Journal of General Internal Medicine

, Volume 10, Issue 5, pp 283–292


Evaluation and management
  • Ralph E. Watson
  • Reynard Bouknight
  • Patrick C. Alguire
Clinical Reviews


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Kemmett D. ABC of dermatology. Diseases of the hair and scalp. Br Med J [Clin Res]. 1988;296:552–5.Google Scholar
  2. 2.
    Erkkola R, Ruutiainen K. Hirsutism: definitions and etiology. Ann Med. 1990;22:99–103.PubMedGoogle Scholar
  3. 3.
    Kovacs WJ, Wilson JD. Hirsutism and virilization. In: Isselbacher KJ, Braunwald E, Wilson JD, Martin JB, Fauci AS, Kasper DL (eds). Harrison’s Principles of Internal Medicine. 13th ed. New York: McGraw-Hill, 1994:268–70.Google Scholar
  4. 4.
    Kobayashi T, Lobotsky J, Lloyd CW. Plasma testosterone and urinary 17-ketosteroids in Japanese and Occidentals. J Clin Endocrinol Metab. 1966;26:610–4.PubMedGoogle Scholar
  5. 5.
    Greenblatt RB. Hirsutism: ancestral curse or endocrinopathy. In: Greenblatt RB, Mahesh VB, Gambrell RD Jr (eds). The Cause and Management of Hirsutism. 1st ed. Park Ridge, IL: Parthenon Publishing Group, 1987:17–29.Google Scholar
  6. 6.
    Kessel B, Liu J. Clinical and laboratory evaluation of hirsutism. Clin Obstet Gynecol. 1991;34:805–16.PubMedCrossRefGoogle Scholar
  7. 7.
    Delahunt JW. Hirsutism. Practical therapeutic guidelines. Drugs. 1993;45:223–31.PubMedGoogle Scholar
  8. 8.
    Leung AK, Robson WL. Hirsutism. Int J Dermatol. 1993;32:773–7.PubMedGoogle Scholar
  9. 9.
    Natrajan PK. Hirsutism and the endocrine system. In: Greenblatt RB, Mahesh VB, Gambrell RD (eds). The Cause and Management of Hirsutism. Park Ridge, IL: Parthenon Publishing Group, 1987;45–60.Google Scholar
  10. 10.
    Snyder CH. Syndrome of gingival hyperplasia, hirsutism, and convulsions. J Pediatr. 1965;67:499–502.PubMedCrossRefGoogle Scholar
  11. 11.
    Van Scott EJ. The hirsute female: physiology of hair growth. Clin Obstet Gynecol. 1964;7:1062–74.CrossRefGoogle Scholar
  12. 12.
    Burton JL, Schutt WH, Caldwell IW. Hypertrichosis due to diazoxide. Br J Dermatol. 1975;93:707–11.PubMedCrossRefGoogle Scholar
  13. 13.
    Baker L, Kaye R, Root AW, Prasad ALN. Diazoxide treatment of idiopathic hypoglycemia of infancy. J Pediatr. 1967;71:494–505.CrossRefGoogle Scholar
  14. 14.
    Earhart RN, Ball J, Nuss DD, Aeling JL. Minoxidil-induced hypertrichosis: treatment with calcium thioglycolate depilatory. South Med J. 1977;70:442–3.PubMedGoogle Scholar
  15. 15.
    Mackay A, Isles C, Henderson I, Fife R, Kennedy AC. Minoxidil in the management of intractable hypertension. Q J Med. 1981;50:175–90.PubMedGoogle Scholar
  16. 16.
    Karpas AE. Iatrogenic hirsutism. In: Greenblatt RB, Mahesh VB, Gambrell RD (eds). The Cause and Management of Hirsutism. Park Ridge, IL: Parthenon Publishing Group, 1987:61–9.Google Scholar
  17. 17.
    Bennett WM, Serra J, Fischer S, Norman DJ, Barry JM. Cyclosporine in renal transplantation with hirsutism [letter]. Am J Kidney Dis. 1985;5:214.PubMedGoogle Scholar
  18. 18.
    Griffing GT, Melby JC. Hirsutism causes and treatments. Hosp Pract (Off Ed). 1991;26:43–58.Google Scholar
  19. 19.
