Approach to treating hirsutism

Determine the cause of hirsutism before starting treatment (other than physical treatments).

Hirsutism management is long-term. Treatment options in general practice are:

Physical measures achieve effects rapidly; they can be used alone or started concurrently with other therapies. COC therapy (or MHT therapy in postmenopausal individuals) is the mainstay of treatment for hirsutism; however, treatment is usually required for at least 6 months before an effect is seen. Compounded eflornithine cream can be considered if a more immediate effect is required (as it has an effect within 6 to 8 weeks), but is expensive and generally reserved for treatment of facial hair.

Antiandrogen therapy can be added if response to COC or MHT therapy is insufficient after 6 months, or can be used alone if COC or MHT therapy is contraindicated.

Refer to a specialist if response to antiandrogen therapy is insufficient after 6 to 12 months of treatment.

Glucocorticoid therapy may be used by specialists to treat hirsutism in females with nonclassical congenital adrenal hyperplasia.