Materiały źródłowe

• #1 Hirsutism: What It Is, In Women, Causes, PCOS & Treatment

  https://my.clevelandclinic.org/health/diseases/14523-hirsutism

  Hirsutism is a condition that causes excess hair to grow on certain parts of your body. It mainly affects females. Hirsutism doesn’t have a known cause, but it’s a symptom of other conditions, including polycystic ovary syndrome. Treatment options include weight loss, medications and other hair removal options. […] Hirsutism mainly affects females. It can affect males, but it’s difficult to tell the difference between hirsutism and typical thick, dark, long hair growth (terminal hair). […] Hirsutism affects 5% to 10% of women who are around child-bearing age. It affects over 40% of women. […] Your healthcare provider will conduct a physical examination to determine the extent of the uncommon hair growth. They’ll also note any other physical signs that may accompany the hair growth, such as acne.

• #1 Hirsutism – OBGYN | UCLA Health

  https://www.uclahealth.org/medical-services/obgyn/conditions-treated/hirsutism

  Hirsutism in women is defined as excessive coarse hair appearing in a male-type pattern. It represents exposure of hair follicles to high levels of the male hormone androgen in the blood and/or the hair follicle itself. Consequently, one-half of women with mild hirsutism have elevated levels of circulating androgens, as do most women with more severe hirsutism, although the severity of hirsutism is not necessarily proportion to the circulating androgen level. […] The first step in assessing hirsutism is to have a complete history and physical examination performed by a trained health care provider. A careful history and physical examination can assess the degree of hirsutism, acne or hair loss, and other problems that are important in directing diagnostic testing and management. An equally important step is assessing the emotional impact of hirsutism on the individual so that a personalized management plan can be developed to target the physical, medical and psychological burdens of unwanted hair. Understanding how a woman feels about her body image and improving this perception are essential components of any management plan.

• #1 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html

  Clinical practice guidelines suggest testing for elevated androgen levels in women with an abnormal hirsutism score. The degree of hirsutism does not necessarily correlate with the testosterone level. Free testosterone is the biologically active component of serum testosterone; however, there is considerable variability in measurements reported by various assays, particularly at low levels. Measurement of free testosterone is more accurate with equilibrium dialysis methods used by specialty laboratories. […] Women with hirsutism and menstrual dysfunction, infertility, or any physical examination findings suggestive of endocrine disorders should undergo further hormonal workup. Rapid development of hirsutism, late onset, progression despite therapy, or signs of virilization may indicate an androgen-secreting tumor.

• #1 Hirsutism – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hirsutism/symptoms-causes/syc-20354935

  Hirsutism may be caused by: […] Excess facial or body hair is often a symptom of an underlying medical problem. See your doctor for assessment if over a few months you experience severe or rapid hair growth on your face or body or signs of virilization. […] If you think you have too much coarse hair on your face or body, talk with your doctor about treatment options.

• #1 Hirsutism, Normal Androgens and Diagnosis of PCOS

  https://www.mdpi.com/2075-4418/12/8/1922

  Hirsutism is defined as the presence of terminal hair with male pattern distribution in women. While in the general population, hirsutism affects around 4–11% of women, it is the main manifestation of hyperandrogenism in women with polycystic ovary syndrome (PCOS), with a prevalence estimated at 65–75%. […] The modified Ferriman–Gallwey (mFG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. […] Although a universal mFG score cutoff would be useful for comparisons, ethnic variations, as well as skin type and other factors, should be considered when evaluating hirsutism in distinct populations. […] Indeed, while most women with PCOS and hirsutism also have higher than reference values for serum androgen levels, some of them may not present with biochemical hyperandrogenism, representing a challenge to the diagnosis of PCOS.

• #1 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html

  Hirsutism is a clinical diagnosis, and prevalence depends on the diagnostic criteria used. Hirsutism is commonly diagnosed using the modified Ferriman-Gallwey scoring system consisting of nine androgen-sensitive body areas. Cutoff scores vary by race and ethnicity: scores of 8 or greater are considered hirsutism in British and U.S. black and white women; 9 or greater in Mediterranean, Hispanic, and Middle Eastern women; 6 or greater in South American women; and 2 or greater in Asian women. Scores up to 15 indicate mild hirsutism, whereas those greater than 25 indicate severe hirsutism. Limitations of this scoring system include its subjective nature and inability to account for locally high scores or previous cosmetic treatments. The Endocrine Society recommends treating patient-important hirsutism, which is unwanted sexual hair growth of sufficient extent to cause patient distress.

• #1 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  A recent clinical practice guideline published by the Endocrine Society recommends against testing for increased androgen levels among women with mild hirsutism, since hyperandrogenemia is undetectable in approximately 50% of these cases using conventional laboratory tests, and because of the low likelihood of identifying a medical disorder that would alter management or outcome. Testing of androgen levels is recommended in women with moderate to severe hirsutism and in women with any degree of hirsutism when it is sudden in onset, rapidly progressive, or when it is associated with any of the following: menstrual irregularity, central obesity, acanthosis nigricans, or clitoromegaly. […] Initial laboratory tests to exclude a serious underlying disease include serum testosterone (on days four to ten of the menstrual cycle) and DHEAS, because the measurement of these two hormone levels can detect most androgen-producing tumors.