    Barbieri RL. Hyperandrogenic disorders. Clin Obstet Gynecol. 1990;33:640–54.PubMedCrossRefGoogle Scholar
  20. 20.
    Higuchi K, Nawata H, Maki T, Higashizima M, Kato K, Ibayashi H. Prolactin has a direct effect on adrenal androgen secretion. J Clin Endocrinol Metab. 1984;59:714–8.PubMedGoogle Scholar
  21. 21.
    Barnes RB. Adrenal dysfunction and hirsutism. Clin Obstet Gynecol. 1991;34:827–34.PubMedCrossRefGoogle Scholar
  22. 22.
    Glickman SP, Rosenfield RL, Bergenstal RM, Helke J. Multiple androgenic abnormalities, including elevated free testosterone, in hyperprolactinemic women. J Clin Endocrinol Metab. 1982;55:251–7.PubMedGoogle Scholar
  23. 23.
    Sperling LC, Heimer WL 2d. Androgen biology as a basis for the diagnosis and treatment of androgenic disorders in women. I. J Am Acad Dermatol. 1993;28:669–83.PubMedGoogle Scholar
  24. 24.
    Shelley DR, Dunaif A. Polycystic ovary syndrome. Compr Ther. 1990;16:26–34.PubMedGoogle Scholar
  25. 25.
    Goldzieher JW, Axelrod LR. Clinical and biochemical features of polycystic ovarian disease. Fertil Steril. 1963;14:631–53.PubMedGoogle Scholar
  26. 26.
    Lobo RA. Hirsutism in polycystic ovary syndrome: current concepts. Clin Obstet Gynecol. 1991;34:817–26.PubMedCrossRefGoogle Scholar
  27. 27.
    Cragun JR, Chang RJ. Polycystic ovary syndrome. In: Quilligan EJ, Zuspan FP (eds). Current Therapy in Obstetrics and Gynecology. Philadelphia: W. B. Saunders, 1990:95–8.Google Scholar
  28. 28.
    McKenna TJ. Pathogenesis and treatment of polycystic ovary syndrome. N Engl J Med. 1988;318:558–62.PubMedCrossRefGoogle Scholar
  29. 29.
    Barnes R, Rosenfield RL. The polycystic ovary syndrome: pathogenesis and treatment. Ann Intern Med. 1989;110:386–99.PubMedGoogle Scholar
  30. 30.
    Burghen GA, Givens JR, Kitabchi AE. Correlation of hyperandrogenism with hyperinsulinism in polycystic ovarian disease. J Clin Endocrinol Metab. 1980;50:113–6.PubMedCrossRefGoogle Scholar
  31. 31.
    Chang RJ, Nakamura RM, Judd HL, Kaplan SA. Insulin resistance in nonobese patients with polycystic ovarian disease. J Clin Endocrinol Metab. 1983;57:356–9.PubMedGoogle Scholar
  32. 32.
    Barbieri RL, Ryan KJ. Hyperandrogenism, insulin resistance, and acanthosis nigricans syndrome: a common endocrinopathy with distinct pathophysiologic features. Am J Obstet Gynecol. 1983;147:90–101.PubMedGoogle Scholar
  33. 33.
    Rittmaster RS, Loriaux DL. Hirsutism. Ann Intern Med. 1987;106:95–107.PubMedGoogle Scholar
  34. 34.
    Isojarvi JIT, Laatikainen TJ, Pakarinen AJ, Juntunen KTS, Myllyla W. Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy. N Engl J Med. 1993;329:1383–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Aiman J. Virilizing ovarian tumors. Clin Obstet Gynecol. 1991;34:835–47.PubMedCrossRefGoogle Scholar
  36. 36.
    Fox H. Sex cord-stromal tumours of the ovary. J Pathol. 1985;145:127–48.PubMedCrossRefGoogle Scholar
  37. 37.
    Barbieri RL, Makris A, Ryan KJ. Insulin stimulates androgen accumulation in incubations of human ovarian stroma and theca. Obstet Gynecol. 1984;64(suppl):73S-80S.PubMedGoogle Scholar
  38. 38.
    Erickson GF, Magoffin DA, Dyer CA, Hofeditz C. The ovarian androgen producing cells: a review of structure/function relationships. Endocr Rev. 1985;6:371–99.PubMedGoogle Scholar
  39. 39.
