Hirsutism and virilism in women.
Level 5 - mechanism / opinion, no new human data
Narrative clinical review without original data or systematic search protocol
What was done
This was a narrative clinical review synthesizing the etiology, pathophysiology, diagnostic evaluation, and treatment modalities for hirsutism and virilization in women. No original clinical trial data or systematic literature search methods were reported in the abstract.
What was found
The abstract reports that normal female testosterone production averages 0.2 mg/day, sourced 25% from the ovaries, 25% from the adrenals, and 50% from peripheral conversion of prehormones (notably androstenedione). Elevated testosterone from adrenal or ovarian sources stimulates follicular 5α-reductase activity, generating dihydrotestosterone locally to drive terminal hair growth. The most common etiologies are non-tumorous ovarian disorders (the androgenized ovary syndrome spectrum, including polycystic ovary syndrome and hyperthecosis), associated with increased pulsatile and tonic luteinizing hormone secretion. Plasma total testosterone, free testosterone, and androstanediol glucuronide provide the primary diagnostic markers. Management relies on combined approaches utilizing local hair removal alongside systemic androgen suppression via oral contraceptives, continuous progestins, glucocorticoids, or antiandrogens.
Why it matters
The review outlines the hormonal pathways governing female hair follicle stimulation, clarifying the role of local follicular conversion of testosterone to dihydrotestosterone. It also provides a structured clinical rationale for combined hormonal suppression and mechanical hair removal in hyperandrogenic disorders.
Limits
The paper is an unsystematic narrative review from 1984, presenting mechanism-based reasoning and expert clinical consensus rather than primary trial evidence. The abstract provides no sample sizes, specific diagnostic threshold values, or quantitative outcome measures comparing treatment efficacies.
Cited by
- supports In women, a substantial portion of testosterone is produced by adrenal synthesis and peripheral tissue conversion rather than solely by the ovaries.