Editing Hirsutism (section)

== Treatment ==
Treatment of hirsutism is indicated when hair growth causes patient distress. The two main approaches to treatment are pharmacologic therapies targeting androgen production/action, and direct hair removal methods including electrolysis and photo-epilation. These may be used independently or in combination.<ref>{{Cite journal |last1=Martin |first1=Kathryn A |last2=Anderson |first2=R Rox |last3=Chang |first3=R Jeffrey |last4=Ehrmann |first4=David A |last5=Lobo |first5=Rogerio A |last6=Murad |first6=M Hassan |last7=Pugeat |first7=Michel M |last8=Rosenfield |first8=Robert L |date=2018-03-07 |title=Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society* Clinical Practice Guideline |journal=The Journal of Clinical Endocrinology & Metabolism |volume=103 |issue=4 |pages=1233–1257 |doi=10.1210/jc.2018-00241 |pmid=29522147 |issn=0021-972X|doi-access=free }}</ref>

=== Pharmacologic therapies ===
Common medications consist of antiandrogens, [[insulin sensitizer]]s, and [[oral contraceptive pill]]s. All three types of therapy have demonstrated efficacy on their own, however insulin sensitizers are shown to be less effective than antiandrogens and oral contraceptive pills.<ref name=":2">{{Cite journal |last1=Barrionuevo |first1=Patricia |last2=Nabhan |first2=Mohammed |last3=Altayar |first3=Osama |last4=Wang |first4=Zhen |last5=Erwin |first5=Patricia J |last6=Asi |first6=Noor |last7=Martin |first7=Kathryn A |last8=Murad |first8=M Hassan |date=2018-03-07 |title=Treatment Options for Hirsutism: A Systematic Review and Network Meta-Analysis |journal=The Journal of Clinical Endocrinology & Metabolism |volume=103 |issue=4 |pages=1258–1264 |doi=10.1210/jc.2017-02052 |pmid=29522176 |s2cid=3783739 |issn=0021-972X|doi-access=free }}</ref> The therapies may be combined, as directed by a physician, in line with the patient's medical goals. [[Antiandrogen]]s are drugs that block the effects of [[androgen]]s like [[testosterone]] and [[dihydrotestosterone]] (DHT) in the body.''<ref name="pmid21623779" />'' They are the most effective pharmacologic treatment for patient-important hirsutism, however they have [[teratogenic]] potential, and are therefore not recommended in people who are pregnant or desire pregnancy. Current data does not favor any one type of oral contraceptive over another.<ref name=":2" />

''List of medications:''
<!---♦♦♦ Please keep the list in alphabetical order ♦♦♦--->
* [[Bicalutamide]]: A pure antiandrogen.<ref name="WilliamsBigby2009">{{cite book |first1=Hywel |last1=Williams |first2=Michael |last2=Bigby |first3=Thomas |last3=Diepgen |first4=Andrew |last4=Herxheimer |first5=Luigi |last5=Naldi |first6=Berthold |last6=Rzany | name-list-style = vanc |title=Evidence-Based Dermatology |url=https://books.google.com/books?id=SbsQij5xkfYC&pg=PA529 |date=22 January 2009 |publisher=John Wiley & Sons |isbn=978-1-4443-0017-8 |pages=529–}}</ref><ref name="pmid24455796">{{cite journal | vauthors = Erem C | title = Update on idiopathic hirsutism: diagnosis and treatment | journal = Acta Clinica Belgica | volume = 68 | issue = 4 | pages = 268–74 | year = 2013 | pmid = 24455796 | doi = 10.2143/ACB.3267 | s2cid = 39120534 }}</ref><ref name="pmid11915584">{{cite journal | vauthors = Müderris II, Bayram F, Ozçelik B, Güven M | title = New alternative treatment in hirsutism: bicalutamide 25 mg/day | journal = Gynecological Endocrinology | volume = 16 | issue = 1 | pages = 63–6 | date = February 2002 | pmid = 11915584 | doi = 10.1080/gye.16.1.63.66 | s2cid = 6942048 }}</ref> It is effective similarly to flutamide but is much safer as well as better-tolerated.<ref name="WilliamsBigby2009" /><ref name="pmid24455796" /><ref name="pmid11915584" />
* [[Birth control pill]]s that consist of an [[estrogen]], usually [[ethinylestradiol]], and a [[progestin]] are supported by the evidence.<ref name=":1" /><ref name="Barr2018" /> They are functional antiandrogens. In addition, certain birth control pills contain a progestin that also has antiandrogenic activity.<ref name="Ekback2017">{{cite journal |last=Ekback |first=Maria Palmetun |year=2017 |title=Hirsutism, What to do? |url=https://www.researchgate.net/publication/321245014 |format=PDF |journal=International Journal of Endocrinology and Metabolic Disorders |volume=3 |issue=3 |doi=10.16966/2380-548X.140 |issn=2380-548X |doi-access=free}}</ref> Examples include birth control pills containing [[cyproterone acetate]], [[chlormadinone acetate]], [[drospirenone]], and [[dienogest]].<ref name="Ekback2017" /><ref name="Blume-PeytaviWhiting2008" />
* [[Cyproterone acetate]]: A dual antiandrogen and [[progestogen]].<ref name="pmid24889738" /> In addition to single form, it is also available in some formulations of combined oral contraceptives at a low dosage (see below).<ref name="pmid24889738" /> It has a risk of [[hepatotoxicity|liver damage]].
