Polycystic Ovary Syndrome

Abstract Hirsutism is defined as excess growth of body or facial terminal (coarse) hair in females, in a male-like pattern. In addition to its possible association with conditions such as polycystic ovary syndrome (PCOS) and the associated risk of cardiometabolic diseases and infertility, hirsutism has a significant negative impact on a woman’s self-esteem and on her quality of life. Hirsutism affects 5–15% of the women, and is the most commonly used clinical diagnostic criterion of androgen excess or hyperandrogenism. Depending on age and race/ethnicity, 80–90% of women with hirsutism will have an androgen excess disorder, most often PCOS, but also non-classic congenital adrenal hyperplasia (NCAH), and androgen-secreting neoplasms, among others. Current treatment of hirsutism may consist of: suppression of androgen production; blockade of peripheral androgen action; and mechanical and cosmetic means of hair removal. This chapter outlines androgen metabolism in women, physiology and pathophysiology of hair growth, epidemiology of hirsutism and differential diagnosis of its multiple aetiologies, and the clinical investigation, and treatment of the hirsute patient.