Guideline No. 444: Hirsutism: Evaluation and Treatment

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📅 November 22, 2024 ✍️ By Kimberly Ford ⏱️ 21 Mins Read 🗂️ Blog 🕒 Last updated: November 22, 2024 📌 Tags:guideline,hirsutism

Abstract

Objective

This guideline reviews the etiology, diagnosis, evaluation, and treatment of hirsutism.

Target Population

Womenhirsutism

Options

Three approaches to management include: 1) mechanical hair removal; 2) suppression of androgen production; and 3) androgen receptor blockade.

Outcomes

The main limitations of the management options include the adverse effects, costs, and duration of treatment.

Benefits, Harms, and Costs

Implementation of the recommendations in this guideline may improve the management of hirsutism in women with this condition. Adverse effects and a potential long duration of treatment are the main drawbacks to initiating treatment, as is the possibility of significant financial costs for certain treatments.

Evidence

A comprehensive literature review was updated to April 2022, following the same methods as for the prior Society of Obstetricians and Gynaecologists of Canada (SOGC) Hirsutism guidelines. Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date limits, but results were limited to English- or French-language materials.

Validation Methods

The authors rated the quality of evidence and strength of recommendations using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a “good practice point.” See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).

Intended Audience

Primary care providersfamily medicine physicians

Tweetable Abstract

Management of hirsutism involves a 3-pronged approach of mechanical hair removal, suppression of androgen production, and androgen receptor blockade.

SUMMARY STATEMENTS

The modified Ferriman-Gallwey score can be used in the assessment of hirsutism to help quantify the problem and assess the response to treatment. Cut-off scores defining hirsutism will vary by racial background. Modified Ferriman-Gallwey scores from 3 to 15 represent mild hirsutism, 16–25 represent moderate hirsutism, and >25 indicate severe hirsutism (moderate).

Hyperandrogenism in women with polycystic ovary syndrome may result from several mechanisms, including insulin resistance, hyperinsulinemia, elevated luteinizing hormone–related increases in theca cell androgen production, and increased adrenal androgen output. (high).

Non-classical congenital adrenal hyperplasia often presents with hirsutism and has a similar clinical picture as polycystic ovary syndrome. However, the prevalence of non-classical congenital adrenal hyperplasia is very low outside of specific high-risk ethnic groups (high).

Hirsutism can be classified into 1 of 3 groups based on etiology: hyperandrogenic hirsutism (including polycystic ovarian syndrome, non-classical congenital adrenal hyperplasia, or androgen-secreting tumours), non-androgenic hirsutism (including medication-induced hirsutism), and idiopathic hirsutism (moderate).

Polycystic ovary syndrome is the most common cause of hirsutism, with idiopathic hirsutism being the second most common (high).

Most patients with hirsutism have normal androgen levels. That said, high androgen levels should be investigated immediately, as some impacts will be permanent, such as voice changes and clitoromegaly (high).

Hirsutism is not a diagnosis, but a symptom or sign, and an underlying etiology should be sought (high).

The most effective therapy for hirsutism is multimodal and combines physical hair removal techniques with medical therapies. At least six months of medical therapy is required to see a significant improvement in hirsutism. Unfortunately, many permanent physical hair removal procedures are considered cosmetic and the costs can be a barrier to treatment (moderate).

Hair growth tends to recur after stopping medical therapy, while laser hair removal, intense pulsed light, and electrolysis produce permanent hair reduction (moderate).

RECOMMENDATIONS

Patients presenting with hirsutism should be evaluated with a focused history taking, physical examination with anthropometric measurements, and appropriate investigations to differentiate between the possible etiologies (strong, moderate).

Patients with moderate to severe hirsutism should undergo blood testing to determine total testosterone and sex hormone–binding globulin levels; however, the benefit of testing in mild hirsutism is questionable. Additional testing is indicated for patients with irregular cycles and signs of hyperandrogenism or other endocrinopathies (conditional, low).

Patients with hyperandrogenic hirsutism should have serum levels of dehydroepiandrosterone sulfate and 17-hydroxyprogesterone measured (strong, moderate).

