Paper III
Justin C Konje in Complete Revision Guide for MRCOG Part 3, 2020
Applied clinical knowledgeDemonstrates being up to date with current literature on hirsutism as evidenced from Discussion of diagnosis of PCOS and differentialsTreatment options – focus on hirsutism – mechanical (bleaching, shaving, depilatory, waxing, laser and drugs – hormones – combined hormonal contraception and anti-androgens)Discussion on weight control and lifestyle modificationImplications for fertility and periodsFamiliarity with current guidelines, e.g. ESHRE and International Consensus Guidelines on diagnosis and management of PCOS
The use of androgens in the postmenopause: evidence from clinical studies
Barry G. Wren in Progress in the Management of the Menopause, 2020
Empirical data from controlled studies on the incidence of hirsutism in postmenopausal women treated with combined estrogen—androgen preparations could not be located. However, our own extensive clinical experience suggests that approximately 20% of women who receive 150 mg testosterone enanthate intramuscularly every 4 weeks along with estrogen, will develop mild hirsutism manifested by an increased growth of hair on the chin and/ or upper lip. When the dose is reduced to 75 mg testosterone enanthate per month, less that 5% of women have any increased hair growth. Moreover, hair growth decreases or usually stops entirely when the patient is switched to treatment with estrogen alone. There is little doubt that, in women, hirsutism is a dosedependent side-effect of exogenous testosterone. Its development would depend also on the amount of estrogen given in combination, since both sex steroids influence the production of sex hormone binding globulin (SHBG) which, in turn, determines the concentration of free, or biologically available testosterone.
Polycystic ovary syndrome and hyperandrogenism in adolescents
Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo in Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Hirsutism and acne may be clinical indicators of androgen excess in an adolescent, and the severity and progression of both of these features should be carefully followed. Hirsutism, defined as excessive, coarse, terminal hairs distributed in a male-like fashion, must be distinguished from hypertrichosis or excessive vellus hair distributed in a nonsexual pattern. PCOS is the most common cause of hirsutism among adolescent females.45 However, not all patients with PCOS will present with this clinical finding. The severity of hirsutism does not correlate well with circulating androgens,46 and ethnic/genetic differences can impact the development and severity of this feature.47,48 The risk of underlying androgen excess is increased when hirsutism is associated with other PCOS findings, such as menstrual irregularities.49
An evaluation of the available pharmacotherapy for the treatment of hirsutism
Published in Expert Opinion on Pharmacotherapy, 2023
Leila Asfour, Ahmed Kazmi, Rodney Sinclair
Hirsutism is defined as excessive growth of terminal hair in androgen-sensitive sites in a woman. It is crucial to take into consideration a patient’s ethnic background and potential cultural influences on their self-perception of hirsutism. There is a discordance between clinician assessment and patient perception of degree of hirsutism. Ensure you have reviewed for any underlying causes of hyperandrogenism. The commonest cause for hirsutism is PCOS and idiopathic hirsutism. It can be associated with severe psychosocial morbidity impacting on patients’ quality of life and relationships. A multimodal approach for optimal treatment is required combining medical with physical therapies. Pharmacotherapy in hirsutism will continue to evolve as we gain increasing experience in the use of anti-androgens. However, currently there is low-level evidence informing our use of the available treatments, predominantly due to poor study design.
Comparison of patient satisfaction with diode laser treatment of female hirsutism: low fluence or high fluence?
Published in Journal of Cosmetic and Laser Therapy, 2021
Mohammad Ebrahimzadeh Ardakani, Mehran Azad, Narges Ghanei, Farshid Etaee, Tarek Naguib, Steven Daveluy
Hirsutism, defined as excessive hair growth in androgen-sensitive areas, affects 5%‐10% of reproductive‐aged women worldwide. Hirsutism has undesirable psychological effects and impairs the quality of life, especially among young women (1). Hirsutism and be familial/idiopathic or related to several underlying conditions: polycystic ovarian syndrome, congenital adrenal hyperplasia, thyroid gland dysfunction, Cushing syndrome, hyperprolactinemia, and consumption of medications such as cyclosporine, danazol, and diazoxide (2,3). There are several treatments for hirsutism including epilation, antiandrogens, electrolysis, and laser hair removal (4). Laser hair removal is an FDA-approved method for permanent hair reduction available since 1997 (5). In hair removal laser therapy, exposure to laser light pulses destroys hair follicles via selective photothermolysis (6). Laser therapy acts on actively growing hair follicles and typically needs three to six or more sessions to effectively eliminate excessive hair (7). There are various techniques for laser therapy. The low-fluence technique uses lower energy levels, resulting in less pain (8). Quickness and efficiency make laser therapy a popular method for hair removal therapy (9). Side effects following laser therapy include redness, skin burn, and follicular edema. Also, pain should be expected during therapy (10). The side effects of laser therapy, especially pain, impact patient satisfaction (11).
Clémentine Delait (1865–1934), the most famous bearded lady on the continent in the 20th century
Published in Gynecological Endocrinology, 2020
Wouter W. de Herder
The most common cause of hirsutism is the polycystic ovary syndrome (PCOS). Hirsutism can also present in combination with Cushing's syndrome and congenital adrenal hyperplasia (CAH). Rarely it is caused by (malignant) androgen-secreting tumors in the ovaries, or in the adrenal cortex. Furthermore, several medications can cause hirsutism [1]. Emile C. Achard (1860–1944) and Joseph Thiers (1885–1960) are recognized for their first description of “diabète des femmes à barbe” (diabetes of the bearded women) in 1921: the combination of diabetes mellitus, deep masculine voice, hirsutism, clitoral hypertrophy and adrenal cortical hyperplasias, or adenomas mostly in postmenopausal women [2]. It has been generally agreed upon that their publication contains reports on patients with PCOS and Cushing’s syndrome (ectopic adrenocorticotropin (ACTH) secretion?) [2]. Also geographical/ethnical differences exist: hirsutism is more frequent in women of Mediterranean, Middle Eastern and South Asian ancestry.
Related Knowledge Centers
- Combined Oral Contraceptive Pill
- Ovary
- Puberty
- Endocrine System
- Androgen
- Hypertrichosis
- Hypothalamus
- Adrenal Gland
- Body Hair
- Ferriman–Gallwey Score