• #1 Hirsutism Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/121038-workup

  Approximately 50% of women with even minimal hirsutism have excessive androgen. Laboratory studies in hirsutism serve both to confirm the clinical impression of hyperandrogenism and to identify the source of excess androgens, either adrenal or ovarian. […] The workup described in the image below recommends 2 visits, a baseline evaluation followed by a 2-week dexamethasone treatment period. Specific discussion of the testing is below. […] The most important assay is the level of serum testosterone, the major circulating androgen. If the total serum testosterone level is normal, measure the free serum level because hyperandrogenism (and insulin resistance, if present) decreases sex steroid-binding globulin, such that the unbound, biologically active testosterone moiety may be elevated even if the total level is unremarkable.

• #1 Hirsutism Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/121038-workup

  Women with hirsutism and amenorrhea of unknown cause should have a serum prolactin or FSH test to evaluate for either a prolactinoma or ovarian failure. […] Women with hirsutism, PCOS, obesity, or acanthosis nigricans may have insulin resistance, and screening for diabetes and hyperlipidemia is warranted. […] If indicated based on the findings from the clinical evaluation and laboratory testing, perform ovarian ultrasonography and adrenal CT scanning or MRI to evaluate for either ovarian or adrenal sources of androgen production.

• #1 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  A serum testosterone level 200 ng/dL is highly suggestive of an adrenal or ovarian tumor. If serum testosterone is elevated despite a normal DHEAS level, an ovarian source is more likely. If a DHEAS level 700 g/dL is present despite a normal serum testosterone level, an adrenal source should be suspected as the cause of hirsutism. […] Monitoring should be carried out throughout the medical follow-up. The assessment of therapeutic responses should be evaluated by the patient herself, by declaring whether there was a decrease in the growth of hair or less need to use other methods to remove the hair.

• #1 Excessive hair

  https://dermnetnz.org/topics/excessive-hair

  Diagnostic features for polycystic ovary syndrome are: Oligo/anovulation, Clinical/biochemical signs of hyperandrogenism, Presence of 12 follicles in each ovary, measuring 29 mm in diameter and increased ovarian volume (10 mL) on pelvic/transvaginal ultrasound (optional). […] Some women with hirsutism may be treated with antiandrogens with variable response. This option is not useful in hypertrichosis.

• #1 Hirsutism Differential Diagnoses

  https://emedicine.medscape.com/article/121038-differential

  Androgen-Secreting Adrenal Tumors […] Androgen-Secreting Ovarian Tumors […] Congenital Adrenal Hyperplasia […] Exogenous Androgens […] Iatrogenic Cushing Syndrome […] Idiopathic Hirsutism […] Polycystic Ovary Syndrome (PCOS) Imaging

• #1 Hirsutism – Wikipedia

  https://en.wikipedia.org/wiki/Hirsutism

  Hirsutism is a clinical diagnosis of excessive androgenic, terminal hair growth. A complete physical evaluation should be done prior to initiating more extensive studies, the examiner should differentiate between widespread body hair increase and male pattern virilization. One method of evaluating hirsutism is the Ferriman-Gallwey Score which gives a score based on the amount and location of hair growth. Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound, due to the high prevalence of polycystic ovary syndrome (PCOS), as well as 17-hydroxyprogesterone (because of the possibility of finding non-classic 21-hydroxylase deficiency). People with hirsutism may present with an elevated serum dehydroepiandrosterone sulfate (DHEA-S) level, however, additional imaging is required to discriminate between malignant and benign etiologies of adrenal hyperandrogenism. Levels greater than 700 g/dL are indicative of adrenal gland dysfunction, particularly congenital adrenal hyperplasia due to 21-hydroxylase deficiency. However, PCOS and idiopathic hirsutism make up 90% of cases.

• #1 Hirsutism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22904

  Hirsutism means the growth of excessive male-pattern hair in women after puberty. It affects facial and body areas dependent on androgens, namely mustache and beard, pubic hair, buttocks, and thighs. It is a frequent reason for dermatological consultation. Hirsutism is the most common endocrine disorder affecting nearly 10% of women in the United States. […] The causes of hirsutism are variable. The condition may be of ovarian or adrenal origin, tumoral or not. The following are some examples. […] Hirsutism is most often due to hyperproduction of androgens, of ovarian or adrenal origin. Hyperandrogenism of tumor origin, which is very severe, must be distinguished from non-tumor hyperandrogenism, which is often minimal or moderate. […] Polycystic Ovary Syndrome (PCOS) represents the most common cause of hirsutism and causes about 75% of all cases.

• #1 Hirsutism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22904

  Hirsutism appears at puberty, accompanied by disturbances of the menstrual cycle, weight gain, dyslipidemia, insulin resistance, acne, and acanthosis nigricans. […] Hyperandrogenism due to ovarian or adrenal tumors is rare. It is responsible for only 0.2% of all cases of hirsutism. […] The responsibility of the endocrinopathies in the occurrence of hirsutism is rare, and other more specific symptoms and signs dominate the clinical picture. […] Idiopathic hirsutism defines the hirsutism that occurs in association with regular menses, normal ovarian morphology, and normal plasmatic androgen levels. It is a diagnosis of exclusion after elimination of other etiologies. […] The basic biological assessment is performed in the early follicular phase and after stopping possible oral contraception for two or three cycles unless a tumor cause is suspected.

