An Approach to the Patient with Hirsutism

Hirsutism is a common endocrinological complaint. The causes of this complaint can vary from dissatisfaction with a normal pattern of hair growth on the one hand, to the first clinical manifestation of androgen overproduction by an adre-naladenocarcinomaontheother. Thepurposeof this short review is to reexamine the physiology of hair growth in normal women, identify the common abnormal patterns, and explore the differential diagnosis associated with each. An ap-proach to working through the differential diagnosis will be described, and the commonly available treatment modalities for the various forms of hirsutism will be examined in terms of risk and benefit. The review is written from the point of view of the physician and the most efficient, cost effective, and safe clinical ap-proach to the patient with the problem. (J Clin Endocrinol Metab 97: 2957–2968, 2012) Human skin contains hair follicles everywhere excepton the lips, the palms of the hands, and the soles of the feet. All of these follicles produce and contain hairs, vellus or terminal, at sometime during life. The number o