Clinico-investigative attributes of 122 patients with hirsutism: A 5-year retrospective study from India

BACKGROUND: Hirsutism is common across ethnicities and a significant cause of negative self-esteem from presumptive loss of femininity. It remains understudied in Indian patients. OBJECTIVE: We studied the clinical and investigative attributes of patients with hirsutism. METHODS: The medical records of 233 patients with hirsutism diagnosed between 2014 and 2019 were analyzed retrospectively. RESULTS: The complete records of 122 patients age 14 to 45 years were available. Approximately 32% were adolescents, and 50% patients were age 21 to 30 years. The mean ± standard deviation modified Ferriman–Gallway (mF–G) score was 17.95 ± 10.58, and hirsutism was graded zero/mild in 57.4% patients. Polycystic ovaries were present in 29.5% of patients. Serum-free testosterone levels were elevated in 16.4% of patients. Associated signs of clinical hyperandrogenism, such as acne, obesity, acanthosis nigricans, and menstrual irregularities, were present in 12 patients (9.8%). Familial hirsutism occurred in 13% of patients and was idiopathic in 10.7% of patients. Significantly more patients (47.7% vs. 27.9%) with severe hirsutism did not complete investigations compared with those with mild hirsutism (45.9% vs. 21.6%), which may be due to the high cost of investigative work-up (as often stated by many patients) compared with periodic depilation. LIMITATIONS: The mF–G score is a visual and subjective scale, and its validity remains limited by interobserver variations. The score’s cut-off values may vary among races/ethnicities. A small number of patients and the retrospective study design are other limitations. CONCLUSION: Hirsutism of polycystic ovary syndrome or idiopathic origin is not uncommon in Indian women. Hirsutism of adrenal or thyroid origin remains uncommon. Self-referral and high cosmetic concerns for facial hair were common in adolescents and young unmarried patients, and the majority had an mF–G score of < 8 to 16. Cut-off values for the mF–G score specific to our population assigning higher than current mF–G value to facial hair are highly desirable.