• #1 Assessment of hirsutism – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/247

  Common differentials include Polycystic ovary syndrome and Idiopathic hirsutism. […] Uncommon differentials include Hyperprolactinaemia, Non-classical congenital adrenal hyperplasia, Cushing’s syndrome (benign), Androgenic medications, Androgen-secreting ovarian tumour, Ovarian hyperthecosis, and Adrenocortical carcinoma.

• #1 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Features of Cushing’s syndrome (weight gain, stretch marks, easy bruising, proximal muscle weakness). […] Abnormal results of levels of testosterone, 17-hydroxyprogesterone, prolactin, etc. […] Hirsutism not controlled by measures advised in primary care. […] Hirsutism may have a detrimental impact on a woman’s body image. […] Facial hirsutism may cause considerable emotional distress and social embarrassment to women; hirsutism exceeding culturally normal levels can be very distressing. […] Hirsutism is commonly associated with lower quality of life and symptoms of anxiety and depression.

• #1 Hirsutism – Recommendations for Diagnosis, Evaluation and Treatment | Българско дружество по ендокринология

  https://endo-bg.com/en/hirzutizam-preporaki-za-diagnoza-otsenka-i-lechenie/

  Hirsutism is defined medically as excessive terminal hair that appears in a male pattern in women. It is indicated by a Ferriman-Gallwey hirsutism score ? 8. Testing for androgen levels is recommended in moderate or severe hirsutism, hirsutism when is sudden in onset and rapidly progressive, hirsutism associated with menstrual irregularity or infertility, central obesity, acanthosis nigricans, and clitoromegaly. Plasma total testosterone is the initial test. If the total testosterone is normal in the presence of risk factors for hyperandrogenism free testosterone must be measured. The most common cause of hirsutism is polycystic ovary syndrome (PCOS) that should be excluded initially. Further evaluation includes pregnancy test in patients with amenorrhea, pelvic ultrasonography to detect an ovarian neoplasm, prolactin level, measurement of DHEAS and 17-hydroxyprogesterone to exclude adrenal hyperandrogenism, assessment for Cushings syndrome, acromegaly or thyroid dysfunction if other specific features are present. Oral hormonal contraceptives (OHC) are treatment of first choice. Because of their teratogenic potential, monotherapy with antiandrogens is not recommended unless adequate contraception is used. For women who cannot or choose not to conceive use of either OHC or antiandrogens is suggested, the choice being individual. A trial of at least 6 months is needed before making changes in dose and medication. Laser/photoepilation is recommended as a method for direct hair removal. For women with known hyperandrogenemia who choose hair removal therapy pharmacological therapy to minimize hair regrowth is suggested.

• #1 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Hirsutism is defined as the excessive growth of thick dark hair in an androgen-dependent pattern where hair growth in women is usually minimal or absent – eg, the face, the chest and the areolae. It occurs as a result of increased androgen production, increased skin sensitivity to androgens, or both. Hirsutism is different to hypertrichosis, which is increased hair growth in a generalised non-sexual distribution and is unrelated to androgens. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) are the most common causes. When hirsutism in women is accompanied by other signs of virilism, it may be a manifestation of a more serious underlying disorder causing hyperandrogenism, such as an ovarian tumour or adrenal neoplasm. […] Hirsutism is a common disorder affecting between 5% and 10% of women of reproductive age.

• #1 Evaluation of hirsutism – Differential diagnosis of symptoms | BMJ Best Practice US

  https://bestpractice.bmj.com/topics/en-us/247

  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). […] Around 70% to 80% of women with androgen excess manifest hirsutism. […] 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. […] The extent of terminal hair varies by ethnic background and the method used to evaluate it. […] 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%. […] Common differentials include Polycystic ovary syndrome and Idiopathic hirsutism.

• #1 Hirsutism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470417/

  Hirsutism is the growth of excessive male-pattern hair in women after puberty. It is a frequent reason for dermatological consultation. This activity reviews the evaluation and management of hirsutism and highlights the role of the healthcare team in the recognition and management of this condition. […] Hirsutism is the most common endocrine disorder affecting nearly 10% of women in the United States. […] The diagnosis of idiopathic hirsutism is a diagnosis of exclusion. Approximately 15% to 50% of women suffering from hirsutism belong to this category. […] The basic biological assessment is performed in the early follicular phase and after stopping possible oral contraception for two or three cycles unless a tumor cause is suspected. […] The diagnosis of hirsutism requires the careful collection of medical history data, physical examination, appropriate biological, and radiological investigations. […] The management of hirsutism is interprofessional, including the dermatologist, the endocrinologist, and the gynecologist.

• #1 Evaluation and Treatment of Women with Hirsutism | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0615/p2565.html

  Hirsutism is a common disorder, often resulting from conditions that are not life-threatening. It may signal more serious clinical pathology, and clinical evaluation should differentiate benign causes from tumors or other conditions such as polycystic ovary syndrome, late-onset adrenal hyperplasia, and Cushing’s syndrome. […] Laboratory testing should be based on the patient’s history and physical findings, but screening for levels of serum testosterone and 17-hydroxyprogesterone is sufficient in most cases. Women with irregular menses and hirsutism should be screened for thyroid dysfunction and prolactin disorders. […] A thorough history and physical examination are essential to evaluate women with hirsutism to determine which patients need additional diagnostic testing. […] Identification of serious underlying disorders is the primary purpose of laboratory testing and should be individualized. About 95 percent of these patients have PCOS or idiopathic hirsutism.

