Hirsutismin

Hirsutism is the excessive growth of coarse, pigmented terminal hair in androgen-dependent areas in women and girls, in a pattern typically seen in men. It is a clinical sign, not a disease in itself, and may reflect elevated androgens or increased hair follicle sensitivity. The extent is often quantified with a scoring system (for example, the Ferriman-Gallwey score), with higher scores indicating more pronounced hirsutism. Ethnicity influences the normal range of scores.

Common causes include hyperandrogenism from conditions such as polycystic ovary syndrome (PCOS), congenital adrenal hyperplasia, and Cushing’s syndrome, as well as androgen-secreting tumors. Less commonly, hirsutism may be idiopathic or due to medications or exogenous androgens. In many individuals, normal androgen levels are present but hair follicles are more responsive to androgens.

Evaluation is guided by history and examination. Important questions cover menstrual regularity, signs of virilization (such as deepening of voice, clitoromegaly), weight changes, and family history. Laboratory tests may include total and free testosterone, sex hormone–binding globulin (SHBG), dehydroepiandrosterone sulfate (DHEAS), prolactin, and thyroid-stimulating hormone. If CAH is suspected, 17-hydroxyprogesterone is measured. Pelvic ultrasound may be used when PCOS is a concern. In younger patients, age-appropriate assessment is essential.

Management aims to treat underlying causes and reduce hair growth. Lifestyle measures can help if PCOS-related insulin resistance is present. For hair reduction, options include topical eflornithine, shaving, waxing, laser hair removal, or electrolysis. Pharmacologic therapies include combined oral contraceptives to reduce androgen effects and antiandrogens such as spironolactone (often with contraception) or, less commonly, finasteride. Glucocorticoids are used for CAH. Prognosis varies; many individuals experience partial improvement with treatment, but hirsutism can be persistent and may recur after stopping therapy.