The evaluation and management of hirsutism*1

Hirsutism, characterized by the growth of coarse hairs in a male-like pattern in women, affects 5-15% of the female population and is often indicative of an underlying endocrine disorder, such as androgen excess. The most prevalent cause of androgen excess is polycystic ovary syndrome (PCOS), but other causes include nonclassic adrenal hyperplasia, insulin-resistant syndromes, androgen-secreting tumors, and androgenic medications. While 70-80% of women with androgen excess exhibit hirsutism, it is less common in Asian women, and 5-15% of hirsute women have normal androgen levels, a condition known as "idiopathic hirsutism." Hirsutism frequently has a genetic basis due to the heritability of conditions like PCOS and the genes involved in hair growth regulation. Diagnosis involves confirming hirsutism and identifying any related disorders. Treatment typically involves a combination of hormonal suppression, androgen blockade, and mechanical or cosmetic hair removal methods, with eflornithine hydrochloride 13.9% cream as a possible topical treatment. A systematic diagnostic approach and combination therapy can effectively manage hirsutism in most patients.