• #1 Patient education: Hirsutism (excess hair growth in females) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hirsutism-excess-hair-growth-in-females-beyond-the-basics

  The two most common causes of hirsutism are polycystic ovary syndrome (PCOS) and idiopathic hirsutism. Both are diagnosed by physical examination, medical and family history, and sometimes blood tests. […] Females with PCOS often have hirsutism in combination with irregular menstrual cycles. […] When cycles are this irregular, it usually means that a female is not ovulating on a regular basis. […] PCOS is a chronic condition, but several treatments can reduce hair growth. […] The treatment of hirsutism requires patience because hair follicles have a life cycle of approximately six months. Most medications must be taken for six months before a noticeable improvement occurs. […] Your provider will monitor the progress of treatment and may repeat tests if he or she is concerned about an underlying condition.

• #1 Hirsutism Guide: Causes, Symptoms and Treatment Options

  https://www.drugs.com/health-guide/hirsutism.html

  Your doctor will ask you about your medical history with special attention to your menstrual cycles. […] If the hirsutism and menstrual irregularity are new, you will need to be evaluated for a potentially more serious condition, such as a tumor of the ovary, adrenal glands or pituitary gland. […] If you need more testing, you are likely to have several blood tests: […] Depending on the results of these tests, your doctor may order additional hormone tests to help clarify the reason you are producing too much androgen by evaluating the function of your adrenal gland and pituitary gland. […] If a specific cause of hirsutism is diagnosed, your doctor may suggest appropriate treatment for that cause. […] For all women with hirsutism, cosmetic treatments and medical treatments that decrease the levels of androgens or their impact on hair follicles can be helpful:

• #1 Patient education: Hirsutism (excess hair growth in females) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hirsutism-excess-hair-growth-in-females-beyond-the-basics

  Several medications are available for the treatment of hirsutism. These medications can decrease the amount of body hair, stop the growth of new hair, and decrease the growth rate and coarseness of existing hair. […] Combined estrogen-progestin contraceptive pills, rings, and patches lower the levels of androgens produced by the ovaries and adrenal glands. […] Antiandrogens are medications that directly decrease androgen production or block the action of androgens on the hair follicle. […] The most commonly used antiandrogen is spironolactone. […] Over time, many females find that a multipronged approach that includes direct hair removal (such as laser), suppression of androgen production with estrogen-progestin contraceptives and androgen blockade with an antiandrogen (spironolactone) may produce the maximal reduction in bothersome hair growth.

• #1 Hirsutism in Women: Understanding and Managing – Prof. Dr. Basak Baksu

  https://basakbaksu.com.tr/en/kadinlarda-hirsutizm/

  Understanding the underlying causes of hirsutism is critical to initiating the correct treatment process. Healthcare professionals can reduce the effects of hirsutism by determining the correct diagnosis and treatment methods. Regular health checks and early diagnosis make it easier to control this condition.

• #2 Hirsutism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470417/

  Hirsutism is the growth of excessive male-pattern hair in women after puberty. It is a frequent reason for dermatological consultation. This activity reviews the evaluation and management of hirsutism and highlights the role of the healthcare team in the recognition and management of this condition. […] Hirsutism is the most common endocrine disorder affecting nearly 10% of women in the United States. […] The diagnosis of idiopathic hirsutism is a diagnosis of exclusion. Approximately 15% to 50% of women suffering from hirsutism belong to this category. […] The basic biological assessment is performed in the early follicular phase and after stopping possible oral contraception for two or three cycles unless a tumor cause is suspected. […] The diagnosis of hirsutism requires the careful collection of medical history data, physical examination, appropriate biological, and radiological investigations. […] The management of hirsutism is interprofessional, including the dermatologist, the endocrinologist, and the gynecologist.

• #2 Hirsutism: What It Is, In Women, Causes, PCOS & Treatment

  https://my.clevelandclinic.org/health/diseases/14523-hirsutism

  Hirsutism is a condition that causes excess hair to grow on certain parts of your body. It mainly affects females. Hirsutism doesn’t have a known cause, but it’s a symptom of other conditions, including polycystic ovary syndrome. Treatment options include weight loss, medications and other hair removal options. […] Hirsutism mainly affects females. It can affect males, but it’s difficult to tell the difference between hirsutism and typical thick, dark, long hair growth (terminal hair). […] Hirsutism affects 5% to 10% of women who are around child-bearing age. It affects over 40% of women. […] Your healthcare provider will conduct a physical examination to determine the extent of the uncommon hair growth. They’ll also note any other physical signs that may accompany the hair growth, such as acne.

