Guideline Summary
The Endocrine Society has released new guidelines on evaluation and treatment of hirsutism in premenopausal women. [14, 15]
Test for elevated androgen levels is recommended in all women with an abnormal hirsutism score. Guidelines suggest against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (ie, in the absence of an abnormal hirsutism score).
For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), start with pharmacologic therapy and add direct hair removal methods (electrolysis, photoepilation) for those who desire additional cosmetic benefit. For women with mild hirsutism and no evidence of an endocrine disorder, either pharmacologic therapy or direct hair removal methods are suggested.
For pharmacologic therapy, oral combined estrogen–progestin contraceptives are suggested for the majority of women, with the addition of an antiandrogen agent after 6 months if the response is suboptimal. Guidelines recommend against antiandrogen monotherapy unless adequate contraception is used. They suggest against using insulin-lowering drugs.
For most women who choose hair removal therapy, laser epilation/photoepilation is suggested.
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Idiopathic hirsutism in an elderly woman.
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The patient has late-onset congenital adrenal hyperplasia. She has clinical features similar to those found in polycystic ovarian syndrome, including hirsutism, acne, obesity, diabetes, and menstrual irregularities.
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The photograph depicts hirsutism in a young woman with polycystic ovarian syndrome. Note the acne lesions and excessive hair on her face and neck.
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The photograph depicts familial hirsutism in a Pakistani woman.
