Epidemiology, diagnosis and management of hirsutism: A consensus statement by the androgen excess and polycystic ovary syndrome society

Human Reproduction Update

Volumn 18, Issue 2, 2012, Pages 146-170

  Escobar Morreale, H F ^a   Carmina, E ^b   Dewailly, D ^c   Gambineri, A ^d   Kelestimur, F ^e   Moghetti, P ^f   Pugeat, M ^g   Qiao, J ^h   Wijeyaratne, C N ⁱ   Witchel, S F ^j   Norman, R J ^k  

^a HOSPITAL RAMÓN Y CAJAL   (Spain)

^b UNIVERSITY OF PALERMO   (Italy)

^c LILLE UNIVERSITY HOSPITAL   (France)

^d UNIVERSITY OF BOLOGNA   (Italy)

^e ERCIYES UNIVERSITY MEDICAL FACULTY   (Turkey)

^f UNIVERSITY HOSPITAL OF VERONA   (Italy)

^g UNIVERSITÉ LYON 1   (France)

^h PEKING UNIVERSITY THIRD HOSPITAL   (China)

ⁱ UNIVERSITY OF COLOMBO   (Sri Lanka)

^j CHILDREN S HOSPITAL OF PITTSBURGH   (United States)

^k UNIVERSITY OF ADELAIDE   (Australia)

more..

Author keywords

Androgen excess; Guidelines; Hirsutism; Polycystic ovary syndrome; Terminal hair

Indexed keywords

ANDROGEN RECEPTOR; ANDROSTANOLONE; CORTICOTROPIN; CYPROTERONE ACETATE; DIANE; EFLORNITHINE; FINASTERIDE; FLUTAMIDE; GLUCOCORTICOID; GONADORELIN DERIVATIVE; INSULIN SENSITIZING AGENT; KETOCONAZOLE; METFORMIN; ORAL CONTRACEPTIVE AGENT; PIOGLITAZONE; PLACEBO; PRASTERONE SULFATE; SPIRONOLACTONE; TROGLITAZONE;

AMENORRHEA; ANDROGEN RELEASE; ARTICLE; BLOOD PRESSURE MEASUREMENT; CONGENITAL ADRENAL HYPERPLASIA; DIET THERAPY; DIODE LASER; DRUG EFFICACY; ECHOGRAPHY; ELECTROLYSIS; ESTHETIC SURGERY; EXERCISE; HAIR FOLLICLE; HAIR GROWTH; HIRSUTISM; HUMAN; HYPERANDROGENISM; IDIOPATHIC DISEASE; LIFESTYLE MODIFICATION; LIQUID CHROMATOGRAPHY; LIVER TOXICITY; LOW DRUG DOSE; LOW LEVEL LASER THERAPY; MEDICAL HISTORY; METABOLIC PARAMETERS; MONOTHERAPY; MORPHOGENESIS; NONHUMAN; OVARY POLYCYSTIC DISEASE; OVULATION; PATHOPHYSIOLOGY; PHYSICAL EXAMINATION; PRIORITY JOURNAL; PSYCHOLOGICAL WELL BEING; RANDOMIZED CONTROLLED TRIAL (TOPIC); SEBACEOUS GLAND; SMOKING CESSATION; SYSTEMATIC REVIEW; TANDEM MASS SPECTROMETRY; THROMBOPHILIA;

ANDROGENS; FEMALE; HAIR FOLLICLE; HIRSUTISM; HUMANS; POLYCYSTIC OVARY SYNDROME; SOCIETIES, MEDICAL;

EID: 84857564953     PISSN: 13554786     EISSN: 14602369     Source Type: Journal    
DOI: 10.1093/humupd/dmr042     Document Type: Article

References (206)

