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Hirsutism - Management
Basis for recommendation
Androgen secreting tumour
- Hair growth of recent onset and rapid progression, signs of virilization, particularly severe hirsutism, and a pelvic or abdominal mass are indications of a more serious underlying cause, such as an androgen-secreting (ovarian or adrenal) tumour.
- A high total testosterone concentration may indicate an androgen-secreting tumour [Sathyapalan and Atkin, 2009].
- If the total testosterone is normal (< 4.1 nanomol/L) or only slightly increased (< 5 nanomol/L), an androgen secreting tumour can be excluded.
When treatment in primary care has been ineffective
- Hirsutism that has failed to respond to treatment in primary care may respond to systemic treatments such as anti-androgens, insulin-sensitizing drugs, and gonadotrophin-releasing hormone agonists [Lavery et al, 2005; Martin et al, 2008; Koulouri and Conway, 2009].
- Because these drugs are not licensed for the treatment of hirsutism and have potentially serious adverse effects, CKS recommends that they should only be used under specialist supervision.
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