• #2 Evaluation and Treatment of Women with Hirsutism | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0615/p2565.html

  For diagnostic purposes, serum levels of testosterone and 17-OHP are usually sufficient. […] Hirsutism outside of the perimenarchal period, rapid progression of hirsutism, or signs of Cushing’s syndrome or virilization should indicate the possibility of an ovarian or adrenal neoplasm. […] Diagnostic testing should examine levels of serum testosterone, 17-OHP, and DHEAS. Levels of serum testosterone greater than 200 ng per dL (6.94 nmol per L) and/or DHEAS greater than 700 ng per dL (24.3 nmol per L) are strongly indicative of virilizing tumors. […] For patients with irregular menses, anovulation, PCOS, late-onset adrenal hyperplasia, and idiopathic hirsutism, prolactin levels and thyroid function tests may be considered to identify thyroid dysfunction and pituitary tumors.

• #2 Hirsutism – British Skin Foundation

  https://knowyourskin.britishskinfoundation.org.uk/condition/hirsutism/?q=https://knowyourskin.britishskinfoundation.org.uk/condition/

  Hirsutism can be caused by an increased androgen (male hormone) production, increased skin sensitivity to androgens, or both. […] The dermatologist may request some hormone tests, possibly an ultrasound of the pelvis (to investigate the potential diagnosis of PCOS) and may refer you to an endocrinologist (specialist in hormonal disorders). […] It is important to see a doctor if hirsutism is associated with any of the following: Developing quickly (over 1-2 years), or before puberty. […] Treatments for hirsutism where there is no underlying cause or in association with PCOS include: […] Eflornithine cream works by slowing hair growth. […] Oral contraceptive pills. The combined oral contraceptive pill reduces the amount of circulating free androgens and may help to reduce hirsutism, especially those that have a progestin component that is less androgenic or are combined with an anti-androgen such as cyproterone acetate or drospirenone. […] Anti-androgens. The doctor may prescribe these to block the action of the androgens that can cause hirsutism. […] Other medicines. Insulin sensitisers, including metformin and pioglitazone, are widely used in PCOS which is associated with hirsutism.

• #2 Hirsutism, Normal Androgens and Diagnosis of PCOS

  https://www.mdpi.com/2075-4418/12/8/1922

  The Ferriman–Gallwey (FG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. […] The modified FG (mFG) score evaluates hair growth in nine body areas. Hair growth is rated from 0 (no terminal hair) to 4 (male pattern hair) in each area, with scores of 1, 2, and 3 indicating intermediate levels of body hair growth, for a maximum score of 36. […] Although a universal mFG score cutoff would be useful for comparisons, ethnic variations, as well as skin type and other factors, should be considered when evaluating hirsutism in distinct populations. […] The concept of hyperandrogenism should be based primarily on clinical findings. Androgen measurements are not a substitute for clinical judgement, and it is particularly in patients without obvious signs of hyperandrogenism that biochemical evaluation is indispensable.

• #2 Hirsutism, Normal Androgens and Diagnosis of PCOS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406611/

  Hirsutism is defined as the presence of terminal hair with male pattern distribution in women. While in the general population, hirsutism affects around 4-11% of women, it is the main manifestation of hyperandrogenism in women with polycystic ovary syndrome (PCOS), with a prevalence estimated at 65-75%. […] The modified Ferriman-Gallwey (mFG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. […] Indeed, while most women with PCOS and hirsutism also have higher than reference values for serum androgen levels, some of them may not present with biochemical hyperandrogenism, representing a challenge to the diagnosis of PCOS. […] Although a universal mFG score cutoff would be useful for comparisons, ethnic variations, as well as skin type and other factors, should be considered when evaluating hirsutism in distinct populations.

• #2 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html

  Clinical practice guidelines suggest testing for elevated androgen levels in women with an abnormal hirsutism score. The degree of hirsutism does not necessarily correlate with the testosterone level. Free testosterone is the biologically active component of serum testosterone; however, there is considerable variability in measurements reported by various assays, particularly at low levels. Measurement of free testosterone is more accurate with equilibrium dialysis methods used by specialty laboratories. […] Women with hirsutism and menstrual dysfunction, infertility, or any physical examination findings suggestive of endocrine disorders should undergo further hormonal workup. Rapid development of hirsutism, late onset, progression despite therapy, or signs of virilization may indicate an androgen-secreting tumor.

• #2 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  A recent clinical practice guideline published by the Endocrine Society recommends against testing for increased androgen levels among women with mild hirsutism, since hyperandrogenemia is undetectable in approximately 50% of these cases using conventional laboratory tests, and because of the low likelihood of identifying a medical disorder that would alter management or outcome. Testing of androgen levels is recommended in women with moderate to severe hirsutism and in women with any degree of hirsutism when it is sudden in onset, rapidly progressive, or when it is associated with any of the following: menstrual irregularity, central obesity, acanthosis nigricans, or clitoromegaly. […] Initial laboratory tests to exclude a serious underlying disease include serum testosterone (on days four to ten of the menstrual cycle) and DHEAS, because the measurement of these two hormone levels can detect most androgen-producing tumors.

