CHAPTER 55 - Hirsutism and virilization

Abstract

Hirsutism is the excessive growth of terminal hair in androgen-dependent areas. Hirsutism affects 5%–10% of females and is frequently associated with irregular menses and acne. The common causes of hirsutism are polycystic ovary syndrome, nonclassical congenital adrenal hyperplasia, idiopathic or familial hirsutism, and medications. Virilization consists of hirsutism, acne, and irregular menses along with signs of masculinization: Deepening of the voice, increased muscle mass, temporal balding, clitoromegaly, and increased libido. The common causes of virilization are ovarian tumors, adrenal tumors, and congenital adrenal hyperplasia. Hirsutism and virilization usually result from excess androgens. Recent guidelines recommend initial screening with total testosterone followed by a free testosterone level, if the total testosterone is normal. Dehydroepiandrosterone sulfate and 17-hydroxyprogesterone are measured only in those patients with high total or free testosterone to determine the etiology of the hyperandrogenism. For patients not desiring pregnancy, the most common treatment is oral contraceptive pills (OCP). Antiandrogens can also be prescribed in addition to OCP or alone, if another form of reliable contraception is utilized. Topical eflornithine can also be prescribed. Multiple different cosmetic measures are effective and are often used in conjunction with the OCP and antiandrogens such as shaving, plucking, waxing, chemical depilating, electrolysis or photoepilation with lasers or intense pulsed light therapy.