Progestin Androgenicity in Combined Oral Contraceptives

Androgenicity Overview

Higher androgenicity may increase risks of acne, oily skin, and hirsutism, but may also improve libido for some patients.
Lower or anti-androgenic activity may improve acne and reduce unwanted hair growth but can increase risk of venous thromboembolism (VTE) when combined with higher estrogen doses.
Generational classification refers to when the progestin was developed, not necessarily a value judgment on efficacy.

Comparison of Common Progestins in COCs

Progestin	Class (Generation)	Androgenic Activity	Androgen Receptor Blocking Activity	Example COC Formulations
Norethindrone	Estrane (1st Generation)	Moderate	No	Nortrel 7/7/7, Femcon FE
Norethindrone acetate	Estrane (1st Generation)	Moderate	No	Estrostep FE, Junel
Ethynodiol diacetate	Estrane (1st Generation)	Low–Moderate	No	Zovia, Kelnor
Levonorgestrel	Gonane (2nd Generation)	High	No	Aviane, Seasonale
Norgestrel	Gonane (2nd Generation)	High	No	Cryselle, Low-Ogestrel
Norgestimate	New Gonane (3rd Generation)	Low	No	Tri-Sprintec, Estarylla
Desogestrel	New Gonane (3rd Generation)	Low	No	Apri, Isibloom
Drospirenone	alpha-Spironolactone (4th Gen)	None	Yes	Yasmin, Nikki

Quick Tips:

For acne, PCOS, or hirsutism: Consider low-androgenic or anti-androgenic options (e.g., Drospirenone, Desogestrel, Norgestimate).
For mood concerns or libido loss: High-androgenic progestins (Levonorgestrel, Norgestrel) may benefit some patients, though side effects vary.
For cost or formulary concerns: 2nd generation progestins (Levonorgestrel) are widely covered and often available generically.
For patients at risk of VTE: Be cautious with Drospirenone and Desogestrel—they may have a slightly higher VTE risk when paired with ethinyl estradiol.

Note: This resource is intended for pharmacists and healthcare professionals. Always consult current clinical guidelines and individual product labeling before making prescribing or counseling decisions.