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The patient's breasts should be examined for galactorrhea.Physicians should look for other typical signs of endocrinopathies, such as Cushing syndrome or thyroid dysfunction.

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Classic adrenal hyperplasia is diagnosed at birth by ambiguous genitalia, but nonclassic adrenal hyperplasia can remain asymptomatic until after puberty, when women develop menstrual dysfunction and anovulation.17Androgen-secreting tumors are rare in women with hirsutism, comprising 0.2 percent of cases in two studies of women presenting with clinical hyperandrogenemia.911 Neoplasms may be adrenal or ovarian in origin, and often cause large elevations in androgen level. Rapid onset of hirsutism, virilization, or a palpable abdominal or pelvic mass all raise suspicion for an androgen-secreting tumor.1Several other endocrinopathies can present with hirsutism but often have more distinctive presentations.A menstrual and reproductive history should also be obtained, as well as the hair patterns of family members (if possible) because idiopathic hirsutism is often familial.18 Patients should be asked if they have noticed changes in their voice, abdomen, breasts, skin, or muscle mass.It is also important to ask what hair removal measures have already been tried.6 The patient should be evaluated for signs of virilization, including clitoromegaly, acne, deep voice, balding, or loss of typical female body contours.For information about the SORT evidence rating system, go to [ corrected] This scale is limited by its subjective nature and its failure to account for all androgenic areas (e.g., sideburns, buttocks), focal hirsutism, ongoing use of cosmetic measures, or effect on patient well-being. A score of 1 to 4 is given for nine areas of the body.Given these limitations, some experts recommend use of the term “patient-important hirsutism” to indicate symptoms significant enough to cause the patient distress, regardless of the degree of physical findings.1 Print Figure 1. A score of 1 to 4 is given for nine areas of the body. A total score less than 8 is considered normal, a score of 8 to 15 indicates mild hirsutism, and a score greater than 15 indicates moderate or severe hirsutism. Androgens, including testosterone, dihydrotestosterone, and their prohormones dehydroepiandrosterone sulfate and androstenedione, are the key factors in the growth and development of sexual hair.An abdominal and bimanual examination should be performed to identify palpable tumors.

A skin examination should check for acne, striae, or acanthosis nigricans.

Evidence for the effectiveness of electrolysis and laser therapy is limited.

In patients who are not planning a pregnancy, first-line pharmacologic treatment should include oral contraceptives.

Hirsutism is defined as excess terminal hair that commonly appears in a male pattern in women.

It is generally associated with hyperandrogenemia.1 Hirsutism occurs in approximately 7 percent of women and has an estimated economic burden in the United States of more than $600 million annually.23 Hirsutism should be distinguished from hypertrichosis, which is generalized excessive hair growth not caused by androgen excess.

These include acromegaly, Cushing syndrome, hyperprolactinemia, and thyroid dysfunction.118The medical history should include a medication and supplement review.