Sandbox:SMMM
S.Mojdeh Mirmomen
Treatment
Shown below is an algorithm summarizing the treatment of hirsutism according the Endocrine Society Clinical Practice guidelines.
| Initial therapy for patient with hirsutism | |||||||||||||||||||||||||||||||||||||||
| Mild hirsutism and no evidence of an endocrine disorder | Moderate or patient-important hirsutism | Severe hirsutism | |||||||||||||||||||||||||||||||||||||
| Direct hair removal methods | Pharmacological therapy | Pharmacological therapy (add direct hair removal if needed) | Combined pharmacological therapy | ||||||||||||||||||||||||||||||||||||
| • Photoepilation for women with auburn, brown, or black unwanted hair • Electrolysis for women with white or blonde hair | • Start oral contraceptives in women who are not seeking fertility ** Use oral contraceptives containing the lowest effective dose of ethinyl estradiol and a low-risk progestin for women at higher risk for venous thromboembolism (e.g., obese or >39 years old) • Start either oral contraceptives or anti-androgens in women who are not sexually active, have undergone permanent sterilization, or who are using long-acting reversible contraception | Oral contraceptives and antiandrogens | |||||||||||||||||||||||||||||||||||||
| Add an antiandrogen if hirsutism remains despite 6 months of monotherapy with an oral contraceptive | |||||||||||||||||||||||||||||||||||||||
Diagnosis
Shown below is an algorithm summarizing the diagnosis of disease name according the Endocrine Society Clinical Practice guideline.
| Initial evaluation & diagnosis of hirsutism | |||||||||||||||||||||||||||||||||||||||||||||||
| History & physical examination including pelvic examination | |||||||||||||||||||||||||||||||||||||||||||||||
| Medication use? *Ask for anabolic or androgenic steroids (in athletes, patients who are using dietary supplements, patients with sexual dysfunction, or in patients with a partner who uses testosterone gel) and valproic acid (in patient with neurologic disorders | Discontinue medication | ||||||||||||||||||||||||||||||||||||||||||||||
| Isolated local hair growth | Direct hair removal methods | Improvement or stable | Normal variant | ||||||||||||||||||||||||||||||||||||||||||||
| Abnormal hirsutism score or local hair growth with symptoms suggesting hyperandrogenic endocrine disorder*? *menstrual irregularity, infertility, galactorrhea, signs or symptoms of hypothyroidism, Cushing syndrome, acromegaly, central obesity,acanthosis nigricans, clitoromegaly, or sudden-onset or rapid-progression hirsutism suggests the presence of a hyperandrogenic endocrine disorder | |||||||||||||||||||||||||||||||||||||||||||||||
| Early morning total testosterone blood level | Progression or unstable | ||||||||||||||||||||||||||||||||||||||||||||||