Referral for evaluation by a medical or reproductive endocrinologist (or another practitioner with similar expertise) is indicated in the presence of 1) virilization; 2) serum testosterone or dehydroepiandrosterone sulfate levels more than twice the upper limit of normal; 3) signs or symptoms of Cushing syndrome; or 4) early follicular phase serum 17-hydroxyprogesterone levels >6 nmol/L (strong, high).

Therapy should be offered to all patients with hirsutism who desire treatment (good practice point).

Combined hormonal contraceptives should be offered as first-line therapy if there are no contraindications (strong, high).

Mechanical hair removal and/or topical treatments can be offered as first-line therapy or as an adjuvant to medical therapy (strong, high).

Antiandrogens can be considered as monotherapy or in addition to combined hormonal contraceptives to enhance efficacy (strong, high).

Patients on antiandrogens require an effective method of contraception and should be counselled regarding the risk of feminization of a male fetus if pregnancy were to occur (good practice point).

Keywords

hirsutism
polycystic ovary syndrome
disease management
symptom assessment
therapeutics

Abbreviations

17-OHP (17-hydroxyprogesterone)
ACTH (Adrenocorticotropic hormone)
CHC (Combined hormonal contraceptives)
DHEA-S (Dehydroepiandrosterone sulfate)
mFG (Modified Ferriman-Gallwey)
NC-CAH (Non-classical congenital adrenal hyperplasia)
PCOS (Polycystic ovary syndrome)
SHBG (Sex hormone–binding globulin)

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References

DeUgarte, C.M. ∙ Woods, K.S. ∙ Bartolucci, A.A. ...

Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism

J Clin Endocrinol Metab. 2006; 91:1345-1350 Available at

http://www.ncbi.nlm.nih.gov/pubmed/16449347

Crossref

Scopus (171)

PubMed

Google Scholar

Ferriman, D. ∙ Gallwey, J.D.

Clinical assessment of body hair growth in women

J Clin Endocrinol Metab. 1961; 21:1440-1447

Crossref

Scopus (2170)

PubMed

Google Scholar

Azziz, R. ∙ Sanchez, L.A. ∙ Knochenhauer, E.S. ...

Androgen excess in women: experience with over 1000 consecutive patients

J Clin Endocrinol Metab. 2004; 89:453-462

Crossref

Scopus (685)

PubMed

Google Scholar

Carmina, E. ∙ Rosato, F. ∙ Janni, A. ...

Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism

J Clin Endocrinol Metab. 2006; 91:2-6

Crossref

Scopus (353)

PubMed

Google Scholar

Yildiz, B.O.

Diagnosis of hyperandrogenism: clinical criteria

Best Pract Res Clin Endocrinol Metab. 2006; 20:167-176

Crossref

Scopus (87)

PubMed

Google Scholar

Simpson NB, JH. Hair Patterns: Hirsutes and androgenetic alopecia. Dawber R, editor. Oxford: Blackwell Science; 1997.

Google Scholar

Greenblatt R. Hirsutism - Ancestral curse or endocrinopathy? Mahesh VG, RB, editor. Boston: John Wright; 1983.

Google Scholar

Hohl, A. ∙ Ronsoni, M.F. ∙ Oliveira, M.

Hirsutism: diagnosis and treatment

Arq Bras Endocrinol Metabol. 2014; 58:97-107

Crossref

Scopus (38)

PubMed

Google Scholar

Hatch, R. ∙ Rosenfield, R.L. ∙ Kim, M.H. ...

Hirsutism: implications, etiology, and management

Am J Obstet Gynecol. 1981; 140:815-830

Crossref

Scopus (897)

PubMed

Google Scholar

10.

Escobar-Morreale, H.F. ∙ Carmina, E. ∙ Dewailly, D. ...

Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society

Hum Reprod Update. 2012; 18:146-170

Crossref

Scopus (362)

PubMed

Google Scholar

11.

Ríos, X. ∙ Vergara, J.I. ∙ Wandurraga, E.A. ...

Clinical assessment of body hair in Colombian women: determining the cutoff score that defines hirsutism

Biomedica. 2013; 33:370-374

PubMed

Google Scholar

12.

Yildiz, B.O. ∙ Bolour, S. ∙ Woods, K. ...

Visually scoring hirsutism

Hum Reprod Update. 2010; 16:51-64

Crossref

Scopus (267)

PubMed

Google Scholar

13.

Zhao, X. ∙ Ni, R. ∙ Li, L. ...

