Synopsis
Distinguish common slowly progressive hirsutism from severe androgen excess, investigate ovarian and adrenal sources accurately, and relieve unwanted hair without exposing a pregnancy to anti-androgen harm.
- Hirsutism is terminal hair growth in androgen-dependent areas; hypertrichosis is diffuse non-androgen-pattern hair growth and has a different medicine and systemic differential.
- PCOS is the commonest cause of hirsutism, but rapid tempo, virilisation, postmenopausal onset or severe laboratory abnormality must not be squeezed into that diagnosis.
- Ask how quickly hair changed, what removal methods conceal, whether cycles altered, and whether voice, scalp hair, muscles, libido or genital anatomy changed.
Key red flags
Change over months with deep voice, clitoromegaly, accelerated scalp loss or muscle change is a tumour or severe androgen-excess red flag rather than routine PCOS.
Investigation priorities
Confirm androgen excess and identify a result severe enough to accelerate specialist assessment.
Management branches
Slowly progressive unwanted terminal hair with no rapid systemic or genital change.
- Document onset, tempo, cycle and pregnancy history, medicines and supplements, removal practices, family pattern and psychosocial impact; examine androgen distribution, scalp, skin, blood pressure and Cushing features.
- Measure validated testosterone and SHBG and screen selected mimics with pregnancy testing, thyroid, prolactin and early-morning 17-hydroxyprogesterone according to the clinical pattern.
Key medicines
Eflornithine creamApply a thin layer to affected facial skin twice daily following the licensed interval and application instructions.
Combined hormonal contraceptiveChoose a licensed formulation and regimen under UK contraceptive eligibility guidance after individual risk assessment.