| Polycystic ovary syndrome | 72 to 82 | Irregular menses |
| Normal to mildly elevated androgen levels |
| Polycystic ovaries on ultrasonography |
| Central obesity |
| Infertility |
| Insulin resistance |
| Acanthosis nigricans |
| Idiopathic hyperandrogenemia | 6 to 15 | Normal menses |
| Normal ovaries on ultrasonography |
| Elevated androgen levels |
| No other explainable cause |
| Idiopathic hirsutism | 4 to 7 | Normal menses, androgen levels, and ovaries on ultrasonography |
| No other explainable cause |
| Adrenal hyperplasia | 2 to 4 | Family history of congenital adrenal hyperplasia |
| High-risk ethnic group (e.g., Ashkenazi Jews [1 in 27], Hispanic persons [1 in 40], Slavs [1 in 50]) |
| Classic form: ambiguous genitalia at birth |
| Nonclassic, late-onset form: menstrual dysfunction, oligoanovulation, infertility |
| Elevated 17-hydroxyprogesterone level before and after corticotropin stimulation test |
| Androgen-secreting tumors | 0.2 | Rapid onset of hirsutism |
| Progression of hirsutism despite treatment |
| Virilization (e.g., clitoromegaly, increased muscle mass, loss of female body contour) |
| Palpable abdominal or pelvic mass |
| Early morning total testosterone level greater than200 ng per dL (6.94 nmol per L) |
| Iatrogenic hirsutism | Uncommon (exact percentage not well-defined in the literature) | Medication history (see Table 2) |
| Acromegaly | Rare to present with isolated hirsutism | Frontal bossing, increased hand and foot size, mandibular enlargement, coarse facial features, hyperhidrosis, deepened voice |
| Elevated serum insulin-like growth factor 1 |
| Cushing syndrome | Rare to present with isolated hirsutism | Central obesity, moon facies, purple skin striae, proximal muscle weakness, acne |
| Hypertension, impaired glucose tolerance |
| Elevated 24-hour urine free cortisol level |
| Hyperprolactinemia | Rare to present with isolated hirsutism | Galactorrhea, amenorrhea, infertility |
| Elevated prolactin level |
| Thyroid dysfunction | Rare to present with isolated hirsutism | Hypothyroidism: fatigue, cold intolerance, dry skin, hair loss, myxedema, weight gain, difficulty concentrating, irregular menses |
| Hyperthyroidism: hyperactivity, heat intolerance, moist skin, palpitations, oligomenorrhea, goiter, exophthalmos |
| Abnormal thyroid function tests |
