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  1. Raekha Kumar, clinical research associate1,
  2. Joan St John, general practitioner with special interest in diabetes2,
  3. Devasenan Devendra, community consultant endocrinologist and senior lecturer in medicine3
  1. 1Imperial College School of Medicine, Jeffrey Kelson Diabetes Centre, Central Middlesex Hospital, London NW10 7NS
  2. 2The Law Medical Practice Group, Wembley, Middlesex HA9 6QQ
  3. 3Imperial College School of Medicine, Jeffrey Kelson Diabetes Centre, Central Middlesex Hospital
  1. Correspondence to: D Devendra d.devendra{at}imperial.ac.uk
  • Accepted 26 June 2009

A 20 year old woman of Indian origin attends your surgery with an excess growth of dark hair on her face, arms, and thighs, which has been getting worse over the past two years. She has a body mass index of 27.

What issues you should cover

Hirsutism is the presence of terminal hair (long, coarse, and pigmented) in women and girls, in a male androgen sensitive pattern. This must be differentiated from hypertrichosis, which is generalised hair growth not exclusive to androgen sensitive areas (caused by—for example, the use of Minoxidil). Hirsutism affects 5-15% of women of reproductive age. Androgens, principally testosterone (from the adrenal glands and ovaries), increase hair growth by converting fine, unpigmented vellus hair to terminal hair in androgen sensitive areas such as the face, …

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