The prevalence of androgen excess among patients with minimal unwanted hair growth


      The prevalence of androgen excess (AE) and the value of preemptive endocrine evaluation in women with minimal unwanted hair growth are unclear.


      A total of 228 patients presented with minimal unwanted hair growth and a mF-G score of 5 or less. Total and free testosterone, dehydroepiandrosterone sulfate, 17-hydroxy-progesterone, sex hormone-binding globulin, and basal insulin and glucose levels were measured.


      Of the patients, 54% demonstrated an AE disorder (50%: polycystic ovary syndrome, 2%: hyperandrogenic insulin-resistant acanthosis nigricans syndrome, 2%: nonclassic adrenal hyperplasia), 29% isolated oligoovulation, 6% isolated hyperandrogenemia, and 10% had a normal evaluation. Of the patients with menstrual irregularities, 65% had an underlying AE disorder compared with 22% of those with normal menstrual function (P < .001). Of eumenorrheic patients, 11% had oligo-ovulation and an AE disorder.


      Patients with minimal unwanted hair growth should be evaluated endocrinologically because approximately 50% of subjects demonstrate an AE disorder. Eumenorrhea does not preclude an underlying AE disorder, and ovulatory function should be assessed in these women.

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        • Ferriman D.
        • Gallwey J.D.
        Clinical assessment of body hair growth in women.
        J Clin Endocrinol Metabol. 1961; 21: 1440-1447
        • McKnight E.
        The prevalence of “hirsutism” in young women.
        Lancet. 1964; 1: 410-413
        • Hartz A.J.
        • Barboriak P.N.
        • Wong A.
        • Katayama K.P.
        • Rimm A.A.
        The association of obesity with infertility and related menstrual abnormalities in women.
        Int J Obes. 1979; 3: 57-73
        • Knochenhauer E.S.
        • Key T.J.
        • Kahsar-Miller M.
        • Waggoner W.
        • Boots L.R.
        • Azziz R.
        Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study.
        J Clin Endocrinol Metabol. 1998; 83: 3078-3082
        • Hatch R.
        • Rosenfield R.L.
        • Kim M.H.
        • Tredway D.
        Hirsutism: implications, etiology and management.
        Am J Obstet Gynecol. 1981; 140: 815-830
        • O'Driscoll J.B.
        • Mamtora H.
        • Higginson J.
        • Pollock A.
        • Kane J.
        • Anderson D.C.
        A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia.
        Clin Endocrinol. 1994; 41: 231-236
        • Moran C.
        • Tapia M del C.
        • Hernandez E.
        • Vasquez G.
        • Garcia-Hernandez E.
        • Bermudez J.A.
        Etiological review of hirsutism in 250 patients.
        Arch Med Res. 1994; 25: 311-314
        • Diamanti-Kandarakis E.
        • Kouli C.R.
        • Bergielle A.T.
        • Filandra F.A.
        • Tsianatelli T.C.
        • Spina G.G.
        • et al.
        A survey of the polycystic ovary syndrome in the Greek island of Lesbos: hormonal and metabolic profile.
        J Clin Endocrinol Metab. 1999; 84: 4006-4011
        • Asuncion M.
        • Calvo R.M.
        • San Millan J.L.
        • Sancho J.
        • Avila S.
        • Escobar-Morreale H.F.
        A prospective study of the prevalence of the polycystic ovary syndrome in unselected caucasian women from Spain.
        J Clin Endocrinol Metab. 2000; 84: 4006-4011
        • Azziz R.
        • Sanchez L.A.
        • Knochenhauer E.S.
        • Moran C.
        • Lazenby J.
        • Stephens K.C.
        • et al.
        Androgen excess in women: experience with over 1000 consecutive patients.
        J Clin Endocrinol Metab. 2004; 89: 453-462
      1. World Health Organization. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation of Obesity. Geneva, June 3–5, 1997.

