Investigation of hirsutism
| Diagnosis | Investigation/test |
|---|---|
| Mild, chronic hirsutism, regular cycles | No tests? (or testosterone, pelvic ultrasonography) |
| Moderate hirsutism with or without cycle disturbance | Testosterone, LH, FSH, ultrasonography |
| Severe hirsutism, short history, testosterone >5 nmol/l* | DHEAS, 17-OHP, dexamethasone suppression test, 24-hour urine free cortisol, ovarian and/or adrenal imaging, fasting glucose/insulin |
↵* Extensive investigation should be reserved for more severe cases and/or those with a short history of hirsutism or with markedly elevated serum testosterone (i.e. > twice upper limit of normal range for the laboratory).
DHEAS, dehydroepiandrosterone sulphate; FSH, follicle-stimulating hormone; LH, luteinising hormone; 17-OHP, 17-hydroxyprogesterone (usually measured before and during a short Synacthen test).