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Hirsutism

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• Hirsutism is common, occurring in 5 to 10 percent of all women. • Hirsutism is usually a sign of an underlying endocrine disorder (most commonly polycystic ovary syndrome [PCOS]); women who present with hirsutism should therefore be offered an endocrine evaluation followed by appropriate therapy. • Hirsutism is associated with personal distress, anxiety and depression; it is important for clinicians to take their patients' cosmetic concerns seriously. • Treatment options include pharmacologic therapy (starting with combination oral estrogen-progestin contraceptives for most), direct hair removal methods such as photoepilation/laser, or both. • Photoepilation (hair removal using laser and intense pulsed light) is most effective for women with light skin and dark hair. It is less effective and sometimes associated with complications in women with darker skin, especially those with Middle Eastern and Mediterranean ancestry. Table 1. Definitions of Terms Used in This Guideline Term Definition Hirsutism Hirsutism is excessive terminal hair that appears in a male pattern (excessive hair in androgen-dependent areas; i.e., sexual hair) in women. Ferriman–Gallwey score e modified Ferriman–Gallwey score is the gold standard for evaluating hirsutism. Nine body areas most sensitive to androgen are assigned a score from 0 (no hair) to 4 (frankly virile), and these separate scores are summed to provide a hormonal hirsutism score (Fig. 1). Local hair growth is is unwanted localized hair growth in the absence of an abnormal hirsutism score. Patient-important hirsutism Unwanted sexual hair growth of any degree that causes sufficient distress for women to seek additional treatment. Hyperandrogenism Hyperandrogenism (for the purposes of this guideline) is defined as clinical features that result from increased androgen production and/ or action. Idiopathic hirsutism is is hirsutism without hyperandrogenemia or other signs or symptoms indicative of a hyperandrogenic endocrine disorder. Key Points

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