Evaluation and Treatment of Hirsutism in Premenopausal Women

The guideline for evaluating and treating hirsutism in premenopausal women, developed by the Endocrine Society and other related organizations, recommended obtaining a random serum total testosterone measurement for women with abnormal hirsutism scores to assess androgen excess. For those with elevated testosterone or at high risk of congenital adrenal hyperplasia, an early-morning 17-hydroxyprogesterone measurement was advised. Pharmacologic treatment should start with oral contraceptive pills (OCPs) for women not seeking pregnancy, with the addition of direct hair removal methods if necessary. Combination therapy with an antiandrogen was suggested if significant hirsutism persisted after 6 months of OCP monotherapy. All recommendations were based on weak and low-quality evidence.