Defining hirsutism in Chinese women: a cross-sectional study

Fertil Steril. 2011; 96:792-796

Full Text

Full Text (PDF)

Scopus (110)

PubMed

Google Scholar

14.

Kim, J.J. ∙ Chae, S.J. ∙ Choi, Y.M. ...

Assessment of hirsutism among Korean women: results of a randomly selected sample of women seeking pre-employment physical check-up

Hum Reprod. 2011; 26:214-220

Crossref

Scopus (53)

PubMed

Google Scholar

15.

Loriaux, D.L.

An approach to the patient with hirsutism

J Clin Endocrinol Metab. 2012; 97:2957-2968

Crossref

Scopus (40)

PubMed

Google Scholar

16.

Aswini, R. ∙ Jayapalan, S.

Modified Ferriman-Gallwey Score in Hirsutism and its Association with Metabolic Syndrome

Int J Trichology. 2017; 9:7-13

Crossref

Scopus (39)

PubMed

Google Scholar

17.

Martin, K.A. ∙ Anderson, R.R. ∙ Chang, R.J. ...

Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline

J Clin Endocrinol Metab. 2018; 103:1233-1257 Available at: https://doi.org/10.1210/jc.2018-00241

Scopus (194)

PubMed

Google Scholar

18.

Lizneva, D. ∙ Gavrilova-Jordan, L. ∙ Walker, W. ...

Androgen excess: Investigations and management

Best Pract Res Clin Obstet Gynaecol. 2016; 37:98-118

Crossref

Scopus (87)

PubMed

Google Scholar

19.

Lobo, R.A.

Idiopathic hisutism: Fact or fiction

Sem Reprod Endocrinol. 1986; 179-183

Crossref

Scopus (11)

Google Scholar

20.

Workshop, E.A.

Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome

Fertil Steril. 2004; 81:19-25

Full Text

Full Text (PDF)

Scopus (5324)

Google Scholar

21.

Laredo, S.H. ∙ M ∙ Casper, R. ...

Polycystic Ovary Syndrome and Insulin Resistance: New Approaches to Management, including Exercise

J Soc Obstet Gynaecol Can. 2001; 23

Google Scholar

22.

Köşüş, N. ∙ Köşüş, A. ∙ Kamalak, Z. ...

Impact of adrenal versus ovarian androgen ratio on signs and symptoms of polycystic ovarian syndrome

Gynecol Endocrinol. 2012; 28:611-614

Crossref

Scopus (16)

PubMed

Google Scholar

23.

Landay, M. ∙ Huang, A. ∙ Azziz, R.

Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS

Fertil Steril. 2009; 92:643-647

Full Text

Full Text (PDF)

Scopus (53)

PubMed

Google Scholar

24.

Elmer, K.B. ∙ George, R.M.

HAIR-AN syndrome: a multisystem challenge

Am Fam Physician. 2001; 63:2385-2390

PubMed

Google Scholar

25.

Goodman, N.F. ∙ Cobin, R.H. ∙ Futterweit, W. ...

American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State Clinical Review: Guide to the Best Practices in the Evaluation and Treatment of Polycystic Ovary Syndrome--Part 1

Endocr Pract. 2015; 21:1291-1300

Full Text

Full Text (PDF)

Scopus (411)

PubMed

Google Scholar

26.

Karrer-Voegeli, S. ∙ Rey, F. ∙ Reymond, M.J. ...

Androgen dependence of hirsutism, acne, and alopecia in women: retrospective analysis of 228 patients investigated for hyperandrogenism

Medicine (Baltimore). 2009; 88:32-45

Crossref

Scopus (100)

PubMed

Google Scholar

27.

Kaltsas, G. ∙ Mukherjee, J. ∙ Kola, B. ...

Is ovarian and adrenal venous catheterization and sampling helpful in the investigation of hyperandrogenic women?

Clinical endocrinology. 2003; 59:34-43

Crossref

Scopus (99)

PubMed

Google Scholar

28.

Derksen, J. ∙ Nagesser, S.K. ∙ Meinders, A.E. ...

Identification of virilizing adrenal tumors in hirsute women

N Engl J Med. 1994; 331:968-973

Crossref

Scopus (162)

PubMed

Google Scholar

29.

