title: Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline.
abstract: OBJECTIVE
  Our objective was to develop clinical practice guidelines for the evaluation and treatment of hirsutism in premenopausal women.
  
  
  METHODS
  The Task Force was composed of a chair, selected by the Clinical Guidelines Subcommittee (CGS) of The Endocrine Society, six additional experts, two methodologists, and a medical writer. The Task Force received no corporate funding or remuneration.
  
  
  METHODS
  Systematic reviews of available evidence were used to formulate the key treatment and prevention recommendations. We used the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) group criteria to describe both the quality of evidence and the strength of recommendations. We used "recommend" for strong recommendations, and "suggest" for weak recommendations.
  
  
  METHODS
  Consensus was guided by systematic reviews of evidence and discussions during one group meeting, several conference calls, and e-mail communications. The drafts prepared by the Task Force with the help of a medical writer were reviewed successively by The Endocrine Society's CGS, Clinical Affairs Core Committee (CACC), and Council. The version approved by the CGS and CACC was placed on The Endocrine Society's Web site for comments by members. At each stage of review, the Task Force received written comments and incorporated needed changes.
  
  
  CONCLUSIONS
  We suggest testing for elevated androgen levels in women with moderate or severe hirsutism or hirsutism of any degree when it is sudden in onset, rapidly progressive, or associated with other abnormalities such as menstrual dysfunction, obesity, or clitoromegaly. For women with patient-important hirsutism despite cosmetic measures, we suggest either pharmacological therapy or direct hair removal methods. For pharmacological therapy, we suggest oral contraceptives for the majority of women, adding an antiandrogen after 6 months if the response is suboptimal. We recommend against antiandrogen monotherapy unless adequate contraception is used. We suggest against using insulin-lowering drugs. For women who choose hair removal therapy, we suggest laser/photoepilation.
authors.affiliation: Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Martin
authors.forename: R Jeffrey
authors.initials: RJ
authors.lastname: Chang
authors.forename: David A
authors.initials: DA
authors.lastname: Ehrmann
authors.forename: Lourdes
authors.initials: L
authors.lastname: Ibanez
authors.forename: Rogerio A
authors.initials: RA
authors.lastname: Lobo
authors.forename: Robert L
authors.initials: RL
authors.lastname: Rosenfield
authors.forename: Jerry
authors.initials: J
authors.lastname: Shapiro
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: Brian A
authors.initials: BA
authors.lastname: Swiglo
mesh_terms: D002986:Clinical Trials as Topic; D019317:Evidence-Based Medicine; D005260:Female; D006628:Hirsutism / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D017697:Premenopause