* [[Eflornithine]]: Blocks [[putrescine]] that is necessary for the growth of hair follicles.<ref>{{Cite journal |last1=Wolf |first1=John E. |last2=Shander |first2=Douglas |last3=Huber |first3=Ferdinand |last4=Jackson |first4=Joseph |last5=Lin |first5=Chen-Sheng |last6=Mathes |first6=Barbara M. |last7=Schrode |first7=Kathy |last8=the Eflornithine HCl Study Group |date=January 2007 |title=Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair: Eflornithine treatment for unwanted facial hair |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1365-4632.2006.03079.x |journal=International Journal of Dermatology |language=en |volume=46 |issue=1 |pages=94–98 |doi=10.1111/j.1365-4632.2006.03079.x|pmid=17214730 |s2cid=10795478 }}</ref>
* [[Finasteride]] and [[dutasteride]]: [[5α-Reductase inhibitor]]s.<ref name="Blume-PeytaviWhiting2008" /> They inhibit the production of the potent androgen DHT.<ref name="Blume-PeytaviWhiting2008" /> A meta-analysis showed inconsistent results of finasteride in the treatment of hirsutism.<ref name=":1" />
* [[Flutamide]]: A pure antiandrogen.<ref name="pmid24889738" /> It has been found to possess equivalent or greater effectiveness than spironolactone, cyproterone acetate, and [[finasteride]] in the treatment of hirsutism.<ref name="Publishers1999">{{cite book|author=Bentham Science Publishers|title=Current Pharmaceutical Design|url=https://books.google.com/books?id=9rfNZL6oEO0C&pg=PA717|date=September 1999|publisher=Bentham Science Publishers|pages=712–717}}</ref><ref name="pmid24889738" /> However, it has a high risk of liver damage and hence is no longer recommended as a first- or second-line treatment.<ref name="pmid28379593">{{cite journal | vauthors = Giorgetti R, di Muzio M, Giorgetti A, Girolami D, Borgia L, Tagliabracci A | title = Flutamide-induced hepatotoxicity: ethical and scientific issues | journal = Eur Rev Med Pharmacol Sci | volume = 21 | issue = 1 Suppl | pages = 69–77 | year = 2017 | pmid = 28379593 }}</ref><ref name="Ostrzenski2002">{{cite book|author=Adam Ostrzenski|title=Gynecology: Integrating Conventional, Complementary, and Natural Alternative Therapy|url=https://books.google.com/books?id=TYlZsGdwqrQC&pg=PA86|year=2002|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-2761-7|pages=86–}}</ref><ref name="Blume-PeytaviWhiting2008">{{cite book|author1=Ulrike Blume-Peytavi|author2=David A. Whiting|author3=Ralph M. Trüeb|title=Hair Growth and Disorders|url=https://books.google.com/books?id=pHrX2-huQCoC&pg=PA181|date=26 June 2008|publisher=Springer Science & Business Media|isbn=978-3-540-46911-7|pages=181–,369–}}</ref><ref name="Becker2001">{{cite book|author=Kenneth L. Becker|title=Principles and Practice of Endocrinology and Metabolism|url=https://books.google.com/books?id=FVfzRvaucq8C&pg=PA1196|year=2001|publisher=Lippincott Williams & Wilkins|isbn=978-0-7817-1750-2|pages=1196, 1208}}</ref> Flutamide is safe and effective.<ref name=":1">{{Cite journal|last1=van Zuuren|first1=Esther J|last2=Fedorowicz|first2=Zbys|last3=Carter|first3=Ben|last4=Pandis|first4=Nikolaos|date=2015-04-28|title=Interventions for hirsutism (excluding laser and photoepilation therapy alone)|url=http://www.cochrane.org/CD010334/SKIN_treatments-unwanted-male-pattern-hair-growth-women|journal=Cochrane Database of Systematic Reviews|volume=2015 |issue=4|pages=CD010334|language=en|doi=10.1002/14651858.CD010334.pub2|pmid=25918921|issn=1465-1858|pmc=6481758}}</ref>
