Presence of coarse hairs in females in a male-like pattern and affects between 5-10% of women.

With few exceptions, is a sign of androgen excess or hyperandrogenism.

More than 4 million women in the U.S. have androgen excess.

Affects 5-11% of women of reproductive age.

Overall 70-80% of patients with androgen excess demonstrate hirsutism.

Results from interaction between androgens and androgen sensitivity of the hair follicle.

Women with androgen levels two times normal have a higher likelihood of hirsutism.

Severity of hirsutism does not correlate well with androgen levels since there is marked variability in the sensitivity of the hair follicle to androgen.

Some women with excess androgens have no hirsutism but may have seborrhea, acne or alopecia while in other women without excess androgen idiopathic hirsutism may occur.

Level of free testosterone often elevated when total testosterone level is normal.

Women with hirsutism may have relatively low levels of sex hormone binding globulin, as it is suppressed by hyperinsulinemia of insulin resistance and androgen excess, which determines the fraction of plasma testosterone that is free or bound to albumin.

Improved by metformin.

Oral contraceptive pills particularly those with anti-androgenic activity are associated with improvements as are anti-androgens such as flutamide and spironolactone.

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