• #2 Evaluation and Treatment of Women with Hirsutism | AAFP

  https://www.aafp.org/pubs/afp/issues/2003/0615/p2565.html

  Hirsutism is a common disorder, often resulting from conditions that are not life-threatening. It may signal more serious clinical pathology, and clinical evaluation should differentiate benign causes from tumors or other conditions such as polycystic ovary syndrome, late-onset adrenal hyperplasia, and Cushing’s syndrome. […] Laboratory testing should be based on the patient’s history and physical findings, but screening for levels of serum testosterone and 17-hydroxyprogesterone is sufficient in most cases. Women with irregular menses and hirsutism should be screened for thyroid dysfunction and prolactin disorders. […] A thorough history and physical examination are essential to evaluate women with hirsutism to determine which patients need additional diagnostic testing. […] Identification of serious underlying disorders is the primary purpose of laboratory testing and should be individualized. About 95 percent of these patients have PCOS or idiopathic hirsutism.

• #2 Hirsutism, Normal Androgens and Diagnosis of PCOS

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406611/

  Most women with androgen levels more than twice the upper limit of the reference range have some degree of hirsutism, but it has been demonstrated that androgen levels, measured by conventional techniques, correlate poorly with the severity of hirsutism. […] Clinical hyperandrogenism is still very important while defining hyperandrogenism for the PCOS diagnosis, especially in women with normal androgens. […] The Ferriman-Gallwey (FG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. […] The concept of hyperandrogenism should be based primarily on clinical findings. Androgen measurements are not a substitute for clinical judgement, and it is particularly in patients without obvious signs of hyperandrogenism that biochemical evaluation is indispensable. […] The term idiopathic hirsutism should be applied only to hirsute women with normal ovulatory function and detectable normal androgen levels (testosterone, androstenedione, and DHEAS).

• #2 Hirsutism: Symptoms, causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/182659

  A physician will look at the medical history with a special focus on the menstrual cycle. If the individual has a regular pattern of menstrual periods, the hirsutism is likely to have a genetic or inherited cause. […] If menstruation has always been irregular, the cause could be polycystic ovary syndrome (PCOS). […] By measuring levels of testosterone and DHEA in the blood, a doctor can check for signs of PCOS, ovarian tumors, adrenal gland tumors, or tumors that can stimulate the adrenal glands. […] In cases of mild hirsutism, in which no other symptoms suggesting overproduction of androgen hormones, further testing may not be necessary. […] If more testing is necessary, several blood tests are available to test for deficiencies in the adrenal gland hormones. […] The doctor may test for levels of the hormone prolactin to check for signs of a tumor in the pituitary gland. […] The following might also help to identify tumors or physical irregularities that could have led to hirsutism: MRI scans of the brain, a CT scan of the adrenal glands, an ultrasound of the ovaries.

• #2 Hirsutism and Polycystic Ovary Syndrome (PCOS) patient education booklet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/hirsutism-and-polycystic-ovary-syndrome-pcos/

  Hirsutism is a symptom of medical disorders associated with the hormones called androgens. […] During your initial medical consultation, your physician will try first to make a distinction between terminal hairs growing in a male pattern indicating hirsutism and hair growth due to genetic or ethnic predisposition. […] If you are diagnosed with hirsutism, your physician may perform blood tests, ultrasound, special x-rays, and hormone tests to evaluate the function of your ovaries and adrenal glands. […] Hirsutism has several causes, which are summarized in Table 2 and described below: […] Polycystic ovary syndrome is a common hormonal disorder that affects 5% 10% of women. […] Because of the variable nature of PCOS, its diagnosis is based upon the combination of clinical, ultrasound, and laboratory features.

• #2 Assessment of hirsutism – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/247

  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). […] Around 70% to 80% of women with androgen excess manifest hirsutism. […] Excessive sexual hair may be accompanied by signs of virilisation: male-pattern alopecia, deepening of the voice, clitoromegaly, increased muscle bulk. When present, virilisation indicates an underlying condition associated with moderately to severely elevated androgen levels. […] The extent of terminal hair varies by ethnic background and the method used to evaluate it. […] 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%.

• #2 Hirsutism Causes, Symptoms, Diagnosis and Treatment – Cura4U

  https://cura4u.com/conditions/hirsutism

  History of the symptoms and physical examination by the doctor to determine the severity of the abnormal hair growth and find out other physical signs that may be present with the hair growth, such as acne, is crucial in diagnosis. […] Certain tests are advised if excessive hair growth is diagnosed as hirsutism. These include blood tests to detect increased hormone levels such as androgens, androstenedione, DHEA-S, and testosterone, thyroid function tests including thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), prolactin. […] Imaging studies may also be performed, such as ultrasound of the ovaries to further evaluate Polycystic Ovary (PCO) or tumors. Other tests may also be performed to assess ovaries and adrenal glands, to rule out other medical conditions. 90% of the cases are due to PCOS and idiopathic hirsutism.

• #2 Patient education: Hirsutism (excess hair growth in females) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hirsutism-excess-hair-growth-in-females-beyond-the-basics

  The two most common causes of hirsutism are polycystic ovary syndrome (PCOS) and idiopathic hirsutism. Both are diagnosed by physical examination, medical and family history, and sometimes blood tests. […] Females with PCOS often have hirsutism in combination with irregular menstrual cycles. […] When cycles are this irregular, it usually means that a female is not ovulating on a regular basis. […] PCOS is a chronic condition, but several treatments can reduce hair growth. […] The treatment of hirsutism requires patience because hair follicles have a life cycle of approximately six months. Most medications must be taken for six months before a noticeable improvement occurs. […] Your provider will monitor the progress of treatment and may repeat tests if he or she is concerned about an underlying condition.

