ACP Broadsheet 131: March 1992. Hirsute Women: Should They Be Investigated?

The document from March 1992 discusses the evaluation and investigation of hirsutism in women. It suggests that most women with hirsutism only require a careful clinical evaluation to determine if they have hirsutism or hypertrichosis and to assess the degree of hair growth for appropriate treatment. Clinical evaluation for signs of virilism is also necessary to decide the extent of further investigation. If virilism is not present, minimal laboratory investigation is needed. The majority of hirsute women, who likely have mild ovarian hyperandrogenism, should be tested for polycystic ovaries, while only those showing signs of virilism require intensive investigation. The document describes a minimalist approach, where unless a tumor is diagnosed, anti-androgen treatment is reserved for those with severe hirsutism seeking treatment. This is because current treatments do not require precise localization of excess androgen sources, and anti-androgens are more effective at reducing hair growth than hydrocortisone, even in cases of late onset congenital adrenal hyperplasia.