Hirsutism is a consequence of several factors
2. The sensitivity of the androgen receptors at
the level of the hair follicle.
3.The activity of 5œ-reductase
Role of 5-Reductase
ne in hair follicles
Is increased in
and other forms
•the commonest cause (90%).
•More in African, Mediterranian population.
•Positive family history.
•* No menstrual abnormalities.
* due to increased sensitivity of hair follicle
1) Constitutional (idiopathic):
hirsute with pilosebaceous unit
hirsutism and ovulatory disorders
hirsutism and signs of virilization
Presentation of hirsutism
The clinical evaluation of hirsutism
When and where is the hair?
Weight and menstrual history
Symptoms or signs of virilisation
• Temporal hair loss
• Voice change
• Clitoral enlargement
Investigations are needed if:
Hirsutism occurs in childhood
There are features of virilization
Hirsutism is of sudden or recent onset
There is menstrual irregularity or cessation
Testosterone ng dl)
U/S of the ovary Anovulation
Adenxal mass Nothing
Laparotomy CT of the adrenala & ovaries
Total Testosterone (T)
T > 200 ng/dl
DS > 700 μg/dl
17-OHP > 2 ng/ml
T & DS Normal
Late-onset CAH 17-OH-P >200 ng/dL
Androgen-secreting ov tumor Total T >200 ng/dL
Androgen-secreting ad tumor DHEAS >700 g/dL
Cushing syndrome Cortisol Increased
Exogenous androgen use Toxicology
OCPs: first option when fertility is not desired
Decrease in LH secretion and decrease in
Increase in hepatic production of (SHBG)
Decreased adrenal androgen secretion
A progestin with strong antiandrogenic action.
Inhibits gonadotrophin secretion and compet
efor androgen receptors on target organs
100mg from D5-D14 with ethinyloestradiol
30µg, from D 5 to D25
Androgen receptors blockade
Suppression of Androgen biosynthesis
Increased metabolic clearance of teststerone
( Testosterone Estrogen )
50-200 mg/day pd
Spironolactone + OC is well established regimen
Spironolactone, 50-200 mg per day
Blocks the androgen receptors
Decreases androgen production
Usually used with Ocs
Equally effective but danger of liver
Last resort of treatment.
Needle is inserted into the hair follicle
•a current is used to destroy the dermal papilla.
•All areas, usually the face
•May give permanent removal
•Pain, scarring, painful, repeat treatments needed, time consuming,
b. Laser & intense pulsed light
• A light source sufficient to penetrate to the follicular bulge & the papillae is
directed at the hair by probe.
•May give permanent hair reduction, efficient, painless
•Dark hair required, expensive, scarring, skin pigmentation, repeated treatments
Treatment options for hirsutism
Combined Oral Contraceptive
• With or without COC e.g. Diane
• Causes irregular periods