• #2 Excessive hair

  https://dermnetnz.org/topics/excessive-hair

  Hirsutism is a male pattern of secondary or post-pubertal hair growth occurring in women. […] Late-onset hirsutism may be due to hyperandrogenism, where there is an increase in circulating androgens including testosterone. […] Hirsutism is usually first noted in late teenage years and tends to get more severe as the woman gets older. […] The severity of hirsutism is assessed using a modified version of the Ferriman-Gallwey visual scale for nine areas of the body. […] Hirsutism and hypertrichosis are diagnosed clinically. Investigations are not usually necessary unless the Ferriman-Gallwey score is 15 when blood tests are done to evaluate male hormone levels and underlying diseases. […] If early-onset of hirsutism, premature adrenarche, and family history of congenital adrenal hyperplasia: 17-hydroxyprogesterone.

• #2 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  The Ferriman-Gallwey score is used in evaluation of hirsutism. It reflects the amount of hair over different body areas. This may require adjustment for ethnic group. […] It is important to investigate to establish the cause of hirsutism, even when mild, as the degree of hirsutism does not correlate well with the magnitude of androgen excess. However, the first stage is careful history and examination. If there is no suggestion of hyperandrogenism, full endocrine evaluation may not be required. […] The task is then to establish whether the hirsutism is androgen-mediated and if so, the cause of excess androgen. […] Further investigation is indicated if there are features of androgen excess, rapid progression, infertility or menstrual irregularity. […] Treatment for hirsutism is unnecessary if no abnormal aetiology can be diagnosed and if the patient is not concerned about the cosmetic appearance. Management is mainly directed at any underlying cause if present. Treatment of hirsutism is not usually curative, unless a treatable underlying cause has been found. Because of the cyclical nature of hair growth, any systemic treatment may take up to six months to be effective.

• #2 Patient education: Hirsutism (excess hair growth in females) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hirsutism-excess-hair-growth-in-females-beyond-the-basics

  Hirsutism refers to the growth of coarse, dark hair in areas where females typically grow fine hair or no hair at all: above the lip and on the chin, chest, abdomen, and back. This excess hair growth is caused by an increased level of male hormones (androgens). […] Females with excess hair growth need to be evaluated by a health care provider, especially if the hair develops or worsens rapidly, or if relatives have comparatively less hair growth. In the vast majority of cases, hirsutism is not caused by a serious medical condition; however, the cause of hirsutism should be determined, and underlying conditions may need to be treated. […] Hirsutism is caused by an excess production or action of hormones called androgens. Androgens are secreted by the ovaries and adrenal glands into the circulation. Hair follicles respond to androgens by growing thick hair and producing sebum.

• #2 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Features of Cushing’s syndrome (weight gain, stretch marks, easy bruising, proximal muscle weakness). […] Abnormal results of levels of testosterone, 17-hydroxyprogesterone, prolactin, etc. […] Hirsutism not controlled by measures advised in primary care. […] Hirsutism may have a detrimental impact on a woman’s body image. […] Facial hirsutism may cause considerable emotional distress and social embarrassment to women; hirsutism exceeding culturally normal levels can be very distressing. […] Hirsutism is commonly associated with lower quality of life and symptoms of anxiety and depression.

• #2 Hirsutism: What It Is, In Women, Causes, PCOS & Treatment

  https://my.clevelandclinic.org/health/diseases/14523-hirsutism

  Once your healthcare provider has diagnosed hirsutism, they may use the Ferriman-Gallwey scale to grade its severity. […] If you have hirsutism, your healthcare provider may perform a variety of tests, including blood tests to check your hormone levels, ultrasound to examine your ovaries and uterus, and X-rays to evaluate your ovaries and adrenal glands to rule out other conditions. […] Yes, hirsutism is treatable. Treatments include weight loss, medications, hair removal options, and home remedies. […] Hirsutism requires ongoing treatment. None of the treatments make the hair go away completely, but they help make your hair grow more slowly and decrease the amount of unwanted hair. Most people are happy with their results once they find an effective treatment regimen that works for them. […] It’s a good idea to see your healthcare provider as soon as you notice unusual hair growth. Hirsutism may be a symptom of PCOS, Cushings syndrome or other conditions.

• #2 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  A serum testosterone level 200 ng/dL is highly suggestive of an adrenal or ovarian tumor. If serum testosterone is elevated despite a normal DHEAS level, an ovarian source is more likely. If a DHEAS level 700 g/dL is present despite a normal serum testosterone level, an adrenal source should be suspected as the cause of hirsutism. […] Monitoring should be carried out throughout the medical follow-up. The assessment of therapeutic responses should be evaluated by the patient herself, by declaring whether there was a decrease in the growth of hair or less need to use other methods to remove the hair.

• #2 Hirsutism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22904

  The diagnosis of idiopathic hirsutism is a diagnosis of exclusion. Approximately 15% to 50% of women suffering from hirsutism belong to this category. […] The management of hirsutism is interprofessional, including the dermatologist, the endocrinologist, and the gynecologist. The treatments used serve to reduce the severity of hirsutism, as well as to improve overall health and self-esteem. […] Hirsutism is a common disorder encountered in clinical practice. While not life-threatening, it has significant morbidity because of cosmetic issues. In some women, it may be a sign of an underlying malignancy.