1. Akalin S. Effects of ketoconazole in hirsute women. Acta Endocrinol (Copenh) 1991; 124:19-22.
2. Allen HF, Mazzoni C, Heptulla RA, Murray MA, Miller N, Koenigs L, Reiter EO. Randomized controlled trial evaluating response to metformin versus standard therapy in the treatment of adolescents with polycystic ovary syndrome. J Pediatr Endocrinol Metab 2005;18:761-768.
3. Andl T, Reddy ST, Gaddapara T, Millar SE. WNT signals are required for the initiation of hair follicle development. Dev Cell 2002;2:643-653.
4. Api M, Badoglu B, Akca A, Api O, Gorgen H, Cetin A. Interobserver variability of modified Ferriman-Gallwey hirsutism score in a Turkish population. Arch Gynecol Obstet 2009;279:473-479.
5. Aroda VR, Ciaraldi TP, Burke P, Mudaliar S, Clopton P, Phillips S, Chang RJ, Henry RR. Metabolic and hormonal changes induced by pioglitazone in polycystic ovary syndrome: a randomized, placebo-controlled clinical trial. J Clin Endocrinol Metab 2009;94:469-476.
6. Asuncion M, Calvo RM, San Millan JL, Sancho J, Avila S, Escobar-Morreale HF. A prospective study of the prevalence of the polycystic ovary syndrome in unselected Caucasian women from Spain. J Clin Endocrinol Metab 2000;85:2434-2438.
7. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D et al. Grading quality of evidence and strength of recommendations. Br Med J 2004;328:1490.
8. Auchus RJ, Rainey WE. Adrenarche - physiology, biochemistry and human disease. Clin Endocrinol (Oxf) 2004;60:288-296.
9. Azziz R,Waggoner WT, Ochoa T, Knochenhauer ES, Boots LR. Idiopathic hirsutism: an uncommon cause of hirsutism in Alabama. Fertil Steril 1998;70:274-278.
10. Azziz R, Hincapie LA, Knochenhauer ES, Dewailly D, Fox L, Boots LR. Screening for 21-hydroxylase-deficient nonclassic adrenal hyperplasia among hyperandrogenic women: a prospective study. Fertil Steril 1999;72:915-925.
11. Azziz R, Carmina E, Sawaya ME. Idiopathic hirsutism. Endocr Rev 2000;21:347-362.
12. Azziz R, Ehrmann D, Legro RS, Whitcomb RW, Hanley R, Fereshetian AG, O'Keefe M, Ghazzi MN. Troglitazone improves ovulation and hirsutism in the polycystic ovary syndrome: a multicenter, double blind, placebo-controlled trial. J Clin Endocrinol Metab 2001;86:1626-1632.
13. Azziz R, Woods KS, Reyna R, Key TJ, Knochenhauer ES, Yildiz BO. The prevalence and features of the polycystic ovary syndrome in an unselected population. J Clin Endocrinol Metab 2004;89:2745-2749.
14. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE et al. Position statement: criteria for defining polycystic ovary syndrome as a predominantly hyperandrogenic syndrome: an Androgen Excess Society guideline. J Clin Endocrinol Metab 2006;91:4237-4245.
15. Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009;91:456-488.
16. Balen AH, Laven JS, Tan SL, Dewailly D. Ultrasound assessment of the polycystic ovary: international consensus definitions. Hum Reprod Update 2003; 9:505-514.
17. Barber TM, Wass JA, McCarthy MI, Franks S. Metabolic characteristics of women with polycystic ovaries and oligo-amenorrhoea but normal androgen levels: implications for the management of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2007;66:513-517.
18. Barman Balfour JA, McClellan K. Topical Eflornithine. Am J Clin Dermatol 2001; 2:197-201.
19. Barth JH, Cherry CA, Wojnarowska F, Dawber RP. Cyproterone acetate for severe hirsutism: results of a double-blind dose-ranging study. Clin Endocrinol (Oxf) 1991; 35:5-10.
20. Barth JH, Catalan J, Cherry CA, Day A. Psychological morbidity in women referred for treatment of hirsutism. J Psychosom Res 1993;37:615-619.
21. Batukan C, Muderris II. Efficacy of a new oral contraceptive containing drospirenone and ethinyl estradiol in the long-term treatment of hirsutism. Fertil Steril 2006; 85:436-440.
