Merck Manual

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Some Causes and Features of Hirsutism

Some Causes and Features of Hirsutism


Common Features*


Adrenal gland disorders

Adrenal hyperplasia (enlarged adrenal glands that produce abnormally large amounts of male hormones)

Development of masculine characteristics (virilization), such as a deepened voice, baldness, an enlarged clitoris, increased muscle size, irregular or absent menstrual periods, and acne

When adrenal hyperplasia is present at birth, external genital organs that are not clearly male or female (ambiguous)

Blood and sometimes urine tests to measure hormone levels

A dexamethasone suppression test (dexamethasone, taken by mouth, followed several hours later by a blood test to measure hormone levels)

Adrenal tumors (usually cancerous)

Development of masculine characteristics if an adrenal tumor produces excess androgens (like testosterone), or if the person has Cushing syndrome (an adrenal tumor that makes excess cortisol [see below])


Blood and urine tests to measure hormone levels

Excess fat throughout the torso, a pad of fat between the shoulders (buffalo hump), thin arms and legs, purple stretch marks on the abdomen, easy bruising, a large and round face (moon face), high blood pressure High Blood Pressure High Blood Pressure , and diabetes mellitus Diabetes Mellitus (DM)

Urine and usually blood tests to measure the level of cortisol (which may be high in Cushing syndrome)

Usually a dexamethasone suppression test

No disorder present

Familial hirsutism

Hirsutism in family members

No other symptoms (normal menstrual cycles and no other masculine characteristics)

A doctor’s examination

Blood tests to measure hormone levels (which are normal)

Ovarian disorders

Hirsutism that begins after puberty

Development of masculine characteristics, obesity, infertility, menstrual irregularities, acne, loss of scalp hair, decreased sensitivity to insulin, and darkened and thickened skin in the underarms, on the nape of the neck, and in skinfolds (acanthosis nigricans)

A doctor’s examination

Blood tests to measure levels of hormones, such as testosterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH)

Usually ultrasonography


Sometimes one or more of the following symptoms, which often begin suddenly:

  • Pelvic pain

  • Abdominal swelling or bloating

  • Weight loss

  • Development of other masculine characteristics


Sometimes CT or MRI

Pituitary disorders

A pituitary adenoma (a noncancerous tumor) that secretes prolactin

Production of breast milk in women who are not breastfeeding ( galactorrhea Galactorrhea )

No menstrual periods

Sometimes vision problems

Blood tests to measure the level of prolactin

CT or MRI of the brain

A pituitary disorder that causes Cushing disease (such as a pituitary tumor)

Blood and sometimes urine tests to measure the level of cortisol (which may be high)

A dexamethasone suppression test

MRI of the brain


Androgenic drugs:

  • Anabolic steroids Anabolic Steroids , including those taken to enhance athletic performance, such as testosterone products and danazol

  • Birth control pills or other contraceptives that have a high dose of progesterone

Development of male characteristics

Use of anabolic steroids (sometimes not admitted by the user)

A doctor's examination

* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.

CT = computed tomography; MRI = magnetic resonance imaging.