The Endocrine Society has released new clinical practice guidelines for the treatment of hirsutism in premenopausal women. The guidelines appear in the April issue of the Journal of Clinical Endocrinology & Metabolism (JCEM), a publication of The Endocrine Society.
Hirsutism is defined medically as excessive terminal hair that appears in a male pattern in women. Terminal hair refers to the stiff, pigmented hairs normally seen in men on the face, chest, abdomen, and back, and which are not normal in women. The cause of hirsutism can be either an increased level of androgens in women or an oversensitivity of hair follicles to natural levels of androgens in women.
"Hirsutism is a potential indication of an underlying medical disorder that may require specific treatment, and such a disorder may have implications for menstrual function, fertility, and metabolic risks," said Kathryn Martin, MD, of the Reproductive Endocrine Unit at Massachusetts General Hospital in Boston, Massachusetts, and member of the Society's task force that developed the guidelines. "These evidence-based guidelines give healthcare professionals an approach to treating hirsutism based upon a comprehensive review of clinical trials of drug therapy and hair removal techniques such as laser and electrolysis."
The guidelines suggest testing for elevated androgen levels in women with moderate or severe hirsutism, or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction or obesity.
For pharmacological therapy, the guidelines suggest oral contraceptives for the majority of women, adding an antiandrogen after six months if the response in suboptimal. An antiandrogen is a substance that prevents or inhibits the effects of male sex hormones. The guidelines recommend against using antiandrogens alone unless adequate contraception is used, because antiadrogens pose a potential risk to the normal sexual development of a male fetus.