Which progestin with no androgenic activity is listed as an option for acne or hirsutism?

• A. Desogestrel
• B. Drospirenone
• C. Norgestimate
• D. Levonorgestrel

Answer: (B)

Acne and hirsutism in contraception often respond best to progestins that do not activate androgen receptors. Drospirenone fits this pattern because it has antiandrogenic properties rather than androgenic activity, meaning it can counter or avoid promoting acne and facial hair growth while providing progestin effects. Its antimineralocorticoid activity also contributes to favorable skin and fluid balance, which can help in acne management.

In contrast, progestins with androgenic activity can worsen acne or hirsutism, and those with only very low or uncertain androgenic activity don’t provide the same antiandrogenic benefits. Desogestrel and norgestimate have relatively low androgenic effects but are not entirely free of androgenic activity, while levonorgestrel is notably androgenic. That combination of no (or antiandrogenic) activity and proven benefit for acne/hirsutism makes drospirenone the best choice.