Which hormones should be checked for hirsutism in a female?

From the Guidelines

For abnormal hair growth in a girl, the most critical hormones to check are total and free testosterone, dehydroepiandrosterone sulfate (DHEAS), androstenedione, and 17-hydroxyprogesterone, as well as luteinizing hormone (LH) and follicle-stimulating hormone (FSH) to assess the LH:FSH ratio, which can help identify polycystic ovary syndrome (PCOS) 1. When evaluating a girl with abnormal hair growth, it is essential to consider the potential underlying causes, with PCOS being one of the most common.

• The diagnostic workup should include the measurement of androgens such as total and free testosterone, DHEAS, androstenedione, and 17-hydroxyprogesterone, as these can help identify biochemical hyperandrogenism, a key feature of PCOS 1.
• Additionally, assessing the LH:FSH ratio by measuring LH and FSH levels can aid in the diagnosis of PCOS, as an elevated LH:FSH ratio is often seen in this condition 1.
• Other important tests include thyroid function tests (TSH, free T4) and prolactin levels to rule out thyroid disorders and hyperprolactinemia, which can also contribute to abnormal hair growth 1.
• If Cushing's syndrome is suspected, cortisol levels should be evaluated, as this condition can also cause hirsutism 1. The timing of these blood tests is crucial, ideally performed in the early follicular phase of the menstrual cycle (days 3-5) for accurate results 1. It is also important to note that the measurement of androgens can be challenging, and the choice of assay method can impact the results, with liquid chromatography-tandem mass spectrometry (LC-MS/MS) being considered the reference standard 1.
• However, in clinical practice, immunoassay methods are often used, and it is essential to be aware of their limitations and potential sources of error 1. Early identification of the underlying cause of abnormal hair growth allows for appropriate treatment, which may include oral contraceptives, anti-androgens like spironolactone, or specific treatments for the underlying condition, ultimately improving the girl's quality of life and reducing the risk of long-term complications 1.

From the Research

Abnormal Hair Growth in Girls

To evaluate abnormal hair growth in girls, several hormones should be checked, including:

• Androgen levels, such as testosterone and dihydrotestosterone (DHT) 2, 3
• Dehydroepiandrosterone (DHEA) and its sulfate (DHEAS), which are major adrenal androgen precursors 4, 5
• 11-oxygenated androgens, such as 11β-hydroxyandrostenedione (11OHA4) and 11-ketotestosterone, which have emerged as major components of several disorders of androgen excess 4

Hormone Testing

Hormone testing is essential to determine the underlying cause of abnormal hair growth in girls. The following tests may be recommended:

• Serum testosterone level, as a level >200 ng/dL is highly suggestive of adrenal or ovarian tumor 3
• Serum DHEA and DHEAS levels, as they can indicate adrenal androgen excess 4, 6
• Other hormone tests, such as 17-hydroxy-progesterone (17-OHP) and androstenedione, may also be necessary to evaluate androgen biosynthesis pathways 6

Diagnosis and Treatment

The diagnosis and treatment of abnormal hair growth in girls depend on the underlying cause. The following approaches may be considered:

• Evaluation of excess hair growth using a standardized score, such as the hirsutism score 2
• Pharmacological therapy, such as oral combined estrogen-progestin contraceptives, antiandrogens, and insulin-lowering drugs 2, 3
• Cosmetic treatments, such as laser/photoepilation, electrolysis, and hair removal methods 2, 3