Evaluation of hirsutism

Diseases

Summary

Hirsutism is a condition seen in women that is associated with development of androgen-dependent terminal hair (coarse, pigmented) following a male-pattern distribution (face, chest, abdomen, back).

Pathophysiology

Hair in different areas of the body demonstrates varying levels of androgen sensitivity, depending mostly on local sensitivity of androgen receptors and 5-alpha-reductase activity levels. Terminal hair, also known as sexual hair, is dependent on androgens for development and maintenance.[1] Hair response to androgens varies from person to person and includes increase in follicle size, fiber diameter, and the amount of time spent in anagen (the growth-cycle phase of a hair follicle).[2] [3]

Around 70% to 80% of women with androgen excess manifest hirsutism.[4] Excessive sexual hair may be accompanied by signs of virilization: male-pattern alopecia, deepening of the voice, clitoromegaly, increased muscle bulk. When present, virilization indicates an underlying condition associated with moderately to severely elevated androgen levels.

Epidemiology

The extent of terminal hair varies by ethnic background and the method used to evaluate it.[4] Women of Asian ethnicity have less body hair compared with southern European women. Among white and black American women, the prevalence of hirsutism, as assessed by a standard score, is 20%.[5]

Citations

Key Articles

Martin KA, Anderson RR, Chang RJ, et al. Evaluation and treatment of hirsutism in premenopausal women: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018 Apr 1;103(4):1233-57.[Abstract][Full Text]
Legro RS, Arslanian SA, Ehrmann DA, et al; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92.[Abstract][Full Text]
Teede HJ, Tay CT, Laven J, et al. Recommendations from the 2023 international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2023 Oct;120(4):767-93.[Abstract][Full Text]

Referenced Articles

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