Hirsutism in women

Hirsutism in women is the presence of unwanted coarse body hair in a male distribution. It affects 5-15% of women,1 and it can have profound psychological sequelae. It undermines the woman's confidence and self esteem, and its effect on quality of life should not be underestimated. Some women live apparently normal lives but may spend two or three hours a day using cosmetic or camouflage methods. Other women may become reclusive and only venture out after dark. In teenagers, hirsutism can be a cause of bullying, social isolation, and poor educational performance. By the time they seek medical advice, many women will have reached a point of desperation.

Hirsutism is usually caused by increased production of androgen (a collective term for male sex hormones) or increased sensitivity of hair follicles to androgens. The condition is often associated with acne and seborrhoea. Management of female hirsutism requires, first of all, the exclusion of any underlying sinister cause, such as an androgen secreting tumour, by confirmation that the history is not acute and is not associated with amenorrhoea or virilisation. Measurement of serum testosterone alone is sufficient for basic screening. Urgent referral to a specialist clinic is indicated if the concentration of serum testosterone is more than 5 nmol/l. The other investigations which might be needed are listed in box 1.