hirsutism

Hirsutism is excessive growth of coarse, dark hair in androgen-sensitive areas in women and girls, typically affecting the face, chest, abdomen, back, and thighs. The severity is often assessed with scoring systems such as the Ferriman-Gallwey score, though thresholds vary by ethnicity and method.

Most cases arise from increased androgen activity or sensitivity of hair follicles. The most common cause is polycystic ovary syndrome (PCOS). Other conditions include nonclassic congenital adrenal hyperplasia, Cushing's syndrome, and androgen-secreting tumors, as well as certain medications or hormonal imbalances. Some individuals have idiopathic or familial hirsutism with normal androgen levels.

Evaluation starts with a thorough history and physical examination, including assessment of menstrual function and signs of virilization. A pregnancy test is essential in reproductive-age individuals. Laboratory testing may include serum total and free testosterone, DHEAS, 17-hydroxyprogesterone, and prolactin, with metabolic screening as indicated. Pelvic ultrasound can help assess ovarian morphology when PCOS is suspected. The differential diagnosis includes PCOS, idiopathic hirsutism, and other states of androgen excess.

Management aims to reduce androgen effect, slow hair growth, and treat any underlying condition. Weight loss and lifestyle modification are beneficial for overweight patients with PCOS. First-line pharmacotherapy is combined estrogen-progestin oral contraceptives. If hair growth persists, antiandrogens such as spironolactone or finasteride may be added, typically with contraception to prevent fetal exposure. Topical eflornithine cream can slow facial hair growth. Hair removal methods (shaving, waxing, depilatories) are temporary, while laser hair reduction or electrolysis offers longer-lasting options. Regular follow-up helps monitor efficacy and adverse effects. Seek care for rapid-onset virilization, irregular periods with sudden hair growth, or a new androgen-secreting tumor concern.