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Given these limitations, some experts recommend use of the term “patient-important hirsutism” to indicate symptoms significant enough to cause the patient distress, regardless of the degree of physical findings.1 Print Figure 1. A score of 1 to 4 is given for nine areas of the body. A total score less than 8 is considered normal, a score of 8 to 15 indicates mild hirsutism, and a score greater than 15 indicates moderate or severe hirsutism. Androgens, including testosterone, dihydrotestosterone, and their prohormones dehydroepiandrosterone sulfate and androstenedione, are the key factors in the growth and development of sexual hair.
A total score less than 8 is considered normal, a score of 8 to 15 indicates mild hirsutism, and a score greater than 15 indicates moderate or severe hirsutism. Androgens act on sex-specific areas of the body, converting small, straight, fair vellus hairs to larger, curlier, and darker terminal hairs.8 Men have higher androgen levels during and after puberty, and thus a greater degree of terminal hair development in sex-specific areas compared with women.
It is generally associated with hyperandrogenemia.1 Hirsutism occurs in approximately 7 percent of women and has an estimated economic burden in the United States of more than 0 million annually.23 Hirsutism should be distinguished from hypertrichosis, which is generalized excessive hair growth not caused by androgen excess.
Hypertrichosis may be congenital or caused by metabolic disorders such as thyroid dysfunction, anorexia nervosa, and porphyria.4A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series.
In Kerala, southern India, research among medical and engineering students and manual labourers showed that both groups of students had more body hair on average than manual workers.Shaving is effective but needs to be repeated often.Evidence for the effectiveness of electrolysis and laser therapy is limited.In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives.Topical agents, such as eflornithine, may also be used.
For patients with moderate or severe symptoms, an early morning total testosterone level should be obtained, and if moderately elevated, it should be followed by a plasma free testosterone level.