Clinical management of hirsutism: An integrated approach

Abstract

Hirsutism, the excessive growth of coarse terminal hair in women in a male-pattern distribution, is a common condition with multifactorial aetiology and substantial psychosocial impact. Affecting 5–15% of women of reproductive age, it is most often linked to polycystic ovary syndrome (PCOS), idiopathic hirsutism, or, less commonly, non-classic congenital adrenal hyperplasia, androgen secreting tumours, and drug-induced causes. Effective management requires a comprehensive approach, beginning with accurate diagnosis through clinical scoring systems, laboratory investigations, and imaging, where indicated. Treatment is typically multimodal, combining lifestyle modification, cosmetic and mechanical hair removal, physical methods such as laser therapy and electrolysis, and pharmacological options including combined oral contraceptives, antiandrogens, insulin sensitisers, and topical agents like eflornithine. Adjunctive use of herbal and emerging therapies shows promise but requires further validation. Given the chronic nature of hirsutism, ongoing treatment and counselling are critical to improving quality of life and addressing associated psychosocial burdens. An integrated, patient-centred approach that considers both physical and psychological outcomes remains central to effective long-term management.