Approach to diagnosis of hirsutism

Diagnosis of hirsutism requires:

• clinical assessment
• investigation for underlying treatable conditions (regardless of the severity of the hirsutism). Underlying polycystic ovary syndrome (PCOS) is commonly identified. Rapid investigation is required if features suggestive of an androgen-secreting tumour are present, although these are less common.

If there is no evidence of endocrine abnormalities other than hirsutism, the condition may be idiopathic. Diagnosis of idiopathic hirsutism requires demonstration of normal serum testosterone concentration and free androgen index, and exclusion of PCOS (see Features and diagnosis of PCOS).