5 Questions on Hirsutism

Test your knowledge of the Endocrine Society’s (ES) 2018 guidelines about hirsutism in women with the short quiz below.

Question 1. The Ferriman-Galway hirsutism score evaluates hirsutism on each of the following body areas except:

A. Upper lip

B. Upper thighs 

C. Back

D. Calves 

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Answer: D. Calves. The Ferriman-Galway score is considered the gold standard for evaluating hirsutism. It includes 9 body areas, each of which is scored on a scale of 0 (no hair) to 4 (frankly virile). The scores are added to produce an overall hormonal hirsutism score, with a score ≥8 considered generalized hirsutism and <8 a common normal variant. These 9 body areas include: upper lip, chin, chest, abdomen, pubic area, upper arms, upper thighs, back, and buttocks.

Question 2. Which of the following is recommended as initial pharmacotherapy for most women with hirsutism:

A. Oral contraceptives

B. Antiandrogens

C. Combination therapy with oral contraceptives and antiandrogens

D. Either A or B

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Answer: A. Oral contraceptives. For most women with hirsutism who are not planning on pregnancy, the ES recommends oral contraceptives as initial pharmacotherapy. Because all oral contraceptives appear to be equally effective in treating hirsutism, the ES does not recommend any one over another. The ES recommends against antiandrogens as initial pharmacotherapy, unless women are not sexually active, have had permanent sterilization, or are using long-acting reversible contraception. This is due to the teratogenic potential of antiandrogens. Combination therapy with oral contraceptives and antiandrogens is recommended as initial pharmacotherapy in women with severe hirsutism that is causing emotional distress, or in women who have not responded adequately to oral contraceptive monotherapy.

Question 3. Hair removal using electrolysis is recommended for women with which hair color?

A. Brown

B. Blond

C. Black

D. Auburn

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Answer: B. Blond. The ES recommends electrolysis for women with blond or white hair and photoepilation for women with brown, black, or auburn hair. Photoepilation can be used for permanent hair removal over large areas, and requires pigmented hair. Electrolysis can be used on small treatment areas only, and does not depend on hair pigmentation.

Question 4. Flutamide is recommended for the treatment of hirsutism in women.

A. True

B. False

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Answer: B. False. The ES advises against using both standard and low-doses of the antiandrogen flutamide to treat female hirsutism, due to the risk of hepatotoxicity. Numerous trials have found an association between flutamide, liver failure, and death.

Question 5. How long should a trial of pharmacotherapy for hirsutism last before changing dosage?

A. 2 months

B. 4 months

C. 6 months

D. 8 months 

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Answer: C. 6 months. The ES recommends that all trials of pharmacotherapy should last 6 months before making a change in dosage, switching medications, or adding medication. Because hair has a long growth cycle, it can take about 6 months for the effects of hormonal therapy to become apparent and 9 months to see maximal effects. Facial hair growth has a shorter cycle of about 4 months.

References:

Martin KA, Anderson RR, Chang RJ, et al. Evaluation and treatment of hirsutism in premenopausal women: An Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2018;103:1233-1257.