    Anderson DC. Sex-hormone-binding globulin. Clin Endocrinol (Oxf). 1974;3:69–96.Google Scholar
  40. 40.
    Randall VA. Androgens and human hair growth. Clin Endocrinol (Oxf). 1994;40:439–57.Google Scholar
  41. 41.
    Greenblatt RB. Idiopathic hirsutism. In: Greenblatt RB, Mahesh VB, Gambrell RD (eds). The Cause and Management of Hirsutism. Park Ridge, IL: Parthenon Publishing Group, 1987:131–6.Google Scholar
  42. 42.
    Rosenfield RL, Lucky AW. Acne, hirsutism, and alopecia in adolescent girls. Clinical expressions of androgen excess. Endocrinol Metab Clin North Am. 1993;22:507–32.PubMedGoogle Scholar
  43. 43.
    Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab. 1961;21:1440–7.PubMedCrossRefGoogle Scholar
  44. 44.
    Moncada E. Familial study of hirsutism. J Clin Endocrinol Metab. 1970;31:556–64.PubMedGoogle Scholar
  45. 45.
    Rosenfield RL. Pilosebaceous physiology in relation to hirsutism and acne. Clin Endocrinol Metab. 1986;15:341–62.PubMedCrossRefGoogle Scholar
  46. 46.
    Tagatz GE, Kopher RA, Nagel TC, Okagaki T. The clitoral index: a bioassay of androgenic stimulation. Obstet Gynecol. 1979;54:562–4.PubMedGoogle Scholar
  47. 47.
    Schriock EA, Schriock ED. Treatment of hirsutism. Clin Obstet Gynecol. 1991;34:852–63.PubMedCrossRefGoogle Scholar
  48. 48.
    Redmond GP, Bergfeld WF. Diagnostic approach to androgen disorders in women: acne, hirsutism, and alopecia. Cleve Clin J Med. 1990;57:423–7.PubMedGoogle Scholar
  49. 49.
    Derksen J, Nagesser SK, Meinders AE, Haak HR, van de Velde CJ. Identification of virilizing adrenal tumors in hirsute women. N Engl J Med. 1994;331:968–73.PubMedCrossRefGoogle Scholar
  50. 50.
    Ehrmann DA, Rosenfield RL. Clinical review 10: An endocrinologic approach to the patient with hirsutism. J Clin Endocrinol Metab. 1990;71:1–4.PubMedCrossRefGoogle Scholar
  51. 51.
    Bailey-Pridham DD, Sanfilippo JS. Hirsutism in the adolescent female. Pediatr Clin North Am. 1989;36:581–99.PubMedGoogle Scholar
  52. 52.
    Sperling LC, Heimer WL 2d. Androgen biology as a basis for the diagnosis and treatment of androgenic disorders in women. II. J Am Acad Dermatol. 1993;28:901–16.PubMedGoogle Scholar
  53. 53.
    Kvedar JC, Gibson M, Krusinski PA. Hirsutism: evaluation and treatment. J Am Acad Dermatol. 1985;12:215–25.PubMedCrossRefGoogle Scholar
  54. 54.
    Jeffcoate W. The treatment of women with hirsutism. Clin Endocrinol (Oxf). 1993;39:143–50.Google Scholar
  55. 55.
    Redmond GP, Bergfeld WF. Treatment of androgenic disorders in women: acne, hirsutism, and alopecia. Cleve Clin J Med. 1990;57:428–32.PubMedGoogle Scholar
  56. 56.
    Lemay A, Dewailly SD, Grenier R, Huard J. Attenuation of mild hyperandrogenic activity in postpubertal acne by a triphasic oral contraceptive containing low doses of ethynyl estradiol and d,l-norgestrel. J Clin Endocrinol Metab. 1990;71:8–14.PubMedGoogle Scholar
  57. 57.
    Pang S. Relevance of biological properties of progestogen of oral contraceptives in treatment of androgen excess symptoms I comment]. J Clin Endocrinol Metab. 1990;71:5–7.PubMedGoogle Scholar
  58. 58.
    Negri P, Agnello G, Borghesani F, et al. SHBG, testosterone, androstenedione, 17-OH-progesterone plasma levels in PCO affected women treated with a triphasic oral contraceptive. Acta Eur Fertil. 1987;18:375–80.PubMedGoogle Scholar
  59. 59.
