Synopsis
Separate androgen-dependent terminal hair from generalised excess growth, detect virilising disease promptly, investigate endocrine or medicine causes proportionately, and offer safe physical and medical hair reduction.
- Hirsutism means coarse terminal hair in androgen-dependent sites such as chin, upper lip, chest, lower abdomen and back; hypertrichosis is excess hair outside that sexual distribution.
- Ask what has changed from the person's baseline and what removal methods conceal. Hair density varies normally by family and ancestry, so a visual score is not a universal disease threshold.
- Slowly progressive hirsutism with irregular cycles, acne or metabolic features commonly reflects PCOS, but normal cycles and hormones can coexist with idiopathic follicular androgen sensitivity.
Key red flags
Rapid progression over months, deepening voice, clitoromegaly, increased muscle bulk, temporal scalp recession, severe biochemical androgen excess or new postmenopausal hirsutism requires urgent endocrine and gynaecological or adrenal localisation.
Deep voice, clitoral enlargement, rapid temporal recession, increased muscle bulk or reduced breast tissue indicates androgen effect beyond ordinary hirsutism.
Investigation priorities
Confirm biochemical androgen excess and identify a result requiring faster specialist localisation.
Management branches
Terminal hair has increased gradually without virilisation or a severe systemic feature.
- Document tempo, cycles, pregnancy goals, acne, scalp loss, medicines, supplements, family pattern and removal methods, then examine hair distribution, blood pressure and metabolic or Cushing features.
- Measure validated testosterone and SHBG and select pregnancy, thyroid, prolactin or 17-hydroxyprogesterone tests from the phenotype; complete a PCOS assessment when supported.