Hirsutism
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Hirsutism
Laboratory tests to be done 3 months after stopping any hormonal contraception
- Total testosterone
- SHBG (to calculate the free androgen index)
- DHEA-S (if testosterone normal)if needednon-French guidelineIf testosterone is normal. DHEA-S and androstenedione add little further information for the diagnosis of PCOS but are more useful to exclude another cause of hyperandrogenism [3].
- LH
- FSH
- 17-hydroxyprogesterone (in the morning, in the follicular phase)
- Serum prolactin
- TSH
Do not order
Hirsutism in adult women
Laboratory tests to be done 3 months after stopping any hormonal contraception
- Total testosterone
- SHBG (to calculate the free androgen index)if neededEstimate free testosterone with the free androgen index, recommended by the international guidelines; the French Society of Endocrinology (2010) retains total testosterone first-line [2,4].
- 17-hydroxyprogesterone (in the morning, in the follicular phase)
- Serum prolactin
- TSH
- Delta-4-androstenedione (if testosterone normal)if needednon-French guidelineNormal total and free testosterone while hyperandrogenism is still suspected: can be measured, bearing in mind its lower specificity and the fall in DHEA-S with age [2].
- DHEA-S (if testosterone normal, or if testosterone > 2 times normal)if neededNormal testosterone: lower specificity [2]; testosterone above twice the upper limit: DHEA-S points to an adrenal tumour (high level) or ovarian tumour (normal level) [4].
Do not order
- Androgen measurement in a woman with regular cycles and simple unwanted local hair growth without an abnormal hirsutism score: not suggested [5].
Sources (9)
- Escobar-Morreale HF, Carmina E, Dewailly D, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012;18(2):146-70.
- Teede HJ, Tay CT, Laven JJE, et al. Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Hum Reprod. 2023.
- Peña, A.S., Witchel, S.F., Hoeger, K.M. et al. Adolescent polycystic ovary syndrome according to the international evidence-based guideline. BMC Med 18, 72 (2020). https://doi.org/10.1186/s12916-020-01516-x
- Pugeat M, Déchaud H, Raverot V, et al.; Société française d'endocrinologie. Recommendations for investigation of hyperandrogenism. Ann Endocrinol (Paris). 2010;71(1):2-7.
- 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(4):1233-1257.
- Matheson E, Bain J. Hirsutism in Women. Am Fam Physician. 2019;100(3):168-175.
- NHS Borders. Borders RefHelp Toolkit : Reproductive endocrinology. Right Decision Service (Écosse), prochaine révision prévue le 04/06/2027.
- Chen, Y., Tang, YJ., Li, X. et al. What can we do for the adolescents with polycystic ovary syndrome?. World J Pediatr 20, 1205–1208 (2024).
- Assurance maladie. Nomenclature des actes de biologie médicale (NABM), version 105 : acte 1802 (SDHEA).