ABSTRACT

Hirsutism results from either an exogenous or endogenous increase in circulating androgens or from individually increased sensitivity (metabolism) of the hair follicle to normal serum androgen levels. Exogenous sources include androgenic medications, such as oral contraceptives with androgenic progestins (norgestrel, levonorgestrel, norethindrone), anabolic steroids (danazol), high-dose glucocorticoids, androgen therapy (testosterone), and valproic acid (raises plasma testosterone). Endogenous androgens in women arise from the ovary or adrenal glands, and peripherally from the skin and fat. There is thought to be considerable heterogeneity of responses among androgen-dependent follicles in different individuals (7). Therefore, the clinical severity of hirsutism does not always correlate well with expected levels of circulating androgens.