INTRODUCTION
Hirsutism is defined as the growth of excessive terminal hair in androgen-dependent sites in females.1 Hirsutism affects 10% to 20% of women,2 having a major impact on their quality of life.3
Hirsutism can be idiopathic or secondary to ovarian etiology (eg, polycystic ovarian syndrome (PCOS) and ovarian tumors), adrenal etiology (eg, congenital adrenal hyperplasia, Cushing syndrome, and adrenal virilizing tumors), or pituitary etiology (eg, Cushing disease or hyperprolactinemia), or can be drug-induced.4 PCOS is the most common cause of hirsutism in affected patients.5 Affected patients present with hyperandrogenism, menstrual irregularities, infertility, and dysmetabolic syndrome.4
Treatment options for hirsutism include pharmacological therapies, such as oral contraceptive pills, antiandrogens, insulin sensitizers, and topical eflornithine, and cosmetic maneuvers including laser hair removal, shaving, waxing, plucking, bleaching, chemical treatment, and electrolysis.2 Laser-assisted hair removal is supported as a viable therapy for the treatment of hirsutism.6,7 Metformin is a well-known insulin sensitizer that works in the context of hirsutism by reducing the circulating insulin levels, which subsequently decreases the concentration of free circulating androgens.8 Hormonal treatments include oral contraceptive pills and antiandrogens in the form of spironolactone, cyproterone acetate, finasteride, and nonsteroidal antiandrogens such as flutamide.9
Hirsutism can be idiopathic or secondary to ovarian etiology (eg, polycystic ovarian syndrome (PCOS) and ovarian tumors), adrenal etiology (eg, congenital adrenal hyperplasia, Cushing syndrome, and adrenal virilizing tumors), or pituitary etiology (eg, Cushing disease or hyperprolactinemia), or can be drug-induced.4 PCOS is the most common cause of hirsutism in affected patients.5 Affected patients present with hyperandrogenism, menstrual irregularities, infertility, and dysmetabolic syndrome.4
Treatment options for hirsutism include pharmacological therapies, such as oral contraceptive pills, antiandrogens, insulin sensitizers, and topical eflornithine, and cosmetic maneuvers including laser hair removal, shaving, waxing, plucking, bleaching, chemical treatment, and electrolysis.2 Laser-assisted hair removal is supported as a viable therapy for the treatment of hirsutism.6,7 Metformin is a well-known insulin sensitizer that works in the context of hirsutism by reducing the circulating insulin levels, which subsequently decreases the concentration of free circulating androgens.8 Hormonal treatments include oral contraceptive pills and antiandrogens in the form of spironolactone, cyproterone acetate, finasteride, and nonsteroidal antiandrogens such as flutamide.9
PATIENTS AND METHODS
This was a single-center, prospective, balanced randomization (allocation ratio 1:1:1), controlled study.
One hundred fifty women were enrolled in the present study after providing informed written consent. The inclusion criteria were an age of 18 to 40 years with a confirmed diagnosis of PCOS according to the Rotterdam criteria10 and facial hirsutism as assessed by the Ferriman–Gallwey score. Hirsute patients with
One hundred fifty women were enrolled in the present study after providing informed written consent. The inclusion criteria were an age of 18 to 40 years with a confirmed diagnosis of PCOS according to the Rotterdam criteria10 and facial hirsutism as assessed by the Ferriman–Gallwey score. Hirsute patients with
