The Hirsute Woman: Challenges in Evaluation and Management

    September 2011 in “Endocrine Practice
    Rodis Paparodis, Andrea Dunaif
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    TLDR Most hirsutism cases are due to PCOS, and treatment focuses on lowering testosterone and blocking its effects.
    The document from 2011 provides an overview of hirsutism, its causes, diagnosis, and treatment options. It explains that hirsutism is often caused by conditions such as polycystic ovary syndrome (PCOS), which was the most common cause in a study of 2445 patients, accounting for 70.6% of cases. Other causes include nonclassic congenital adrenal hyperplasia (NCCAH), androgen-secreting neoplasms, hyperprolactinemia, and hypothyroidism. The evaluation of hirsutism should include a detailed history, physical examination, and specific blood tests, with consideration of race and ethnicity in the assessment. Treatment options include oral contraceptives, antiandrogens like spironolactone and flutamide, and insulin-sensitizing drugs like metformin, particularly for women with PCOS who are considering pregnancy. The document concludes that serious disorders presenting as hirsutism are rare and that treatment aims to reduce testosterone production and bioavailability, as well as block androgen action in tissues.
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