Cosmetic measures

• Cosmetic treatment is not usually available on the NHS.
• Cosmetic procedures that can be applied in a domestic setting are not generally recommended, especially in more severe hirsutism, as their effect is only temporary [Archer and Chang, 2004; Moghetti and Toscano, 2006].
• Shaving does not increase the rate of hair growth or thicken hair, contrary to popular belief. It is a useful technique and yields instant results. However, it does leave stubble that is unpleasant, unsightly, and sharp, and it may irritate the skin.
• Waxing and plucking are effective, but can be painful and may cause scarring, folliculitis, and hyperpigmentation. These techniques can also lead to resistance to electrolysis.
• Bleaching can improve appearance in the short term, but may also lead to skin irritation.
• Skin irritation is problematic, as it is itchy and unsightly and, paradoxically, can lead to increased hair growth.
• Cosmetic procedures carried out in specialist clinics tend to have a longer effect, although they are not usually permanent [Archer and Chang, 2004]:
• Electrolysis uses a localized electric charge to destroy hair cells at the bulb. It is effective, but is time-consuming and painful, and it may leave scars or cause pigmentation changes.
• Lasers are used selectively in the process of photothermolysis, a more recent technique that generally yields better results than electrolysis [Balen, 2000]. It affects hair only in the growing phase and thus must be repeated over several months. A woman with dark hair and light skin is the ideal candidate [Balen et al, 2005].

Secondary care treatments

• Systemic treatments that may be used in secondary care include:
• Anti-androgens (such as high-dose cyproterone acetate, spironolactone, and flutamide).
• 5-alpha-reductase inhibitors (such as finasteride).
• Insulin-sensitizing drugs (such as metformin and the glitazones [pioglitazone and rosiglitazone]).
• Gonadotrophin-releasing hormone analogues (such as goserelin and leuprorelin).