Review Article| Volume 19, ISSUE 2, P155-160, March 2001

Download started.


Rational investigations in the diagnosis and management of women with hirsutism or androgenetic alopecia

  • Julian H Barth
    Address correspondence to Julian H. Barth, Department of Clinical Biochemistry & Immunology, Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds LS1 3EX, England, UK
    Leeds Teaching Hospitals NHS Trust, Leeds, England, United Kingdom
    Search for articles by this author
      The diagnosis of excess body hair or scalp loss is based purely on the patient’s history and clinical examination. The purpose of investigation is to obtain further information necessary for management of the patient and not to confirm the diagnosis of hirsuties or androgenic alopecia. Treatment decisions should be made on the severity of hair growth for which several scoring systems have been described.
      • Barth J.H.
      • Rushton D.H.
      Measurement of hair growth.
      The underlying cause is likely to be polycystic ovaries (PCO) in the vast majority of hirsute women, and investigation should be used to identify the few women with other causes, as treatment is aimed at altering hair growth and not at modifying minor abnormalities in circulating hormone concentrations.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinics in Dermatology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Barth J.H.
        • Rushton D.H.
        Measurement of hair growth.
        in: Serup J. Jemec G.B.E. Handbook of non-invasive methods and the skin. CRC Press, Boca Raton, FL1995: 543-547
        • O’Driscoll J.B.
        • Mamtora H.
        • Higginson J.
        • et al.
        A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia.
        Clin Endocrinol (Oxf). 1994; 41: 231-236
        • Moran C.
        • Tapia M.C.
        • Hernandez E.
        • et al.
        Etiological review of hirsutism in 250 patients.
        Arch Med Res. 1994; 25: 311-314
        • Derksen J.
        • Nagesser S.K.
        • Meinders A.E.
        • et al.
        Identification of virilizing adrenal tumors in hirsute women.
        N Engl J Med. 1994; 331: 968-973
      1. Woodruff JD, Parmley TH. Virilizing ovarian tumors. In: Mahesh VB, Greenblatt RB, Wright PSG, editors. Hirsutism and virilism: Pathogenesis and management. London:1983:129–158.

