Evaluation and Treatment of Hirsutism in Premenopausal Women

JAMA. 2018 Apr 17;319(15):1613-1614. doi: 10.1001/jama.2018.2611.


GUIDELINE TITLE: Evaluation and Treatment of Hirsutism in Premenopausal Women

DEVELOPER: Endocrine Society, Androgen Excess and Polycystic Ovary Syndrome Society, European Society of Endocrinology

RELEASE DATE: March 2018

PRIOR VERSION: February 5, 2008

FUNDING SOURCE: Endocrine Society

TARGET POPULATION: Premenopausal women with excess hair growth


  1. Obtain a random serum total testosterone measurement to assess for androgen excess in all women with an abnormal hirsutism score (weak recommendation, low-quality evidence).

  2. Obtain an early-morning 17-hydroxyprogesterone measurement in all women with elevated testosterone and in women with hirsutism who are at high risk of congenital adrenal hyperplasia (weak recommendation; low-quality evidence).

  3. Do not measure androgen levels in women with normal menses and a normal hirsutism score (weak recommendation; low-quality evidence).

Pharmacologic treatment:

  1. Start with pharmacologic therapy and add direct hair removal methods for women with a normal hirsutism score but patient-important hirsutism despite shaving or plucking (weak recommendation; very low-quality evidence). In women who are not seeking pregnancy, oral contraceptive pills (OCPs) are recommended as initial therapy (weak recommendation; low-quality evidence).

  2. Either OCPs or antiandrogens are acceptable initial therapies in women who are not sexually active, have undergone permanent sterilization, or are using long-acting reversible contraception (weak recommendation; very low-quality evidence).

  3. Combination therapy with an antiandrogen is recommended if patient-important hirsutism persists despite 6 months of monotherapy with an OCP (weak recommendation; low-quality evidence).

MeSH terms

  • 17-alpha-Hydroxyprogesterone / blood
  • Adult
  • Androgen Antagonists / therapeutic use*
  • Contraceptives, Oral, Hormonal / therapeutic use*
  • Female
  • Hair Removal*
  • Hirsutism / diagnosis*
  • Hirsutism / drug therapy*
  • Hirsutism / therapy
  • Humans
  • Polycystic Ovary Syndrome
  • Practice Guidelines as Topic
  • Premenopause
  • Testosterone / blood


  • Androgen Antagonists
  • Contraceptives, Oral, Hormonal
  • Testosterone
  • 17-alpha-Hydroxyprogesterone