Hirsutism

• Definition: excessive growth of terminal hair (the thick, pigmented hair) in an androgen-dependent distribution in women (upper lip, chin, chest, back, lower abdomen, thigh, forearm) 

• Hypertrichosis: generalized excessive growth of vellus hair (the thin, non-pigmented hair). 

Clinical assessment 

The severity of hirsutism is subjective. Some women suffer profound embarrassment from a degree of hair growth that others would not consider remarkable. Important observations are a 

Examination:

• Looking: anxious 
• BMI
• Drug and menstrual history,
• BP 
• Signs of virilisation: ABCD: clitoromegaly, deep voice, male-pattern balding, breast atrophy
• Acne vulgaris 
• F/O Cushing’s syndrome.
• Hirsutism of recent onset →suggestive of an androgen-secreting tumor

Investigations