There may be other symptoms in association with hirsutism as a result of the androgenic activity such as android obesity and acanthosis nigricans. The most common causes of hirsutism are genetics, idiopathic, or polycystic ovarian disease. For a few women, hirsutism signals a serious underlying disorder such as an ovarian or adrenal tumor, congenital adrenal hyperplasia, or Cushing's syndrome. A detailed medical history and examination can identify women in whom a serious disease is suspected and for whom laboratory evaluation is warranted. There are other tests that can be of use in defining the disease and determining appropriate treatment, but numerous tests are time consuming and expensive.
Patient distress is the prime indication for therapy.
Therapy is directed at suppressing ovarian or adrenal androgen production, inhibiting the conversion of testosterone to dihydrotestosterone, or antagonizing the effects of androgens at the receptor level. Drug treatment should be continued for 12 months before assessing response. Spironolactone is generally the drug tried first. Ovarian hormones, e.g. medroxyprogesterone acetate plus ethinylestradiol, or cyproterone acetate plus ethinylestradiol may be added if response is inadequate. A practical approach to hirsutism.