Hirsutism is defined as the excessive growth of terminal hair on the face and body of a female in a typical male pattern distribution. Untreated, it can be associated with considerable loss of self-esteem and psychological morbidity. Hyperandrogenaemia is the key trigger for excess hair growth, but the expression and severity are modified by genetic factors. Polycystic ovary syndrome, resulting in excess ovarian androgen production, is the most common cause of hirsutism. A raised serum testosterone level of greater than 5nmol/l should prompt further investigations to exclude adrenal pathology or an underlying androgen-secreting tumour. The treatment of hirsutism is most effective using combination therapy, including androgen suppression, peripheral androgen blockade and mechanical/cosmetic amelioration and destruction of the unwanted hairs.
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