Background A 20-year-old woman presented with excess facial and body hair, which she had noticed for the first time after her menarche and which had gradually worsened since then. In addition, the patient's menstrual cycles had always been irregular. Her family history revealed that her mother also had a history of excess body hair. Among the patient's family members there was no other history of chronic diseases, including type 2 diabetes. She denied taking any regular medications and had been shaving and waxing regularly to remove the excess hair. On examination, the patient was a lean woman with normal vital signs. Prominent coarse hair was noted over her upper lip, chin, lower abdomen, lower back and upper legs. The remainder of the physical examination was unremarkable.
Investigations Physical examination, and investigations that included a transabdominal pelvic ultrasound scan and measurement of TSH, prolactin, 17-hydroxyprogesterone and total testosterone levels.
Diagnosis Hirsutism associated with polycystic ovary syndrome.
Management The patient was treated with cyproterone acetate 2 mg/day and ethinylestradiol 0.035 mg/day in combination with spironolactone 100 mg/day as well as with laser hair removal. The patient's symptoms had improved considerably after 1 year of treatment. A cardiometabolic risk assessment, including a standard oral glucose tolerance test and a lipid profile before and after treatment, revealed normal fasting and 2 h plasma glucose levels both at baseline and after 12 months, and a low-normal HDL-cholesterol level that returned to normal after 12 months.
This is a preview of subscription content, access via your institution
Subscribe to this journal
Receive 12 print issues and online access
$189.00 per year
only $15.75 per issue
Rent or buy this article
Get just this article for as long as you need it
Prices may be subject to local taxes which are calculated during checkout
Sonino N et al. (1993) Quality of life of hirsute women. Postgrad Med J 69: 186–189
Yildiz BO (2006) Diagnosis of hyperandrogenism: clinical criteria. Best Pract Res Clin Endocrinol Metab 20: 167–176
Azziz R et al. (2004) Androgen excess in women: experience with over 1000 consecutive patients. J Clin Endocrinol Metab 89: 453–462
Rittmaster RS (1997) Hirsutism. Lancet 349: 191–195
Ewing JA et al. (1978) Hirsutism, race and testosterone levels: comparison of East Asians and Euroamericans. Hum Biol 50: 209–215
Hatch R et al. (1981) Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 140: 815–830
Yildiz BO (2007) Hormonal and biochemical evaluation of polycystic ovary syndrome. In Contemporary Endocrinology: Insulin Resistance and Polycystic Ovarian Syndrome: Pathogenesis, Evaluation, and Treatment, 241–248 (Eds Nestler JE et al.) Totowa, NJ: Humana Press
Rosner W et al. (2007) Position statement: Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab 92: 405–413
Legro RS et al. (2006) The Pregnancy in Polycystic Ovary Syndrome study: baseline characteristics of the randomized cohort including racial effects. Fertil Steril 86: 914–933
Zawadzki JK et al. (1992) Diagnostic criteria for polycystic ovary syndrome. In Polycystic ovary syndrome, 377–384 ( Eds Dunaif A et al.) Boston, MA: Blackwell Scientific Publications
Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group (2004) Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil Steril 81: 19–25
Azziz R et al. (2006) Positions statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 91: 4237–4245
Yildiz BO (2004) Recent advances in the treatment of polycystic ovary syndrome. Expert Opin Investig Drugs 13: 1295–1305
Carmina E (2002) Anti-androgens for the treatment of hirsutism. Expert Opin Investig Drugs 11: 357–363
Costello MF et al. (2007) Metformin versus oral contraceptive pill in polycystic ovary syndrome: a Cochrane review. Hum Reprod 22: 1200–1209
Consent for the publication of Figure 1 was obtained from the patient.
The author declares no competing financial interests.
Supplementary information Box 1
Rare disorders in the differential diagnosis of hirsutism. (DOC 34 kb)
Supplementary information Box 3
Initial investigations for a patient with hirsutism. (DOC 34 kb)
Rights and permissions
About this article
Cite this article
Yildiz, B. Assessment, diagnosis and treatment of a patient with hirsutism. Nat Rev Endocrinol 4, 294–300 (2008). https://doi.org/10.1038/ncpendmet0789
This article is cited by
Polycystic ovary syndrome
Nature Reviews Disease Primers (2016)