Published 28 April 2009, doi:10.1136/bmj.b912
Cite this as: BMJ 2009;338:b912

Practice

Rational testing

Investigating hirsutism

T Sathyapalan, specialist registrar in diabetes1, Stephen L Atkin, professor of academic endocrinology2

1 Endocrinology and General Medicine, Michael White Diabetes Centre, Hull Royal Infirmary, Hull HU3 2RW, 2 Diabetes and Metabolism, Hull-York Medical School, Hull Royal Infirmary

Correspondence to: S L Atkin Stephen.Atkin@hyms.ac.uk

When should we test for clinical hyperandrogenism and what are the best tests?

The first 150 words of the full text of this article appear below.


Clinical hirsutism is usually caused by polycystic ovary syndrome or is idiopathic (has no other clinical or biochemical abnormality)
Initial tests should: assess biochemical hyperandrogenaemia by measuring total testosterone, sex hormone binding globulin, and free androgen index; include thyroid function tests and prolactin measurements; and if clinically indicated, rule out non-classic congenital adrenal hyperplasia by measuring 17-hydroxyprogesterone and Cushing’s syndrome by measuring 24 hour urinary cortisol
Ultrasonographic imaging of ovaries is not needed to diagnose polycystic ovary syndrome in patients with menstrual disturbances and clinical or biochemical evidence of hyperandrogenism


A 29 year old woman presented to her general practitioner because of facial hair that had worsened over the past three years. Her menarche had been at the age of 13 and her menstrual cycle was regular at 30 days. Her weight had been stable over the past two years, but she had previously put on 10 kg in weight . . . [Full text of this article]


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Relevant Article

Fortnightly Review: Polycystic ovarian syndrome: the metabolic syndrome comes to gynaecology
Zoe E C Hopkinson, Naveed Sattar, Richard Fleming, and Ian A Greer
BMJ 1998 317: 329-332. [Extract] [Full Text] [PDF]

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