New recommendations on hirsutism advice for testing for elevated androgen levels in all women with abnormal hirsutism scores as a routine. But if the hirsutism score is normal there is no need to perform testing for elevated androgen levels. Hyper-androgenaemic women should also be screened for non-classical congenital adrenal hyperplasia (NCCAH) due to 21-hydroxylase deficiency, by measuring early morning 17-hydroxyprogesterone levels in the follicular phase or on a random day for those with amenorrhoea or infrequent menses.
· For most women with patient-important hirsutism despite cosmetic measures, the recommendation is to start with pharmacological therapy and add direct hair removal methods such as electrolysis and photoepilation.
· For women with mild hirsutism and no evidence of an endocrine disorder, the advice is either direct hair removal methods or oral combined oestrogen-progestin contraceptives, adding an antiandrogen after six months if response is suboptimal.
· For women at higher risk for venous thromboembolism, initial therapy should be an oral contraceptive containing the lowest effective dose of ethinylestradiol and low-risk progestin.
The society advises against using insulin-lowering drugs. For most women who choose hair removal therapy, laser/photoepilation is recommended.
The new guideline is published in the Journal of Clinical Endocrinology & Metabolism (JCEM).