    Falsetti L, Pasinetti E. Treatment of moderate and severe hirsutism by gonadotropin-releasing hormone agonists in women with polycystic ovary syndrome and idiopathic hirsutism. Fertil Steril. 1994;61:817–22.PubMedGoogle Scholar
  60. 60.
    Morcos RN, Abdul-Malak ME, Shikora E. Treatment of hirsutism with a gonadotropin-releasing hormone agonist and estrogen replacement therapy. Fertil Steril. 1994;61:427–31.PubMedGoogle Scholar
  61. 61.
    Rittmaster RS. Use of gonadotropin-releasing hormone agonists in the treatment of hyperandrogenism. Clin Obstet Gynecol. 1993;36:679–89.PubMedCrossRefGoogle Scholar
  62. 62.
    Faloia E, Filipponi S, Mancini V, Morosini P, Morosini De PR. Treatment with a gonadotropin-releasing hormone agonist in acne or idiopathic hirsutism. J Endocrinol Invest. 1993;16:675–7.PubMedGoogle Scholar
  63. 63.
    Andreyko JL, Monroe SE, Jaffe RB. Treatment of hirsutism with a gonadotropin-releasing hormone agonist (nafarelin). J Clin Endocrinol Metab. 1986;63:854–9.PubMedCrossRefGoogle Scholar
  64. 64.
    Hatasaka HH, Wentz AC. Hirsutism—facts and folklore. Part I: Classification and evaluation. Female Patient. 1991;16:29–36.Google Scholar
  65. 65.
    Vidal-Puig AJ, Munoz-Torres M, Jodar-Gimeno E, et al. Ketoconazole therapy: hormonal and clinical effects in non-tumoral hyperandrogenism. Eur J Endocrinol. 1994;130:333–8.PubMedGoogle Scholar
  66. 66.
    Akalin S. Effects of ketoconazole in hirsute women. Acta Endocrinol (Copenh). 1991;124:19–22.Google Scholar
  67. 67.
    Conget JI, Halperin I, Ferrer J, Gonzalez-Clemente JM, Martinez-Osaba MJ, Vilardell E. Evaluation of clinical and hormonal effects in hirsute women treated with ketoconazole. J Endocrinol Invest. 1990;13:867–70.PubMedGoogle Scholar
  68. 68.
    Martikainen H, Heikkinen J, Ruokonen A, Kauppila A. Hormonal and clinical effects of ketoconazole in hirsute women. J Clin Endocrinol Metab. 1988;66:987–91.PubMedCrossRefGoogle Scholar
  69. 69.
    Kiddy DS, Hamilton-Fairley D, Bush A, et al. Improvement in endocrine and ovarian function during dietary treatment of obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf). 1992;36:105–11.Google Scholar
  70. 70.
    McKenna TJ. The use of anti-androgens in the treatment of hirsutism (editorial]. Clin Endocrinol (Oxf). 1991;35:1–3.Google Scholar
  71. 71.
    Serafini PC, Catalino J, Lobo RA. The effect of spironolactone on genital skin 5 alpha-reductase activity. J Steroid Biochem. 1985;23:191–4.PubMedCrossRefGoogle Scholar
  72. 72.
    Shaw JC. Spironolactone in dermatologic therapy. J Am Acad Dermatol. 1991;24:236–43.PubMedGoogle Scholar
  73. 73.
    Heifer EL, Miller JL, Rose LI. Side-effects of spironolactone therapy in the hirsute woman. J Clin Endocrinol Metab. 1988;66:208–11.CrossRefGoogle Scholar
  74. 74.
    Ponjee GA, Ponjee de RHA, Vader HL. Androstanediolglucuronide: a parameter for peripheral androgen activity before and during therapy with cyproterone acetate. Acta Endocrinol (Copenh). 1991;124:411–6.Google Scholar
  75. 75.
    Vermeulen A, Rubens R. Effects of cyproterone acetate plus ethinylestradiol low dose on plasma androgens and lipids in mildly hirsute or acneic young women. Contraception. 1988;38:419–28.PubMedCrossRefGoogle Scholar
  76. 76.
