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S.Mojdeh Mirmomen

Treatment

Shown below is an algorithm summarizing the treatment of hirsutism according the Endocrine Society Clinical Practice guidelines.

 
 
 
 
 
 
 
 
 
 
Initial therapy for patient with hirsutism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Mild hirsutism and no evidence of an endocrine disorder
 
 
 
 
 
 
Moderate or patient-important hirsutism
 
 
 
 
Severe hirsutism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Direct hair removal methods
 
Pharmacological therapy
 
 
 
Pharmacological therapy (add direct hair removal if needed)
 
 
 
 
Combined pharmacological therapy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
• Photoepilation for women with auburn, brown, or black unwanted hair
• Electrolysis for women with white or blonde hair
 
 
 
 
• Start oral contraceptives in women who are not seeking fertility
** Use oral contraceptives containing the lowest effective dose of ethinyl estradiol and a low-risk progestin for women at higher risk for venous thromboembolism (e.g., obese or >39 years old)
• Start either oral contraceptives or anti-androgens in women who are not sexually active, have undergone permanent sterilization, or who are using long-acting reversible contraception
 
 
 
 
 
 
 
Oral contraceptives and antiandrogens
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Add an antiandrogen if hirsutism remains despite 6 months of monotherapy with an oral contraceptive
 
 
 
 
 
 
 
 
 
 


Diagnosis

Shown below is an algorithm summarizing the diagnosis of disease name according the Endocrine Society Clinical Practice guideline.

 
 
 
Initial evaluation & diagnosis of hirsutism
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
History & physical examination including pelvic examination
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Medication use? *Ask for anabolic or androgenic steroids (in athletes, patients who are using dietary supplements, patients with sexual dysfunction, or in patients with a partner who uses testosterone gel) and valproic acid (in patient with neurologic disorders
 
 
 
Discontinue medication
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Isolated local hair growth
 
 
 
Direct hair removal methods
 
 
 
Improvement or stable
 
 
 
Normal variant
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Abnormal hirsutism score or local hair growth with symptoms suggesting hyperandrogenic endocrine disorder*? *menstrual irregularity, infertility, galactorrhea, signs or symptoms of hypothyroidism, Cushing syndrome, acromegaly, central obesity,acanthosis nigricans, clitoromegaly, or sudden-onset or rapid-progression hirsutism suggests the presence of a hyperandrogenic endocrine disorder
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Early morning total testosterone blood level
 
 
 
Progression or unstable