Carmina, E. ∙ Dewailly, D. ∙ Escobar-Morreale, H.F. ...

Non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency revisited: an update with a special focus on adolescent and adult women

Hum Reprod Update. 2017; 23:580-599

Crossref

Scopus (127)

PubMed

Google Scholar

30.

New, M.S. ∙ PW

Genetics of adrenal steroid 21-hydroxylase deficiency

Endocr Rev. 1986; 7

Crossref

Scopus (45)

PubMed

Google Scholar

31.

Moran, C. ∙ Azziz, R. ∙ Carmina, E. ...

21-Hydroxylase-deficient nonclassic adrenal hyperplasia is a progressive disorder: a multicenter study

Am J Obstet Gynecol. 2000; 183:1468-1474

Full Text

Full Text (PDF)

Scopus (170)

PubMed

Google Scholar

32.

New, M.I. ∙ Ghizzoni, L. ∙ Meyer-Bahlburg, H. ...

Fertility in patients with nonclassical congenital adrenal hyperplasia

Fertil Steril. 2019; 111:13-20

Full Text

Full Text (PDF)

Scopus (17)

PubMed

Google Scholar

33.

Spritzer, P. ∙ Billaud, L. ∙ Thalabard, J.C. ...

Cyproterone acetate versus hydrocortisone treatment in late-onset adrenal hyperplasia

J Clin Endocrinol Metab. 1990; 70:642-646

Crossref

PubMed

Google Scholar

34.

Schriock, E.A. ∙ Schriock, E.D.

Treatment of hirsutism

Clin Obstet Gynecol. 1991; 34:852-863

Crossref

Scopus (27)

PubMed

Google Scholar

35.

Azziz, R. ∙ Carmina, E. ∙ Sawaya, M.E.

Idiopathic hirsutism

Endocr Rev. 2000; 21:347-362

Crossref

Scopus (312)

PubMed

Google Scholar

36.

Piraccini, B.M. ∙ Iorizzo, M. ∙ Rech, G. ...

Drug-induced hair disorders

Curr Drug Saf. 2006; 1:301-305

Crossref

Scopus (34)

PubMed

Google Scholar

37.

Azziz, R.

The evaluation and management of hirsutism

Obstet Gynecol. 2003; 101:995-1007

Crossref

Scopus (175)

PubMed

Google Scholar

38.

Serafini, P. ∙ Lobo, R.A.

Increased 5 alpha-reductase activity in idiopathic hirsutism

Fertil Steril. 1985; 43:74-78

Abstract

Full Text (PDF)

PubMed

Google Scholar

39.

Heidelbaugh, J.J.

Endocrinology Update: Hirsutism

FP Essent. 2016; 451:17-24

PubMed

Google Scholar

40.

Rahimi, H. ∙ Kashi, M. ∙ Tehranchinia, Z. ...

Which laboratory/ultrasonographic parameters affect the severity of hirsutism?

J Cosmet Dermatol. 2022;

Crossref

Scopus (2)

Google Scholar

41.

Cussen, L. ∙ McDonnell, T. ∙ Bennett, G. ...

Approach to androgen excess in women: Clinical and biochemical insights

Clin Endocrinol (Oxf). 2022; 97:174-186

Crossref

Scopus (31)

PubMed

Google Scholar

42.

Matheson, E. ∙ Bain, J.

Hirsutism in Women

Am Fam Physician. 2019; 100:168-175

PubMed

Google Scholar

43.

Brodell, L.A. ∙ Mercurio, M.G.

Hirsutism: Diagnosis and management

Gend Med. 2010; 7:79-87

Abstract

Full Text (PDF)

Scopus (36)

PubMed

Google Scholar

44.

Proulx, J. ∙ Sparling, J.D.

New-onset hirsutism

J Fam Pract. 2021; 70:147-149

PubMed

Google Scholar

45.

Korkidakis, A.K. ∙ Reid, R.L.

Testosterone in women: measurement and therapeutic use

Journal of Obstetrics and Gynaecology Canada. 2017; 39:124-130

Full Text

Full Text (PDF)

Scopus (16)

PubMed

Google Scholar

46.

Sachdeva, S.

Hirsutism: evaluation and treatment

Indian J Dermatol. 2010; 55:3-7

Crossref

Scopus (44)

PubMed

Google Scholar

47.