      2. National Center for Health. Healthy weight, overweight, and obesity among persons 20 years of age and over according to sex, age, race, and Hispanic origin: United States, 1960-62, 1971-74, 1976-80, 1988-94, 1999–2000.
        in: Pastor P. Makuc D.M. Reuben C. Xia H. Health, United States, 2002 with chartbook on trends in health of Americans. National Center for Health Statistics, Hyattsville (MD)2002 (Table 7)
        • Treloar A.E.
        • Boynton R.E.
        • Behn B.G.
        • Brown B.W.
        Variation of the human menstrual cycle through reproductive life.
        Int J Fertil. 1967; 12: 77-126
        • Azziz R.
        • Hincapie L.
        • Knochenhauer E.S.
        • Dewailly D.
        • Fox L.
        • Boots L.R.
        Screening for 21-hydroxylase deficient non-classic adrenal hyperplasia among hyperandrogenic women: a prospective study.
        Fertil Steril. 1999; 72: 915-925
        • Barbieri R.L.
        • Ryan K.J.
        Hyperandrogenism, insulin resistance, and acanthosis nigricans syndrome: a common endocrinopathy with distinct pathophysiologic features.
        Am J Obstet Gynecol. 1983; 147: 90-101
        • Moller D.E.
        • Cohen O.
        • Yamaguchi Y.
        • Assiz R.
        • Grigorescu F.
        • Eberle A.
        • et al.
        Prevalence of mutations in the insulin receptor gene in subjects with features of the type A syndrome of insulin resistance.
        Diabetes. 1994; 43: 247-255
        • Zawadzki J.K.
        • Dunaif A.
        Diagnostic criteria for polycystic ovary syndrome: towards a rational approach.
        in: Dunaif A. Givens J.R. Haseltine F. Merriam G.R. Polycystic ovary syndrome. Blackwell Scientific Publications, Boston1992: 377-384
      3. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome.
        Fertil Steril. 2004; 81: 19-25
      4. The Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS).
        Hum Reprod. 2004; 19: 41-47
        • Farah L.
        • Lazenby A.J.
        • Boots L.R.
        • Azziz R.
        Prevalence of polycystic ovary syndrome in women seeking treatment from community electrologists. Alabama Professional Electrology Association Study Group.
        J Reprod Med. 1999; 44: 870-874
        • Lawrence D.M.
        • Katz M.
        • Robinson T.W.E.
        • Newman M.C.
        • McGarrigle H.H.G.
        • Shaw M.
        • et al.
        Reduced sex hormone binding globulin and derived free testosterone levels in women with severe acne.
        Clin Endocrinol. 1981; 15: 87-91
        • Lucky A.W.
        • McGuire J.
        • Rosenfield R.L.
        • Lucky P.A.
        • Rich B.H.
        Plasma androgens in women with acne vulgaris.
        J Invest Dermatol. 1983; 81: 70-74
        • Schiavone F.E.
        • Rietschel R.L.
        • Sgoutas D.
        • Harris R.
        Elevated free testosterone levels in women with acne.
        Arch Dermatol. 1983; 119: 799-802
        • Vexiau P.
        • Husson C.
        • Chivot M.
        • Brerault J.L.
        • Fiet J.
        • Julien R.
        • et al.
        Androgen excess in women with acne alone compared with women with acne and/or hirsutism.
        J Invest Dermatol. 1990; 94: 279-283
        • Aizawa H.
        • Niimura M.
        Adrenal androgen abnormalities in women with late onset and persistent acne.
        Arch Dermatol Res. 1993; 284: 451-455
        • Slayden S.M.
        • Moran C.
        • Sams Jr., W.M.
        • Boots L.R.
        • Azziz R.
        Hyperandrogenemia in patients presenting with acne.
        Fertil Steril. 2001; 75: 889-892
        • Azziz R.
        • Waggoner W.T.
        • Ochoa T.
        • Knochenhauer E.S.
        • Boots L.R.
        Idiopathic hirsutism: an uncommon cause of hirsutism in Alabama.
        Fertil Steril. 1998; 70: 274-278
        • Carmina E.
        Prevalence of idiopathic hirsutism.
        Eur J Endocrinol. 1998; 139: 421-423
        • Balen A.H.
        • Conway G.S.
        • Kaltsas G.
        • Techatrasak K.
        • Manning P.J.
        • West C.
        • et al.
        Polycystic ovary syndrome: the spectrum of the disoeder in 1741 patients.
        Human Reprod. 1995; 10: 2107-2111
        • Pugeat M.
        • Nicolas M.H.
        • Craves J.C.
        • Alvarado-Dubost C.
        • Fimbel S.
        • Cechaud H.
        • et al.
        Androgens in polycystic ovarian syndrome.
        Ann NY Acad Sci. 1993; 687: 124-135
        • Ferriman D.
        • Purdie A.W.
        The etiology of oligomenorrhea and/or hirsuties: a study of 467 patients.
        Postgrad Med J. 1983; 59: 17-20