Hirsutism
Hirsutism is the growth of dark, coarse terminal hair in women in a male-distribution pattern -- face, chest, abdomen, upper back, and inner thighs. It results from elevated androgen levels or increased sensitivity of hair follicles to androgens. Most cases are benign (PCOS or idiopathic), but rapid onset or virilization warrants evaluation for rare androgen-secreting tumors.
Symptoms
Unwanted coarse dark hair on the face (upper lip, chin, jaw, sideburns), chest, areolae, linea alba, inner thighs, and upper back. Associated symptoms may include acne, scalp hair thinning, clitoral enlargement, or deepened voice if androgen levels are very high.
Causes and risk
PCOS accounts for approximately 75% of cases. Other causes include idiopathic hirsutism (normal androgens with increased follicular sensitivity), non-classic congenital adrenal hyperplasia, androgen-secreting ovarian or adrenal tumors, Cushing's syndrome, hyperprolactinemia, and androgenic medications.
How it is evaluated
Total and free testosterone, DHEAS, LH, FSH, 17-hydroxyprogesterone (fasting, morning, early follicular phase for CAH screening), and prolactin are the core lab panel. Cortisol testing and adrenal imaging are added if Cushing's syndrome is suspected. Pelvic ultrasound evaluates ovarian morphology.
Treatment
Weight loss in PCOS improves androgen levels. Oral contraceptives (preferably with anti-androgenic progestins like drospirenone) suppress ovarian androgen production. Spironolactone blocks androgen receptors at the hair follicle. Eflornithine cream slows facial hair growth. Clinical response takes six to twelve months since hair cycle is slow.