Escobar-Morreale, H.F.

Diagnosis and management of hirsutism

Ann N Y Acad Sci. 2010; 1205:166-174

Crossref

Scopus (42)

PubMed

Google Scholar

48.

Erem, C.

Update on idiopathic hirsutism: diagnosis and treatment

Acta Clin Belg. 2013; 68:268-274

Crossref

Scopus (10)

PubMed

Google Scholar

49.

Falhammar, H. ∙ Nordenstrom, A.

Nonclassic congenital adrenal hyperplasia due to 21-hydroxylase deficiency: clinical presentation, diagnosis, treatment, and outcome

Endocrine. 2015; 50:32-50

Crossref

Scopus (93)

PubMed

Google Scholar

50.

Speiser, P.W. ∙ Arlt, W. ∙ Auchus, R.J. ...

Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline

J Clin Endocrinol Metab. 2018; 103:4043-4088 Available at

https://www.ncbi.nlm.nih.gov/pubmed/30272171

Crossref

Scopus (707)

PubMed

Google Scholar

51.

Witchel, S.F. ∙ Oberfield, S. ∙ Rosenfield, R.L. ...

The Diagnosis of Polycystic Ovary Syndrome during Adolescence

Horm Res Paediatr. 2015;

Crossref

Scopus (232)

PubMed

Google Scholar

52.

Wild, R.A. ∙ Carmina, E. ∙ Diamanti-Kandarakis, E. ...

Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society

J Clin Endocrinol Metab. 2010; 95:2038-2049

Crossref

Scopus (799)

PubMed

Google Scholar

53.

Lumezi, B.G. ∙ Berisha, V.L.

Investigation of body mass index, insulin resistance and diabetes in patients with hirsutism

Postepy Dermatol Alergol. 2021; 38:1006-1010

Crossref

Scopus (3)

PubMed

Google Scholar

54.

Pasch, L. ∙ He, S.Y. ∙ Huddleston, H. ...

Clinician vs Self-ratings of Hirsutism in Patients With Polycystic Ovarian Syndrome: Associations With Quality of Life and Depression

JAMA Dermatol. 2016; 152:783-788

Crossref

Scopus (56)

PubMed

Google Scholar

55.

Drosdzol, A. ∙ Skrzypulec, V. ∙ Plinta, R.

Quality of life, mental health and self-esteem in hirsute adolescent females

J Psychosom Obstet Gynaecol. 2010; 31:168-175

Crossref

Scopus (34)

PubMed

Google Scholar

56.

Ekbäck, M.P. ∙ Lindberg, M. ∙ Benzein, E. ...

Health-related quality of life, depression and anxiety correlate with the degree of hirsutism

Dermatology. 2013; 227:278-284

Crossref

Scopus (50)

PubMed

Google Scholar

57.

Claman, P.

Hirsutism in women: Evaluation and treatment

Hosp Med. 1995; 17-29

Google Scholar

58.

Richards, R.N. ∙ Meharg, G.E.

Electrolysis: observations from 13 years and 140,000 hours of experience

J Am Acad Dermatol. 1995; 33:662-666

Abstract

Full Text (PDF)

Scopus (109)

PubMed

Google Scholar

59.

Sommer, S. ∙ Render, C. ∙ Burd, R. ...

Ruby laser treatment for hirsutism: clinical response and patient tolerance

Br J Dermatol. 1998; 138:1009-1014

Crossref

Scopus (37)

PubMed

Google Scholar

60.

Wheeland, R.G.

Laser-assisted hair removal

Dermatol Clin. 1997; 15:469-477

Full Text

Full Text (PDF)

Scopus (77)

PubMed

Google Scholar

61.

Somani, N. ∙ Turvy, D.

Hirsutism: an evidence-based treatment update

Am J Clin Dermatol. 2014; 15:247-266

Crossref

Scopus (57)

PubMed

Google Scholar

62.

Alexis, A.F.

Lasers and light-based therapies in ethnic skin: treatment options and recommendations for Fitzpatrick skin types V and VI

Br J Dermatol. 2013; 169:91-97

Crossref

Scopus (96)

PubMed

Google Scholar

63.

Ismail, S.A.

Long-pulsed Nd:YAG laser vs. intense pulsed light for hair removal in dark skin: a randomized controlled trial

Br J Dermatol. 2012; 166:317-321

Crossref

Scopus (45)

PubMed

Google Scholar

64.