        • Sandberg E.C.
        • Jackson J.R.
        A clinical analysis of ovarian virilizing tumors.
        Am J Surg. 1963; 105: 784-792
        • Moltz L.
        • Pickartz H.
        • Sorensen R.
        • et al.
        Ovarian and adrenal vein steroids in seven patients with androgen-secreting ovarian neoplasms.
        Fertil Steril. 1984; 42: 585-593
        • Meldrum D.R.
        • Abraham G.E.
        Peripheral and ovarian venous concentration of various steroid hormones in virilising ovarian tumours.
        Obstet Gynecol. 1979; 53: 36-43
        • Friedman C.I.
        • Schmidt G.E.
        • Kim M.H.
        • et al.
        Serum testosterone cencentrations in the evaluation of androgen-producing tumors.
        Am J Obstet Gynecol. 1985; 153: 44-49
        • Barth J.H.
        How hairy are hirsute women?.
        Clin Endocrinol (Oxf). 1997; 47: 255-260
        • Toscano V.
        • Adamo M.V.
        • Caiola S.
        • et al.
        Is hirsutism an evolving syndrome?.
        J Endocrinol. 1983; 97: 379-387
        • Adams J.
        • Polson D.W.
        • Franks S.
        Prevalence of polycystic ovaries in women with anovulation and idiopathic hirsutism.
        Br Med J. 1986; 293: 355-359
        • Obhrai M.
        • Lynch S.S.
        • Holder G.
        • et al.
        Hormonal studies on women with polycystic ovaries diagnosed by ultrasound.
        Clin Endocrinol (Oxf). 1990; 32: 467-474
        • Avivi I.
        • Pollack
        • Gideoni O.
        • et al.
        Overdiagnosis of 21-hydroxylase late onset congenital adrenal hyperplasia.
        Fertil Steril. 1996; 66: 557-563
        • Spritzer P.
        • Billaud L.
        • Thalabard J.-C.
        • et al.
        Cyproterone acetate versus hydrocortisone treatment in late-onset adrenal hyperplasia.
        J Clin Endocrinol Metab. 1990; 70: 642-646
        • Philpott M.P.
        • Sanders D.A.
        • Kealey T.
        Effects of insulin and insulin-like growth factors on cultured human hair follicles.
        J Invest Dermatol. 1994; 102: 857-861
        • Evans D.J.
        • Barth J.H.
        • Burke C.W.
        Body fat topography in women with androgen excess.
        Int J Obes. 1988; 12: 157-162
        • De Pergola G.
        • De Mitrio V.
        • Perricci A.
        • et al.
        Influence of free testosterone on antigen levels of plasminogen activator inhibitor-1 in premenopausal women with central obesity.
        Metabolism. 1992; 41: 131-134
        • Conway G.S.
        • Agrawal R.
        • Betteridge D.J.
        • et al.
        Risk factors for coronary heart disease in lean and obese women with the polycystic ovary syndrome.
        Clin Endocrinol (Oxf). 1992; 37: 119-125
        • Wild R.A.
        • Grubb B.
        • Hartz A.
        • et al.
        Clinical signs of androgen excess as risk factors for coronary disease.
        Fertil Steril. 1990; 54: 255-259
        • Dahlgren E.
        • Johansson S.
        • Lindstedt G.
        • et al.
        Women with polycystic ovary syndrome wedge resected in 1956 to 1965.
        Fertil Steril. 1992; 57: 505-513
        • Lapidus L.
        • Bengtsson C.
        • Larsson B.
        • et al.
        Distribution of adipose tissue and risk of cardiovascular disease and death.
        Br Med J. 1984; 289: 1257-1261
        • Fox R.
        • Corrigan E.
        • Thomas P.A.
        • et al.
        The diagnosis of polycystic ovaries in women with oligo-amenorrhoea.
        Clin Endocrinol (Oxf). 1991; 34: 127-131
        • Koskinen P.
        • Erkkola R.
        • Penttila T.-A.
        • et al.
        Optimal use of hormone determinations in the biochemical diagnosis of the polycystic ovary syndrome.
        Fertil Steril. 1996; 65: 517-522
        • Shah P.N.
        Human body hair—A quantitative study.
        Am J Obstet Gynecol. 1957; 73: 1255-1265
        • Barth J.H.
        • Jenkins M.
        • Belchetz P.E.
        Ovarian hyperthecosis, diabetes and hirsuties in post menopausal women.
        Clin Endocrinol (Oxf). 1997; 46: 123-128
        • Pepersack T.
        • Rossi C.
        • Dupuis F.
        • et al.
        Hormonal status and clinical relevance of hirsutism in elderly women.
        Acta Endocrinol (Copenh). 1993; 129: 307-310
        • Marcondes J.A.
        • Minnani S.L.
        • Luthold W.W.
        • et al.
        Treatment of hirsutism in women with flutamide.
        Fertil Steril. 1992; 57: 543-547
        • Couzinet B.
        • Pholsena M.
        • Young J.
        • et al.
        The impact of a pure anti-androgen (flutamide) on LH, FSH, androgens and clinical status in idiopathic hirsutism.
        Clin Endocrinol (Oxf). 1993; 39: 157-162
        • Dodin S.
        • Faure N.
        • Cedrin I.
        • et al.
        Clinical efficacy and safety of low-dose flutamide alone and combined with an oral contraceptive for the treatment of idiopathic hirsutism.
        Clin Endocrinol (Oxf). 1995; 43: 575-582
        • Kasick J.M.
        • Bergfeld W.F.
        • Steck W.D.
        • et al.
        Adrenal androgenic female-pattern alopecia.
        Cleve Clin Q. 1983; 50: 111-122
        • De Villez R.L.
        • Dunn J.
        Female androgenic alopecia.
        Arch Dermatol. 1986; 122: 1011-1015
        • Montalto J.
        • Whorwood C.B.
        • Funder J.W.
        • et al.
        Plasma C19 steroid sulphate levels and indices of androgen bioavailability in female pattern androgenic alopecia.
        Clin Endocrinol (Oxf). 1990; 32: 1-12
        • Rushton D.H.
        • Ramsay I.D.
        • James K.C.
        • et al.
        Biochemical and trichological characterization of diffuse alopecia in women.
        Br J Dermatol. 1990; 123: 187-197
        • Rushton D.H.
        • Ramsay I.D.
        The importance of adequate serum ferritin levels during oral cyproterone acetate and ethinyl oestradiol treatment of diffuse androgen-dependent alopecia in women.
        Clin Endocrinol (Oxf). 1992; 36: 421-427
        • Freinkel R.K.
        • Freinkel N.
        Hair growth and alopecia in hypothyroidism.
        Arch Dermatol. 1972; 106: 349-352
        • Ramsay I.D.
        • Rushton D.H.
        Reduced serum B12 levels during oral cyproterone-acetate and ethinyl-oestradiol therapy in women with diffuse androgen-dependent alopecia.
        Clin Exp Dermatol. 1990; 15: 277-281
        • Barth J.H.
        How robust is the methodology for trials of therapy in hirsute women?.
        Clin Endocrinol (Oxf). 1996; 45: 379-380
        • Bardin C.W.
        • Lipsett M.B.
        Testosterone and androstenedione blood production rates in normal women and in women with idiopathic hirsutism or polycystic ovaries.
        J Clin Invest. 1967; 46: 891-902
        • Thomas P.K.
        • Ferriman D.G.
        Variation in facial and pubic hair growth in white women.
        Am J Phys Anthrop. 1957; 15: 171-180