An Approach to the Patient With Hirsutism

    January 2013 in “ Obstetrical & gynecological survey ”
    D. Lynn Loriaux
    TLDR Most women with hirsutism have normal hormone levels and can be treated with cosmetic methods; obesity and PCOS are common causes, and treatments depend on the underlying issue.
    This review outlined the diagnosis and management of hirsutism, noting that most women presenting with this condition are endocrinologically normal and can be treated cosmetically. Idiopathic hirsutism, characterized by normal androgen levels and no menstrual irregularities, is often managed with cosmetic measures like shaving, plucking, waxing, and eflornithine. Hyperandrogenism, primarily due to polycystic ovary syndrome (PCOS) and obesity-related disorders, is a common cause requiring endocrinologic evaluation. Less frequent causes include nonclassic congenital adrenal hyperplasia (CAH) and androgen-secreting tumors. Treatment strategies vary based on the underlying cause and include weight loss for obesity-related hirsutism, ovarian suppression, antiandrogens like spironolactone, and glucocorticoids for virilizing CAH. A trial of at least 6 months is recommended for androgen suppression therapy.
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