Puri, N.

Comparative Study of Diode Laser Versus Neodymium-Yttrium Aluminum: Garnet Laser Versus Intense Pulsed Light for the Treatment of Hirsutism

J Cutan Aesthet Surg. 2015; 8:97-101

Crossref

PubMed

Google Scholar

65.

Balfour, J.A. ∙ McClellan, K.

Topical eflornithine

Am J Clin Dermatol. 2001; 2:197-201 discussion 2

Crossref

Scopus (123)

PubMed

Google Scholar

66.

Jackson, J. ∙ Caro, J.J. ∙ Caro, G. ...

The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism

Int J Dermatol. 2007; 46:976-981

Crossref

Scopus (43)

PubMed

Google Scholar

67.

Hamzavi, I. ∙ Tan, E. ∙ Shapiro, J. ...

A randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women

J Am Acad Dermatol. 2007; 57:54-59

Full Text

Full Text (PDF)

Scopus (106)

PubMed

Google Scholar

68.

van der Vange, N. ∙ Blankenstein, M.A. ∙ Kloosterboer, H.J. ...

Effects of seven low-dose combined oral contraceptives on sex hormone binding globulin, corticosteroid binding globulin, total and free testosterone

Contraception. 1990; 41:345-352

Abstract

Full Text (PDF)

Scopus (164)

PubMed

Google Scholar

69.

Sahin, Y. ∙ Dilber, S. ∙ Keleştimur, F.

Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism

Fertil Steril. 2001; 75:496-500

Full Text

Full Text (PDF)

Scopus (62)

PubMed

Google Scholar

70.

Dinger, J. ∙ Bardenheuer, K. ∙ Heinemann, K.

Cardiovascular and general safety of a 24-day regimen of drospirenone-containing combined oral contraceptives: final results from the International Active Surveillance Study of Women Taking Oral Contraceptives

Contraception. 2014; 89:253-263

Full Text

Full Text (PDF)

Scopus (100)

PubMed

Google Scholar

71.

Dinger, J.C. ∙ Heinemann, L.A. ∙ Kühl-Habich, D.

The safety of a drospirenone-containing oral contraceptive: final results from the European Active Surveillance Study on oral contraceptives based on 142,475 women-years of observation

Contraception. 2007; 75:344-354

Full Text

Full Text (PDF)

Scopus (392)

PubMed

Google Scholar

72.

Bitzer, J. ∙ Amy, J.J. ∙ Beerthuizen, R. ...

Statement on combined hormonal contraceptives containing third- or fourth-generation progestogens or cyproterone acetate, and the associated risk of thromboembolism

Eur J Contracept Reprod Health Care. 2013; 18:143-147

Crossref

Scopus (16)

PubMed

Google Scholar

73.

Hugon-Rodin, J. ∙ Gompel, A. ∙ Plu-Bureau, G.

Epidemiology of hormonal contraceptives-related venous thromboembolism

Eur J Endocrinol. 2014; 171:R221-R230

Crossref

Scopus (68)

PubMed

Google Scholar

74.

Bird, S.T. ∙ Hartzema, A.G. ∙ Brophy, J.M. ...

Risk of venous thromboembolism in women with polycystic ovary syndrome: a population-based matched cohort analysis

Cmaj. 2013; 185:E115-E120

Crossref

Scopus (90)

PubMed

Google Scholar

75.

Okoroh, E.M. ∙ Boulet, S.L. ∙ George, M.G. ...

Assessing the intersection of cardiovascular disease, venous thromboembolism, and polycystic ovary syndrome

Thromb Res. 2015; 136:1165-1168

Full Text

Full Text (PDF)

Scopus (23)

PubMed

Google Scholar

76.

Okoroh, E.M. ∙ Hooper, W.C. ∙ Atrash, H.K. ...

Is polycystic ovary syndrome another risk factor for venous thromboembolism? United States, 2003-2008

Am J Obstet Gynecol. 2012; 207:377.e1-377.e8

Full Text

Full Text (PDF)

Scopus (61)

PubMed

Google Scholar

77.

Rittmaster, R.S.

