Hirsutism

Hirsutism is the presence in women of terminal hair in patterns and sequence similar to those that develop in the normal post-pubertal male. It is a distressing endocrine and cosmetic condition associated with significant psychological morbidity. Hyperandrogenism is the underlying disease in most cases and polycystic ovarian syndrome is the commonest cause. There is a strong familial component and a high degree of hereditability. Thorough history-taking and physical examination are pivotal to establishing cause. Initial assessment should exclude underlying serious disease, establish change in sexuality, and assess impact on fertility. Physical examination should include assessment of the severity of hirsutism using the modified Ferriman–Gallway score. A sympathetic approach is vital for successful management. Treatment includes lifestyle modification, mechanical/cosmetic measures, and pharmacological treatment, including androgen suppressors, peripheral androgen blockers, and biological modifiers of hair follicular growth. In general, treatment is combination therapy, and pre-treatment psychological preparation is essential to establish realistic treatment goals. Therapy should be long-term and continuous because hirsutism tends to recur if treatment is withdrawn.