Diagnosis and Treatments of Hirsutism: Where Are We?

The 2011 document reviews the condition of hirsutism and its treatments. Hirsutism is excessive hair growth in women, which can be idiopathic or a sign of underlying conditions like PCOS. The condition's pathophysiology involves androgen activation in hair follicles. Treatments include physical methods (shaving, waxing, plucking, creams, electrolysis, pulsed light, and laser therapy) and pharmacotherapy (topical inhibitors, oral antiandrogens, and ovarian and adrenal suppression). Eflornithine cream has been shown to improve facial hair in women within 4-8 weeks, with better results over 24 weeks. Combination therapies, such as eflornithine with laser, are more effective. Spironolactone and finasteride are effective for idiopathic hirsutism and PCOS-related hirsutism, respectively. Cyproterone acetate with ethinyl estradiol is effective but not FDA approved and has side effects. Finasteride is effective but teratogenic. Flutamide is effective but potentially hepatotoxic. OCPs with antiandrogenic properties can improve hirsutism and regulate menstruation. Insulin sensitizers have been less effective for hirsutism. Obesity can reduce treatment efficacy, and lifestyle changes are recommended. Hand-held laser and light devices for home use are predicted to become more popular. None of the antiandrogen therapies are FDA approved for hirsutism, but they are supported by case series and some placebo-controlled trials. Treatment choice depends on the clinical setting, drug availability, side effects, and cost.