Clinical review 73: Medical treatment of androgen-dependent hirsutism

J Clin Endocrinol Metab. 1995; 80:2559-2563

Crossref

Scopus (80)

PubMed

Google Scholar

78.

Swiglo, B.A. ∙ Cosma, M. ∙ Flynn, D.N. ...

Clinical review: Antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials

J Clin Endocrinol Metab. 2008; 93:1153-1160

Crossref

Scopus (136)

PubMed

Google Scholar

79.

Kelekci, K.H. ∙ Kelekci, S. ∙ Yengel, I. ...

Cyproterone acetate or drospirenone containing combined oral contraceptives plus spironolactone or cyproterone acetate for hirsutism: randomized comparison of three regimens

J Dermatolog Treat. 2012; 23:177-183

Crossref

Scopus (24)

PubMed

Google Scholar

80.

Martin, K.A. ∙ Chang, R.J. ∙ Ehrmann, D.A. ...

Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline

J Clin Endocrinol Metab. 2008; 93:1105-1120

Crossref

Scopus (304)

PubMed

Google Scholar

81.

Brown, J. ∙ Farquhar, C. ∙ Lee, O. ...

Spironolactone versus placebo or in combination with steroids for hirsutism and/or acne

Cochrane Database Syst Rev. 2009; Cd000194

PubMed

Google Scholar

82.

Moghetti, P. ∙ Tosi, F. ∙ Tosti, A. ...

Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial

J Clin Endocrinol Metab. 2000; 85:89-94

Crossref

Scopus (233)

PubMed

Google Scholar

83.

van Zuuren, E.J. ∙ Fedorowicz, Z.

Interventions for Hirsutism. Jama. 2015; 314:1863-1864

Google Scholar

84.

Wong, I.L. ∙ Morris, R.S. ∙ Chang, L. ...

A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women

J Clin Endocrinol Metab. 1995; 80:233-238

Crossref

Scopus (155)

PubMed

Google Scholar

85.

Erenus, M. ∙ Yücelten, D. ∙ Gürbüz, O. ...

Comparison of spironolactone-oral contraceptive versus cyproterone acetate-estrogen regimens in the treatment of hirsutism

Fertil Steril. 1996; 66:216-219

Abstract

Full Text (PDF)

Scopus (58)

PubMed

Google Scholar

86.

Tremblay, R.R.

Treatment of hirsutism with spironolactone

Clin Endocrinol Metab. 1986; 15:363-371

Abstract

Full Text (PDF)

Scopus (59)

PubMed

Google Scholar

87.

Barth, J.H. ∙ Cherry, C.A. ∙ Wojnarowska, F. ...

Cyproterone acetate for severe hirsutism: results of a double-blind dose-ranging study

Clin Endocrinol (Oxf). 1991; 35:5-10

Crossref

Scopus (107)

PubMed

Google Scholar

88.

Belisle, S. ∙ Love, E.J.

Clinical efficacy and safety of cyproterone acetate in severe hirsutism: results of a multicentered Canadian study

Fertil Steril. 1986; 46:1015-1020

Abstract

Full Text (PDF)

PubMed

Google Scholar

89.

Heinemann, L.A. ∙ Will-Shahab, L. ∙ van Kesteren, P. ...

Safety of cyproterone acetate: report of active surveillance

Pharmacoepidemiol Drug Saf. 1997; 6:169-178

Crossref

Scopus (32)

PubMed

Google Scholar

90.

Fruzzetti, F. ∙ de Lorenzo, D. ∙ Parrini, D. ...

Effects of finasteride, a 5 alpha-reductase inhibitor, on circulating androgens and gonadotropin secretion in hirsute women

J Clin Endocrinol Metab. 1994; 79:831-835

Crossref

Scopus (81)

PubMed

Google Scholar

91.

Moghetti, P. ∙ Castello, R. ∙ Magnani, C.M. ...

Clinical and hormonal effects of the 5 alpha-reductase inhibitor finasteride in idiopathic hirsutism

J Clin Endocrinol Metab. 1994; 79:1115-1121

Crossref

Scopus (87)

PubMed

Google Scholar

92.

Cusan, L. ∙ Dupont, A. ∙ Gomez, J.L. ...

Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial

Fertil Steril. 1994; 61:281-287

Abstract

Full Text (PDF)

PubMed

Google Scholar

93.

