Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

716 Hirsutism (Endocrinology)

General Measures

■Discuss potential problems, treatments, implications, follow-up

specific therapy

■Indications for Treatment

➣Hirsutism cosmetic problem

➣Modified Ferriman-Gallwey score >7

➣Mild hirsutism better candidate for drug treatment if family his-

tory of moderate to severe hirsutism

➣Do not restrict medication to women with high androgens

Treatment Options

■Nonpharmacologic, esp when mild:

➣Tweezing, bleaching, waxing, shaving, depilatories: do not accel-

erate hair growth

➣Electrolysis, laser epilation: outcome operator-dependent

➣Bilateral oophorectomy: hyperthecosis unresponsive to medical

therapy, fertility no longer desired

■Pharmacologic: no systemic drug FDA-approved for hirsutism

➣Androgen suppression:

Oral contraceptives (OCs): norethindrone, norgestrel, and

levonorgestrel androgenic; norgestimate, desogestrel least

androgenic; drospirenone antiandrogenic

If side effects with OCs, GnRH analogue with low doses of estro-

gen (and progestin)

Glucocorticoids in selected patients with CAH

➣Androgen inhibition:

Spironolactone: alone or coadminister with OC

Flutamide: as effective as spironolactone, but risk of hepato-

toxicity

Finasteride: costly, less effective, but works additively with

spironolactone

➣Modulation of hair follicle:

Eflornithine cream: topical to facial hair twice daily

■Psychological evaluation/counseling when problem of body image

Side Effects and Contraindications

■Oral contraceptives:

➣Side effects: migraine headaches, depression, breast tenderness,

thrombophlebitis

➣Contraindications: