Hirsutism

Abstract Hirsutism is defined as excess growth of body or facial terminal (coarse) hair in females, in a male-like pattern. The condition 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 (1). Depending on age and race/ethnicity, 80–90% of women with hirsutism will have an androgen excess disorder, most often polycystic ovary syndrome (PCOS), and including idiopathic hirsutism, and non-classic congenital adrenal hyperplasia (NCAH), among the others. This chapter outlines androgen metabolism in women, physiology and pathophysiology of hair growth, epidemiology of and differential diagnosis of hirsutism, other signs of androgen excess including acne, androgenetic alopecia, and virilization, and the clinical investigation, and treatment of the hirsute patient.