• #3 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Hirsutism is defined as the excessive growth of thick dark hair in an androgen-dependent pattern where hair growth in women is usually minimal or absent – eg, the face, the chest and the areolae. It occurs as a result of increased androgen production, increased skin sensitivity to androgens, or both. Hirsutism is different to hypertrichosis, which is increased hair growth in a generalised non-sexual distribution and is unrelated to androgens. Idiopathic hirsutism and polycystic ovary syndrome (PCOS) are the most common causes. When hirsutism in women is accompanied by other signs of virilism, it may be a manifestation of a more serious underlying disorder causing hyperandrogenism, such as an ovarian tumour or adrenal neoplasm. […] Hirsutism is a common disorder affecting between 5% and 10% of women of reproductive age.

• #3 Hirsutism Causes, Symptoms, Diagnosis and Treatment – Cura4U

  https://cura4u.com/conditions/hirsutism

  History of the symptoms and physical examination by the doctor to determine the severity of the abnormal hair growth and find out other physical signs that may be present with the hair growth, such as acne, is crucial in diagnosis. […] Certain tests are advised if excessive hair growth is diagnosed as hirsutism. These include blood tests to detect increased hormone levels such as androgens, androstenedione, DHEA-S, and testosterone, thyroid function tests including thyroid-stimulating hormone (TSH), triiodothyronine (T3), thyroxine (T4), prolactin. […] Imaging studies may also be performed, such as ultrasound of the ovaries to further evaluate Polycystic Ovary (PCO) or tumors. Other tests may also be performed to assess ovaries and adrenal glands, to rule out other medical conditions. 90% of the cases are due to PCOS and idiopathic hirsutism.

• #3 Hirsutism: Symptoms, causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/182659

  A physician will look at the medical history with a special focus on the menstrual cycle. If the individual has a regular pattern of menstrual periods, the hirsutism is likely to have a genetic or inherited cause. […] If menstruation has always been irregular, the cause could be polycystic ovary syndrome (PCOS). […] By measuring levels of testosterone and DHEA in the blood, a doctor can check for signs of PCOS, ovarian tumors, adrenal gland tumors, or tumors that can stimulate the adrenal glands. […] In cases of mild hirsutism, in which no other symptoms suggesting overproduction of androgen hormones, further testing may not be necessary. […] If more testing is necessary, several blood tests are available to test for deficiencies in the adrenal gland hormones. […] The doctor may test for levels of the hormone prolactin to check for signs of a tumor in the pituitary gland. […] The following might also help to identify tumors or physical irregularities that could have led to hirsutism: MRI scans of the brain, a CT scan of the adrenal glands, an ultrasound of the ovaries.

• #3 Hirsutism Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/condition/hirsutism

  Your doctor will examine you and take a medical history. You may be asked about your menstrual cycle, what medications you take, and your family history. Your doctor will check you for hair growth and also may do a pelvic examination to check for tumors or cysts on the ovaries. After doing the physical exam, your doctor may order one of the following tests: […] Blood tests, may show high androgen levels […] Imaging tests, including CT scan, MRI, pelvic ultrasound, used to find cysts or tumors on the ovaries or adrenal glands.

• #3 Assessment of hirsutism – Differential diagnosis of symptoms | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/247

  Common differentials include Polycystic ovary syndrome and Idiopathic hirsutism. […] Uncommon differentials include Hyperprolactinaemia, Non-classical congenital adrenal hyperplasia, Cushing’s syndrome (benign), Androgenic medications, Androgen-secreting ovarian tumour, Ovarian hyperthecosis, and Adrenocortical carcinoma.

• #3 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Features of Cushing’s syndrome (weight gain, stretch marks, easy bruising, proximal muscle weakness). […] Abnormal results of levels of testosterone, 17-hydroxyprogesterone, prolactin, etc. […] Hirsutism not controlled by measures advised in primary care. […] Hirsutism may have a detrimental impact on a woman’s body image. […] Facial hirsutism may cause considerable emotional distress and social embarrassment to women; hirsutism exceeding culturally normal levels can be very distressing. […] Hirsutism is commonly associated with lower quality of life and symptoms of anxiety and depression.

• #3 Screening and Management of the Hyperandrogenic Adolescent | ACOG

  https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-and-management-of-the-hyperandrogenic-adolescent

  Elevation of the free or total testosterone level higher than the adult female normative values is a key diagnostic feature of biochemical hyperandrogenism. […] The finding of polycystic ovarian morphology on ultrasonography has a prevalence in adolescent girls of 30-40% and alone is not predictive of the presence or future development of PCOS. […] Multimodal therapy is the most effective approach to the treatment of hirsutism; this includes lifestyle changes, physical hair removal, and androgen suppression or blockade with medication that slows or prevents new hair growth. […] Hormonal therapy should not be started before menarche. Once initiated, patients should be counseled that it may take 6 months before they see the benefits of treatment. […] The diagnosis of hyperandrogenism can be based on clinical symptoms or measurement of serum androgens. […] Symptoms of androgen excess are quite common among adolescents and can have a substantial effect on self-esteem and emotional well-being. Among adolescents presenting with these symptoms, it is a challenge to distinguish physiologic changes of puberty from PCOS.

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