This document discusses hirsutism, defined as excessive male-pattern hair growth in women. It outlines the epidemiology, pathophysiology, causes, evaluation, and treatment of hirsutism. The most common cause is polycystic ovary syndrome. Evaluation involves using the Ferriman-Gallwey score to assess hair growth at nine body sites. Treatment depends on the severity of hirsutism and underlying condition, starting with oral contraceptives, antiandrogens, or direct hair removal methods.

1. “Never underestimate the power of stupid people in large groups.”
― George Carlin
HIRSUTISM
Hirsutism, defined as excessive male-pattern hair growth,
EPIDEMIOLOGY​ — Hirsutism may affect between 5 and 10 percent of women of reproductive
age
PATHOPHYSIOLOGY
increased production rate of androgens, usually testosterone,
SHBG, is suppressed when androgen production is increased
Increased conversion of testosterone to dihydrotestosterone (DHT) by the enzyme
5-alpha-reductase within the PSU in peripheral tissue, including hair follicles
Ethnicity​ — An Asian woman with a few peri-areolar hairs may warrant further evaluation,
whereas a Mediterranean woman with some hair growth on her upper lip might well be
considered normal and consider herself normal.
CAUSES​ —Several different androgens may be secreted in excess:
●​Testosterone, which is usually of ovarian origin
●​Dehydroepiandrosterone sulfate (DHEAS), which is of adrenal origin
●​Androstenedione, which can be of either adrenal or ovarian origin
1) Polycystic ovary syndrome​ — PCOS is the most common cause of hirsutism in
women . The syndrome is characterized by menstrual irregularity and
hyperandrogenism, both clinical (hirsutism, acne, or male-pattern balding) and
biochemical (elevated serum androgen concentrations)
2) Idiopathic hirsutism​ — The diagnosis of idiopathic hirsutism is given to women with
hirsutism but normal serum androgen concentrations, no menstrual irregularity, and no
identifiable cause of the hirsutism
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

2. “Never underestimate the power of stupid people in large groups.”
― George Carlin
3) Nonclassic congenital adrenal hyperplasia
4) Androgen-secreting tumors​ —
5) Ovarian hyperthecosis​ —
6) Endocrine disorders
•​Cushing's disease –
•​Hyperprolactinemia,
acromegaly, and
hypothyroidism
•​Drugs – Androgen therapy (testosterone or DHEA) ​Danazol​,
EVALUATION OF PATIENT ----FERRIMAN GALLAWAY SCORE
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

3. “Never underestimate the power of stupid people in large groups.”
― George Carlin
Using this method, nine androgen-sensitive sites are graded from 0 to 4
●​A Ferriman-Gallwey score >8 is considered abnormal for black or white women
●​For Mediterranean, Hispanic, and Middle Eastern women, a Ferriman-Gallwey score ≥9 to 10
is considered abnormal and
for Asian women, a score ≥2
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

4. “Never underestimate the power of stupid people in large groups.”
― George Carlin
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

5. “Never underestimate the power of stupid people in large groups.”
― George Carlin
TREATMENT-
for women with mild hirsutism and no evidence of an endocrine disorder, ---starting with
either pharmacologic therapy ​or​ direct hair removal methods (electrolysis or photoepilation
For any pharmacologic therapy, minimum of six months before making changes in dose or
type of medication or adding a medication
1) OCPS
2) For women with a suboptimal cosmetic result after six months of COC- antiandrogen
ADDED
3) In occasional women with severe hirsutism causing emotional distress, -start with
combination therapy (a COC ​and​ an antiandrogen)
4) COCs as first-line therapy for women with nonclassic 21-hydroxylase deficiency
(nonclassic congenital adrenal hyperplasia [NCCAH]) and hirsutism
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava