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Evaluation of premenopausal women with hirsutism

Robert L Barbieri, MD
David A Ehrmann, MD
Section Editors
Peter J Snyder, MD
William F Crowley, Jr, MD
Deputy Editor
Kathryn A Martin, MD


Hirsutism, defined as excessive male-pattern hair growth, affects between 5 and 10 percent of women of reproductive age. It may be the initial, and possibly only, sign of an underlying androgen disorder, the cutaneous manifestations of which may also include acne and male-pattern balding (androgenetic alopecia). The most common cause of hirsutism is polycystic ovary syndrome (PCOS). In some cases, hirsutism is mild and requires only reassurance and local (nonsystemic) therapy, while in others it causes significant psychological distress and requires more extensive therapy.

The evaluation and laboratory testing of hirsutism will be discussed here, while its pathophysiology, causes, and treatment are discussed elsewhere (table 1). (See "Pathophysiology and causes of hirsutism" and "Treatment of hirsutism".)


Hirsutism is a clinical diagnosis defined by the presence of excess terminal hair growth (dark, coarse hairs) in androgen-dependent areas (eg, upper lip, chin, midsternum, upper abdomen, back, and buttocks) in which women typically have little or no hair [1,2]. Hair growth can be graded as either normal or excessive based upon the Ferriman-Gallwey score. (See 'Ferriman-Gallwey score' below.)

Hirsutism is an important clinical problem because:

It affects approximately 5 to 10 percent of women [3].

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Literature review current through: Nov 2017. | This topic last updated: Jan 10, 2017.
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