SOGC clinical practice guidelines. Hirsutism: evaluation and treatment.

OBJECTIVES: To review the etiology, evaluation, and treatment of hirsutism. EVALUATION: A thorough history and physical examination plus selected laboratory evaluations will confirm the diagnosis and direct treatment. TREATMENT: Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve or hasten the therapeutic response. OUTCOMES: At least six to nine months of therapy are required to produce improvement in hirsutism. EVIDENCE: The quality of evidence reported in this guideline has been determined using the criteria described by the Canadian Task Force on the Periodic Health Examination. RECOMMENDATIONS: Hirsutism can be slowly but dramatically improved with a three-pronged approach to treatment: mechanical hair removal, suppression of androgen production, and androgen receptor blockade. Lifestyle changes including weight loss and exercise will lower serum androgen levels and improve self-esteem. The patient should be educated regarding associated health problems or long-term medical consequences of hyperandrogenism, including obesity, irregular menses, anovulation, infertility, pregnancy-induced hypertension, diabetes, hyperlipidemia, hypertension, and heart disease.