Excess Body Hair

Differential Diagnosis

Common Diagnoses

Occasional Diagnoses

  • Congenital Adrenal Hyperplasia (1 in 5000)
  • Anabolic Steroid Abuse
  • Ovarian Tumours: Arrhenoblastoma, Hilus Cell Tumour, Luteoma
  • Adrenal Tumours: Carcinoma and Adenoma
  • Congenital (1 in 5000 Live Births) and Juvenile Hypothyroidism

Rare Diagnoses

Ready Reckoner

Key distinguishing features of the most common diagnoses

Excess Vellous HairNoNoYesNoPossible
Facial HirsutismPossiblePossibleNoYesPossible
Otherwise WellYesYesNoPossiblePossible
Weight LossNoNoYesNoNo

Possible Investigations


Possible:Serum testosterone, SHBG, pelvic ultrasound, FBC, U&E, TFT.

Small Print:FSH/LH, other tests of endocrine function and specialised imaging techniques (for adrenal/pituitary disorders), urinary porphyrins.

  • Serum testosterone and SHBG: Probably the most useful investigation. Mild elevation (up to three times the normal value) and normal or low SHBG suggests PCOS; testosterone levels above this indicate a possible tumour.
  • FBC, U&E: Possible iron deficiency anaemia and electrolyte disturbance in anorexia; U&E may be deranged in adrenal disorders.
  • FSH/LH and TFT: The former may help to confirm menopause and may point towards PCOS (elevated LH, normal FSH); the latter reveals hypothyroidism.
  • Other tests of endocrine function and imaging techniques: To investigate possible adrenal and pituitary disorders (usually undertaken in secondary care).
  • Pelvic ultrasound: Multiple ovarian cysts characteristic of PCOS; may also reveal ovarian tumour.
  • Urinary porphyrins: For porphyria.

Top Tips

  • Mild, long-standing hirsutism does not require investigation.
  • Enquire about self-medication, especially in athletes – anabolic steroids may occasionally be the cause.
  • Take the problem seriously and be prepared for questions about cosmetic treatments such as bleaching, depilatory creams and electrolysis.

Red Flags

  • Sudden and severe hirsutism is the most important marker for serious underlying pathology.
  • Other clues suggesting a possible hormone-secreting tumour include amenorrhoea, onset of baldness at the same time as hirsutism and a patient who seems generally unwell.
  • Consider psychological factors: Hirsutism can cause – or be the presenting complaint in – significant depression.
  • Recent onset of significant headache and visual field defect raise the possibility of a pituitary adenoma.

Published: 2nd August 2022 Updated: 10th April 2024

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