Hirsutism: evaluation and treatment

Hirsutism, a troublesome cosmetic problem, may also be a sign of serious systemic disease that can be screened for by means of the patient's history, physical examination, and certain basic blood tests. Most patients with functional hirsutism have elevated production rates of testosterone, elevated metabolic clearance rates of testosterone, depressed levels of sex hormone-binding globulin, and elevated levels of serum-free testosterone and hair follicle sensitivity. Once a neoplastic source is ruled out and hirsutism established as functional, essentially empiric treatment, including low-dose dexamethasone, oral contraceptives, and spironolactone, has proved to be effective.