    Prelevic GM, Puzigaca Z, Balint-Peric LA. Effects of an oral contraceptive containing cyproterone acetate (Diane-35) on the symptoms, hormone profile, and ovarian volume of hirsute women with poly-cystic ovarian syndrome. Ann N Y Acad Sci. 1993;687:255–62.PubMedCrossRefGoogle Scholar
  77. 77.
    Vincens M, Mercier-Bodard C, Mowszowicz I, Kuttenn F, Mauvais-Jarvis P. Testosterone-estradiol binding globulin (TeBG) in hirsute patients treated with cyproterone acetate (CPA) and percutaneous estradiol. J Steroid Biochem. 1989;33:531–4.PubMedCrossRefGoogle Scholar
  78. 78.
    Hammerstein J, Meckies J, Leo-Rossberg I, Moltz L, Zielske F. Use of cyproterone acetate (CPA) in the treatment of acne, hirsutism and virilism. J Steroid Biochem. 1975;6:827–36.PubMedCrossRefGoogle Scholar
  79. 79.
    Lissak A, Sorokin Y, Calderon I, Dirnfeld M, Lioz H, Abramovici H. Treatment of hirsutism with cimetidine: a prospective randomized controlled trial. Fertil Steril. 1989;51:247–50.PubMedGoogle Scholar
  80. 80.
    Golditch IM, Price VH. Treatment of hirsutism with cimetidine. Obstet Gynecol. 1990;75:911–3.PubMedGoogle Scholar
  81. 81.
    Vigersky RA, Mehlman I, Glass AR, Smith CE. Treatment of hirsute women with cimetidine. N Engl J Mod. 1980;303:1042.CrossRefGoogle Scholar
  82. 82.
    Ehrmann DA, Rosenfield RL, Barnes RB, Brigell DF, Sheikh Z. Detection of functional ovarian hyperandrogenism in women with androgen excess [Comment in: N Engl J Med. 1992:327:194–6.] N Engl J Med. 1992:327:157–62.PubMedCrossRefGoogle Scholar
  83. 83.
    Cusan L, Dupont A, Belanger A, Tremblay RR, Manhes G, Labrie F. Treatment of hirsutism with the pure antiandrogen flutamide. J Am Acad Dermatol. 1990;23:462–9.PubMedCrossRefGoogle Scholar
  84. 84.
    Couzinet B, Pholsena M, Young J, Schaison G. The impact of a pure anti-androgen (flutamide) on LH. FSH, androgens and clinical status in idiopathic hirsutism. Clin Endocrinol (Oxf). 1993;39:157–62.Google Scholar
  85. 85.
    Tremblay RR. Compromise in the treatment of hirsutism with flutamide. In Vivo. 1993;7:549–51.PubMedGoogle Scholar
  86. 86.
    Fruzzetti F, Fruzzetti De LD, Ricci C, Fioretti P. Clinical and endocrine effects of flutamide in hyperandrogenic women. Fertil Steril. 1993;60:806–13.PubMedGoogle Scholar
  87. 87.
    Erenus M, Gurbuz O, Durmusoglu F, Demircay Z, Pekin S. Comparison of the efficacy of spironolactone versus flutamide in the treatment of hirsutism. Fertil Steril. 1994;61:613–6.PubMedGoogle Scholar
  88. 88.
    Cusan L, Dupont A, Gomez JL, Tremblay RR, Labrie F. Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial. Fertil Steril. 1994;61:281–7.PubMedGoogle Scholar
  89. 89.
    Wysowski DK, Freiman JP, Tourtelot JB, Horton ML 3d. Fatal and nonfatal hepatotoxicity associated with flutamide. Ann Intern Med. 1993;118:860–4.PubMedGoogle Scholar
  90. 90.
    Lynfield YL, Macwilliams P. Shaving and hair growth. J Invest Dermatol. 1970;55:170–2.PubMedCrossRefGoogle Scholar
  91. 91.
    Richards RN, Uy M, Meharg G. Temporary hair removal in patients with hirsutism: a clinical study. Cutis. 1990;45:199–202.PubMedGoogle Scholar

Copyright information

© Society of General Internal Medicine 1995

Authors and Affiliations

  • Ralph E. Watson
    • 1
  • Reynard Bouknight
  • Patrick C. Alguire
  1. 1.B 338 Clinical CenterMichigan State UniversityEast Lansing

Personalised recommendations