Hirsutism Time questions: How long has this been happening for? Episodic or constant? How has this been changing over time? Have you had anything like this before? Location: Patient may only say about areas that they are concerned about such as the face and may ignore other areas, especially those covered by clothes so ask about them. Rate of her growth Rating the severity Colour and thickness of the hair. Ideas of what could have triggered it. Did anything in their life change around that time? How has this been affecting their life? Anything makes it worse? Anything makes it better? Associated features Menstrual abnormalities Acne Oily skin Alopecia (androgenic) Acanthosis nigricans (maker of insulin resistance) Laryngeal hypertrophy -> voice changes. Loss of feminine body counter Clitoral hypertrophy -> clitoral length time diameter greater than 35 mm^2. Fertility issues Painful sexual intercourse Weight changes Family history Medications history Medical history Social history Sexual history Diet Smoking Alcohol Recreational drugs Occupation Stress Travel Differentials PCOS Menstrual irregularities Difficulty conceiving Insulin resistance and metabolic syndrome Hirsutism Androgenic alopecia Acne Oily skin Acanthosis nigricans. HAIR – AN syndrome -> hyperandrogenism, insulin resistance and acanthosis nigricans - subtype of PCOS Ovarian hyperthecosis Worsening hirsutism Virilization -> when a female develops male characteristics Severe insulin abnormalities Mainly seen in post-menopausal women Cushing syndrome Hirsutism Acne Striae Flushing of the face Easily bruised skin with ecchymoses Weight gain Anxiety and irritability Depression Sleep disturbance Osteopenia and increased fracture risk Muscle atrophy and weakness Decreased libido Androgen secreting tumours Hirsutism Body hair growth Hair loss Irregular menstrual cycle Voice deepening Hyperprolactinemia Galactorrhea, esp. in females, but rare in males. Irregular menstrual cycle Loss of libido Low testosterone If male hair loss Osteoporosis Pregnancy Exogenous androgens