How can the cause of my hirsutism be determined?

The story and examination findings may suggest the cause. Investigations including blood tests to determine hormone levels, and ultrasound are usually required. A simple flowchart (Figure 8.2) indicates the basic investigations and how they lead to a diagnosis.

Ultrasound examination and blood tests help to determine the cause. If you have polycystic ovaries, ultrasound examination will usually demonstrate the typical picture (Q7. 1). Tumours of an ovary or adrenal gland are uncommon but could be shown by the ultrasound examination. An elevated LH in the blood during the first eight days of the menstrual cycle suggests polycystic ovary syndrome unless the FSH is also high suggesting the menopause. Testosterone may be slightly elevated in polycystic ovary syndrome or higher if there is a hormone secreting tumour. An elevated 17 alpha hydroxyprogesterone level suggests the adrenogenital syndrome. Sometimes the tests demonstrate no obvious abnormality and we assume that the skin is particularly sensitive to androgens; this may be a familial problem.

Many patients presenting with hirsutism are understandably anxious to exclude a major medical problem. Reassurance that investigations are normal or show just a minor imbalance may be all that they are seeking.  

Figure 8.2 Flowchart for the investigation of hirsutism.