• 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
