Hirsutism: investigation and management.

In all hirsute women, a careful diagnostic evaluation should be performed, and the findings will largely influence the therapeutic decisions and the follow-up of the patients. An assay of serum 17-OH progesterone is needed, while the measurement of total testosterone and sex hormone-binding globulin, with the calculation of free androgen index, are useful to assess androgen secretion. Other tests should be suggested only according to responses of specific clinical questions. Owing to their high cardiovascular and metabolic risk, patients with polycystic ovary syndrome should have an oral glucose-tolerance test and a complete lipid profile. No ideal treatment for hirsutism exists but, with careful combination of pharmacological treatments and direct hair removal, it is generally possible to obtain a prolonged improvement of hirsutism.