Practise Updates: Diagnosis and Management of Idiopathic Hirsutism

Abstract

Idiopathic hirsutism (IH) is a common clinical condition with multiple diagnostic and therapeutic uncertainties. There are no clear recommendations for the diagnosis and management of the condition. This practice update was developed to guide the primary care physicians and the specialists in better and more systematic management of IH particularly in the Indian context. Twelve experienced members consisting of eminent endocrinologists, physicians, a dermatologist, a gynaecologist and a psychiatrist were invited by the Integrated Diabetes and Endocrine Academy (IDEA). A literature search was performed using online databases from PubMed, Cochrane Library and Google Scholar. Published articles from peer-reviewed indexed journals, with a preference for meta-analyses and randomized controlled trials, were selected. A meeting took place with all the 12 members individually giving their opinions on predetermined questions of interest. After the initial meeting during IDEACON 2023, two more meetings were held and the practice update was formulated after voting. Practice updates were made on important areas such as the cut-off for modified Ferriman-Gallwey Score for the Indian population, conditions to be excluded before diagnosing IH, when to refer to specialists, investigations in a suspected case of IH and choice of therapies for its management.

Keywords: Hyperandrogenism; ferriman-gallwey score; polycystic ovary syndrome.

Figure 1

Phases of hair cycle[2]

Figure 2

Probable mechanisms involved in the pathophysiology of idiopathic hirsutism[5]

Figure 3

Causes of hyperandrogenism to be ruled out before diagnosing idiopathic hirsutism.[325]

Figure 4

Mechanisms of action of oral contraceptives (OCs) in ameliorating idiopathic hirsutism.[342548]

Figure 5

Types of mechanical/physical methods of hair removal