so far, though the hair on my face still needs to be shaved every day. But I can shave my chest and not have to do it again for two or three days. I can pluck that hair and go a little longer without hair removal (though the hairs in my cleavage are not usually strong enough to seize with tweezers). Acne has once again been visibly reduced on my face, chest and back.
The Alesse has made my cycles more predictable, though I still get mid-cycle spotting. I waited for this to dissipate for longer than three months, thinking that it was because of the Spiro, or because of stress and travel, which usually caused me to forget a pill or two now and then. But after six months, I think it's pretty obvious Alesse is not going to control my spotting when my cycle is under the influence of Spiro. That's probably because I don't think there's a lot of estrogen in this pill.
I should also note that I don't think I had an allergic reaction to the Alesse in the first month after all. The rash has come back twice since then, always at different times of the cycle, including the placebo week. (EDIT: It also returned once when I was off the Alesse.)
I have read that the progestin in Alesse is androgenic (and woman with hirsutism probably want a pill with non-androgenic progestins since they don't want more hormones in their body that behave like testosterone). Between that fact and feeling like I'm bleeding for half of every month, I am considering asking for a different birth control pill.
With my next endo visit looming, I'm agonizing over my next step. The other choice the endo might present to me again is switching from Spiro to Cyproterone Acetate. I'm trying to ignore the fact that the name fills me with irrational fear. From my research, it seems to be tolerated well by most women, and has been used to treat androgen sensitivity symptoms for longer than Spiro. But it is reported to work only as well as Spiro, so really I'd only be trying it on the off-chance that it works better in my own body than the Spiro, and I'm at the point where I feel like this is the best it's ever going to get. I'm tired of being frightened new medications. Frankly, I'm kind of tired of medications in general.
I am tempted to just stick with what I'm doing and try laser hair removal again, and see how long the effects last. I know they won't be permanent, but I'm ready to spend a butt-load of money for a few months where I don't have to shave my face, I think.
But enough about what I think. Here again are some pictures of the progress of the various medications. The most dramatic (and easily photographable) difference is, as always, my stomach:
Left to right: Before any medication; 6 months on Spiro (100mg); 4 months on Spiro (200mg); 2.5 months on Finasteride; 6 months on Alesse and Spiro (200mg). The three at the bottom are just close-ups of the hair, which you can kinda see get coarser and darker on the Finasteride again.
Actually, Alesse with 200mg of Spiro looks about the same as 200mg of Spiro on its own. Hm.
Remember, every woman is different and will have different degrees of success. This is just mine.
...Oooh, I don't feel ready to my appointment. I'm going to be as nervous as ever