Hirsutism Guidelines

Updated: Apr 11, 2022
  • Author: George T Griffing, MD; Chief Editor: Michel E Rivlin, MD  more...
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Guidelines Summary

Endocrine Society guidelines

In 2018, the Endocrine Society released an update to their 2008 guidelines on the evaluation and treatment of hirsutism in premenopausal women. [21, 22]

The guidelines suggest testing for elevated androgen levels in all women with an abnormal hirsutism score. However, they recommend against testing for elevated androgen levels in eumenorrheic women with unwanted local hair growth (ie, in the absence of an abnormal hirsutism score) because of the low likelihood of identifying a medical disorder that would change management or outcome. [21, 22]

For most women with patient-important hirsutism despite cosmetic measures (shaving, plucking, waxing), the Endocrine Society recommends starting with pharmacologic therapy and adding 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. [21, 22]

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. The guidelines recommend against antiandrogen monotherapy unless adequate contraception is used. In addition, they recommend against using insulin-lowering drugs solely for treating hirsutism. [21, 22]

For women who choose hair removal therapy, the guidelines suggest photoepilation for those whose unwanted hair is auburn, brown, or black and electrolysis for those with white or blonde hair. [21, 22]

For women of color who choose photoepilation treatment, the Endocrine Society suggests using a long-wavelength, long pulse-duration light source such as Nd:YAG or diode laser delivered with appropriate skin cooling. The guidelines also recommend that clinicians warn Mediterranean and Middle Eastern women with facial hirsutism about the increased risk of developing paradoxical hypertrichosis (PH) with photoepilation therapy and suggest using topical treatment or electrolysis over photoepilation for these patients. [21, 22]