22. Bayram F, Muderris II, Guven M, Kelestimur F. Comparison of high-dose finasteride (5 mg/day) versus low-dose finasteride (2.5 mg/day) in the treatment of hirsutism. Eur J Endocrinol 2002;147:467-471.
23. Beigi A, Sobhi A, Zarrinkoub F. Finasteride versus cyproterone acetate-estrogen regimens in the treatment of hirsutism. Int J Gynaecol Obstet 2004;87:29-33.
24. Belisle S, Love EJ. Clinical efficacy and safety of cyproterone acetate in severe hirsutism: results of a multicentered Canadian study. Fertil Steril 1986; 46:1015-1020.
25. Breitkopf DM, Rosen MP, Young SL, Nagamani M. Efficacy of second versus third generation oral contraceptives in the treatment of hirsutism. Contraception 2003;67:349-353.
26. Burger HG. Androgen production in women. Fertil Steril 2002;77 Suppl 4:S3-S5.
27. Calaf J, Lopez E, Millet A, Alcaniz J, Fortuny A, Vidal O, Callejo J, Escobar-Jimenez F, Torres E, Espinos JJ. Long-term efficacy and tolerability of flutamide combined with oral contraception in moderate to severe hirsutism: a 12-month, double-blind, parallel clinical trial. J Clin Endocrinol Metab 2007;92:3446-3452.
28. Calvo RM, Asuncion M, Sancho J, San Millan JL, Escobar-Morreale HF. The role of the CAG repeat polymorphism in the androgen receptor gene and of skewed X-chromosome inactivation, in the pathogenesis of hirsutism. J Clin Endocrinol Metab 2000;85:1735-1740.
29. Carmina E. The spectrum of androgen excess disorders. Fertil Steril 2006a; 85:1582-1585.
30. Carmina E. Mild androgen phenotypes. Best Pract Res Clin Endocrinol Metab 2006b; 20:207-220.
31. Carmina E, Lobo RA. The addition of dexamethasone to antiandrogen therapy for hirsutism prolongs the duration of remission. Fertil Steril 1998;69:1075-1079.
32. Carmina E, Lobo RA. Hirsutism, alopecia and acne. In: Becker KL (ed). Principles and Practice of Endocrinology and Metabolism. Philadelphia, PA: Lippincott Williams & Wilkins, 2001.
33. Carmina E, Orio F, Palomba S, Longo RA, Lombardi G, Lobo RA. Ovarian size and blood flow in women with polycystic ovary syndrome and their correlations with endocrine parameters. Fertil Steril 2005;84:413-419.
34. Carmina E, Rosato F, Janni A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab 2006; 91:2-6.
35. Casey JH, Burger HG, Kent JR, Kellie AE, Moxham A, Nabarro J, Nabarro JD. Treatment of hirsutism by adrenal and ovarian suppression. J Clin Endocrinol Metab 1966;26:1370-1374.
36. Castelo-Branco C, Del Pino M. Hepatotoxicity during low-dose flutamide treatment for hirsutism. Gynecol Endocrinol 2009;25:419-422.
37. Castelo-Branco C, Moyano D, Gomez O, Balasch J. Long-term safety and tolerability of flutamide for the treatment of hirsutism. Fertil Steril 2009;91:1183-1188.
38. Cheewadhanaraks S, Peeyananjarassri K, Choksuchat C. Clinical diagnosis of hirsutism in Thai women. J Med Assoc Thai 2004;87:459-463.
39. Chen WC, Zouboulis CC. Hormones and the pilosebaceous unit. Dermatoendocrinol 2009;1:81-86.
40. Ciotta L, Cianci A, Calogero AE, Palumbo MA, Marletta E, Sciuto A, Palumbo G. Clinical and endocrine effects of finasteride, a 5 alpha-reductase inhibitor, in women with idiopathic hirsutism. Fertil Steril 1995;64:299-306.
41. Coenen CM, Hollanders JM, Rolland R, Spielmann D, Bulten J. The effects of a low-dose gestodene-containing oral contraceptive on endometrial histology in healthy women. Eur J Contracept Reprod Health Care 1996;1:325-329.
42. Counts DR, Pescovitz OH, Barnes KM, Hench KD, Chrousos GP, Sherins RJ, Comite F, Loriaux DL, Cutler GB Jr. Dissociation of adrenarche and gonadarche in precocious puberty and in isolated hypogonadotropic hypogonadism. J Clin Endocrinol Metab 1987;64:1174-1178.
43. Cullberg G, Hamberger L, Mattsson LA, Mobacken H, Samsioe G. Effects of a low-dose desogestrel-ethinylestradiol combination on hirsutism, androgens and sex hormone binding globulin in women with a polycystic ovary syndrome. Acta Obstet Gynecol Scand 1985;64:195-202.