Sahin, Y. ∙ Bayram, F. ∙ Keleştimur, F. ...

Comparison of cyproterone acetate plus ethinyl estradiol and finasteride in the treatment of hirsutism

J Endocrinol Invest. 1998; 21:348-352

Crossref

Scopus (55)

PubMed

Google Scholar

94.

Venturoli, S. ∙ Marescalchi, O. ∙ Colombo, F.M. ...

A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism

J Clin Endocrinol Metab. 1999; 84:1304-1310

Crossref

Scopus (145)

PubMed

Google Scholar

95.

Castello, R. ∙ Tosi, F. ∙ Perrone, F. ...

Outcome of long-term treatment with the 5 alpha-reductase inhibitor finasteride in idiopathic hirsutism: clinical and hormonal effects during a 1-year course of therapy and 1-year follow-up

Fertil Steril. 1996; 66:734-740

Abstract

Full Text (PDF)

PubMed

Google Scholar

96.

Müderris, II ∙ Bayram, F. ∙ Sahin, Y. ...

A comparison between two doses of flutamide (250 mg/d and 500 mg/d) in the treatment of hirsutism

Fertil Steril. 1997; 68:644-647

Abstract

Full Text (PDF)

Scopus (47)

PubMed

Google Scholar

97.

Carmina, E. ∙ Lobo, R.A.

Peripheral androgen blockade versus glandular androgen suppression in the treatment of hirsutism

Obstet Gynecol. 1991; 78:845-849

PubMed

Google Scholar

98.

Rittmaster, R.S. ∙ Givner, M.L.

Effect of daily and alternate day low dose prednisone on serum cortisol and adrenal androgens in hirsute women

J Clin Endocrinol Metab. 1988; 67:400-403

Crossref

Scopus (46)

PubMed

Google Scholar

99.

Carmina, E. ∙ Lobo, R.A.

Gonadotrophin-releasing hormone agonist therapy for hirsutism is as effective as high dose cyproterone acetate but results in a longer remission

Hum Reprod. 1997; 12:663-666

Crossref

Scopus (38)

PubMed

Google Scholar

100.

Acién, P. ∙ Mauri, M. ∙ Gutierrez, M.

Clinical and hormonal effects of the combination gonadotrophin-releasing hormone agonist plus oral contraceptive pills containing ethinyl-oestradiol (EE) and cyproterone acetate (CPA) versus the EE-CPA pill alone on polycystic ovarian disease-related hyperandrogenisms

Hum Reprod. 1997; 12:423-429

Crossref

Scopus (23)

PubMed

Google Scholar

101.

Heiner, J.S. ∙ Greendale, G.A. ∙ Kawakami, A.K. ...

Comparison of a gonadotropin-releasing hormone agonist and a low dose oral contraceptive given alone or together in the treatment of hirsutism

J Clin Endocrinol Metab. 1995; 80:3412-3418

Crossref

Scopus (67)

PubMed

Google Scholar

102.

Cosma, M. ∙ Swiglo, B.A. ∙ Flynn, D.N. ...

Clinical review: Insulin sensitizers for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials

J Clin Endocrinol Metab. 2008; 93:1135-1142

Crossref

Scopus (125)

PubMed

Google Scholar

103.

Morin-Papunen, L.C. ∙ Koivunen, R.M. ∙ Ruokonen, A. ...

Metformin therapy improves the menstrual pattern with minimal endocrine and metabolic effects in women with polycystic ovary syndrome

Fertil Steril. 1998; 69:691-696

Full Text

Full Text (PDF)

Scopus (272)

PubMed

Google Scholar

104.

Anttila, L. ∙ Koskinen, P. ∙ Kaihola, H.L. ...

Serum androgen and gonadotropin levels decline after progestogen-induced withdrawal bleeding in oligomenorrheic women with or without polycystic ovaries

Fertil Steril. 1992; 58:697-702

Abstract

Full Text (PDF)

PubMed

Google Scholar

105.

Segall-Gutierrez, P. ∙ Du, J. ∙ Niu, C. ...

Effect of subcutaneous depot-medroxyprogesterone acetate (DMPA-SC) on serum androgen markers in normal-weight, obese, and extremely obese women

Contraception. 2012; 86:739-745

Full Text

Full Text (PDF)

Scopus (17)