What are other physical findings in the evaluation of hirsutism?

Updated: May 01, 2020
  • Author: George T Griffing, MD; Chief Editor: Michel E Rivlin, MD  more...
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In women with moderate-to-severe hirsutism (score >15), seek additional signs of hyperandrogenism, including (1) temporal hair recession, (2) oily skin, (3) masculine voice, (4) well-developed musculature, (5) enlargement of the clitoris (>35 mm2 in surface area), (6) irregular menses, and (7) psychological changes (eg, heightened libido, aggressiveness).

The degree to which these clinical factors are present suggests the level of androgen overproduction and, thus, helps to determine the degree of concern for the presence of an underlying disease.

The extent of the evaluation for the cause of hirsutism is greater in women who have more severe clinical evidence of masculinization.

A thorough abdominal and pelvic examination is important in patients with hirsutism because more than half of androgen-secreting adrenal and ovarian tumors are palpable.

Examine the skin for acanthosis nigricans, a manifestation of insulin resistance.

Women with hirsutism are usually obese, with increased waist-hip ratios, and are thought to be at an increased risk for atherosclerosis and coronary heart disease. They also have increased bone mineral density scores at the hip and spine. These increases correlate with higher levels of serum free testosterone and estrogen.

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