Clinical Review

Management of hirsutism

BMJ 2009; 338 doi: (Published 27 March 2009) Cite this as: BMJ 2009;338:b847
  1. Olympia Koulouri, research fellow in endocrinology,
  2. Gerard S Conway, consultant endocrinologist
  1. 1Department of Endocrinology, University College London Hospitals, London NW1 2PQ
  1. Correspondence to: G S Conway g.conway{at}

    Summary points

    • Hirsutism is a common and distressing condition

    • The underlying cause is usually polycystic ovary syndrome

    • Serum testosterone measurements are not needed in most cases

    • Topical and systemic treatments or combinations of the two can adequately control hirsutism in most cases

    • Allow four to six months for any treatment to be effective

    Hirsutism is the presence of excess hair growth in women, and the term usually refers to excessive growth of terminal hair in an androgen dependent distribution. Although it is often thought to be a cosmetic problem, unwanted hair growth adversely affects psychological wellbeing.1 It can have a similar effect on quality of life scores to that of asthma, epilepsy, and diabetes,2 and effective treatments reverse these adverse scores.3

    Sources and selection criteria

    We reviewed all references to “hirsutism” in Medline and the Cochrane Collaboration and selected randomised controlled trials for inclusion in the evidence base. We also referred to the Endocrine Society’s clinical practice guidelines for the management of hirsutism.4 Clinical experience is based on a tertiary referral endocrine service.

    Several new treatments have emerged in recent years, including the wider availability of laser depilation, topical suppressors of hair growth (eflornithene), and a progestogen with antiandrogenic properties (drospirenone). In this review, we assess the evidence base for new treatments in the context of established treatments, although the worldwide availability of these preparations varies greatly. The overall quality of primary evidence of the relative efficacy of treatments for hirsutism is weak and is based on small studies of short duration that lack quality of life outcomes. Recently, however, systematic reviews have amalgamated this evidence and new guidelines are now available.4

    What are the possible causes of hirsutism?

    Most women with hirsutism have polycystic ovary syndrome or idiopathic hirsutism (box 1). Treatment options are the same for both, so ovarian ultrasound is not essential in many cases. …

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