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Hirsutism
is excessive hair that occurs with or without virilization.
Hirsutism is almost exclusively a concern for women when hair takes on an appearance or distribution similar to male hair patterns. The threshold for “too much hair” is largely culturally determined. Hirsutism bothers some men when excessive hair covers the back.
Hirsutism in women may occur with virilization, in which other androgen-dependent changes such as loss of menses, voice deepening, and clitoral hypertrophy develop. Almost all cases of hirsutism with virilization are due to endocrine disorders affecting the ovaries (see Menstrual Abnormalities: Polycystic Ovary Syndrome (PCOS)) or adrenals (see Adrenal Disorders: Adrenal Virilism) and are of medical, not just cosmetic, concern. Hirsutism without virilization is most often genetic or physiologic (occurring in pregnancy or after menopause) and largely of cosmetic concern. However, it may also be caused by drugs (especially phenytoin , corticosteroids, and progestins) or be a sign of endocrine (thyroid, acromegaly) or metabolic (porphyria) disease.
Diagnostic testing in men is unnecessary. In women, diagnosis is by laboratory evaluation, including serum free and total testosterone , dehydroepiandrosterone sulfate, follicle-stimulating hormone, luteinizing hormone, and prolactin; an endocrinologist may be consulted.
Mild cases can be treated without a doctor using depilatories or waxing. These treatments are temporary and tend to irritate the skin. Excess hair can be removed by diode laser or topical ornithine decarboxylase inhibitor cream and by treating any underlying endocrine abnormality.
Last full review/revision November 2005
Content last modified November 2005
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