In regards to the hirsutism, we will prophylactically treat (if the woman has dark skin, dark hair, history of hair growth issues), or after learning that the woman has complaints, with spironolactone. The dose varies somewhat based on the relative size of the woman and the severity of the problem. I will generally start at 25 or 50 mg BID. The most I have ever used is 100 mg BID (maximum usual dose is 300 mg). The response is slow and the blocking affects may not show for up to 6 months. There is some concern that potassium levels should be monitored as spironolactone is a potassium sparing diuretic. However, with our usual lower doses, we have never seen a case of hyperkalemia. Since the spironolactone does block some of the DHT affects, on rare occasion, we will have a complaint of lessened response to the testosterone (usually evidenced by lower libido). Alternately some women prefer no prescription options, so we may recommend Saw Palmetto Berry 600 mg, 1-2 capsules daily (higher dose for more significant problems. These two strategies are also used for complaints of thinning of scalp hair. Once started they need to be continued indefinitely.