* [[GnRH analogue]]s: Suppress androgen production by the gonads and reduce androgen concentrations to castrate levels.<ref>{{Cite journal |last1=Mongioi |first1=A. |last2=Maugeri |first2=G. |last3=Macchi |first3=M. |last4=Calogero |first4=A. |last5=Vicari |first5=E. |last6=Coniglione |first6=F. |last7=Aliffi |first7=A. |last8=Sipione |first8=C. |last9=D'Agata |first9=R. |date=February 1986 |title=Effect of gonadotrophin-releasing hormone analogue (GnRH-A) administration on serum gonadotrophin and steroid levels in patients with polycystic ovarian disease |url=https://pubmed.ncbi.nlm.nih.gov/3082098/ |journal=Acta Endocrinologica |volume=111 |issue=2 |pages=228–234 |doi=10.1530/acta.0.1110228 |issn=0001-5598 |pmid=3082098}}</ref>
* [[Metformin]]: Insulin sensitizer. Antihyperglycemic drug used for diabetes mellitus and treatment of hirsutism associated with insulin resistance (e.g. [[polycystic ovary syndrome]]). Metformin appears ineffective in the treatment of hirsutism, although the evidence was of low quality.<ref name=":1" />
* [[Spironolactone]]: An [[antimineralocorticoid]] with additional antiandrogenic activity at high dosages.<ref name="pmid18389188">{{cite journal |author=Karakurt F |title=Comparison of the clinical efficacy of flutamide and spironolactone plus ethinyloestradiol/cyproterone acetate in the treatment of hirsutism: a randomised controlled study |journal=Adv Ther |volume=25 |issue=4 |pages=321–8 |date=April 2008 |pmid=18389188 |doi=10.1007/s12325-008-0039-5 |name-list-style=vanc|author2=Sahin I |author3=Güler S |display-authors=3 |last4=Demirbas |first4=Berrin |last5=Culha |first5=Cavit |last6=Serter |first6=Rustu |last7=Aral |first7=Yalcin |last8=Bavbek |first8=Nuket|s2cid=23641936 }}</ref><ref name="pmid24889738">{{cite journal | vauthors = Somani N, Turvy D | title = Hirsutism: an evidence-based treatment update | journal = Am J Clin Dermatol | volume = 15 | issue = 3 | pages = 247–66 | year = 2014 | pmid = 24889738 | doi = 10.1007/s40257-014-0078-4 | s2cid = 45234892 }}</ref>

=== Other methods ===
<!---♦♦♦ Please keep the list in alphabetical order ♦♦♦--->
* [[Electrology]]
* [[Epilation]]
* [[Laser hair removal]]
* Lifestyle change, including reducing excessive weight and addressing [[insulin resistance]], may be beneficial. Insulin resistance can cause excessive testosterone levels in women, resulting in hirsutism.<ref>{{Cite journal |vauthors=Taylor SI, Dons RF, Hernandez E, Roth J, Gorden P | title = Insulin resistance associated with androgen excess in women with autoantibodies to the insulin receptor| pmid = 7149493 | volume=97 | issue=6 |date=December 1982 | pages=851–5 | doi=10.7326/0003-4819-97-6-851 | journal=Ann. Intern. Med.}}</ref>
* [[Shaving]]
* [[Waxing]]