44. Cusan L, Dupont A, Gomez JL, Tremblay RR, Labrie F. Comparison of flutamide and spironolactone in the treatment of hirsutism: a randomized controlled trial. Fertil Steril 1994;61:281-287.
45. De Leo V, Fulghesu AM, la Marca A, Morgante G, Pasqui L, Talluri B, Torricelli M, Caruso A. Hormonal and clinical effects of GnRH agonist alone, or in combination with a combined oral contraceptive or flutamide in women with severe hirsutism. Gynecol Endocrinol 2000;14:411-416.
46. Dereli D, Dereli T, Bayraktar F, Ozgen AG, Yilmaz C. Endocrine and metabolic effects of rosiglitazone in non-obese women with polycystic ovary disease. Endocr J 2005;52:299-308.
47. Derksen J, Moolenaar AJ, Van Seters AP, Kock DF. Semiquantitative assessment of hirsutism in Dutch women. Br J Dermatol 1993;128:259-263.
48. DeUgarte CM, Woods KS, Bartolucci AA, Azziz R. Degree of facial and body terminal hair growth in unselected black and white women: toward a populational definition of hirsutism. J Clin Endocrinol Metab 2006;91:1345-1350.
49. Devoto E, Aravena L, Rios R. [Treatment of hirsutism with spironolactone and with spironolactone plus dexamethasone]. Rev Med Chil 2000;128:868-875.
50. Dewis P, Petsos P, Newman M, Anderson DC. The treatment of hirsutism with a combination of desogestrel and ethinyl oestradiol. Clin Endocrinol (Oxf) 1985; 22:29-36.
51. Di Fede G, Mansueto P, Pepe I, Rini GB, Carmina E. High prevalence of polycystic ovary syndrome in women with mild hirsutism and no other significant clinical symptoms. Fertil Steril 2010;94:194-197.
52. Diamanti-Kandarakis E, Kouli CR, Bergiele AT, Filandra FA, Tsianateli TC, Spina GG, Zapanti ED, Bartzis MI. 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.
53. Duijkers IJ, Klipping C. Polycystic ovaries, as defined by the 2003 Rotterdam consensus criteria, are found to be very common in young healthy women. Gynecol Endocrinol 2010;26:152-160.
54. Ebling FJ. The hair cycle and its regulation. Clin Dermatol 1988;6:67-73.
55. Emans SJ, Grace E, Woods ER, Mansfield J, Crigler JF Jr. Treatment with dexamethasone of androgen excess in adolescent patients. J Pediatr 1988; 112:821-826.
56. Erenus M, Yucelten D, Durmusoglu F, Gurbuz O. Comparison of finasteride versus spironolactone in the treatment of idiopathic hirsutism. Fertil Steril 1997; 68:1000-1003.
57. Escobar-Morreale HF. Topical eflornithine: guest commentary. Am J Clin Dermatol 2001;2:202.
58. Escobar-Morreale HF. Macroprolactinemia in women presenting with hyperandrogenic symptoms: implications for the management of polycystic ovary syndrome. Fertil Steril 2004;82:1697-1699.
59. Escobar-Morreale HF. Diagnosis and management of hirsutism. Ann N Y Acad Sci 2010;1205:166-174.
60. Escobar-Morreale HF, Serrano Gotarredona J, García Robles R, Sancho J, Varela C. Mild adrenal and ovarian steroidogenic abnormalities in hirsute women without hyperandrogenemia: does idiopathic hirsutism exist? Metabolism 1997; 46:902-907.
61. Escobar-Morreale HF, Asuncion M, Calvo RM, Sancho J, San Millan JL. Receiver operating characteristic analysis of the performance of basal serum hormone profiles for the diagnosis of polycystic ovary syndrome in epidemiological studies. Eur J Endocrinol 2001;145:619-624.
62. Escobar-Morreale HF, Sanchon R, San Millan JL. A prospective study of the prevalence of nonclassical congenital adrenal hyperplasia among women presenting with hyperandrogenic symptoms and signs. J Clin Endocrinol Metab 2008;93:527-533.
63. Falsetti L, De Fusco D, Eleftheriou G, Rosina B. Treatment of hirsutism by finasteride and flutamide in women with polycystic ovary syndrome. Gynecol Endocrinol 1997; 11:251-257.
64. Falsetti L, Gambera A, Legrenzi L, Iacobello C, Bugari G. Comparison of finasteride versus flutamide in the treatment of hirsutism. Eur J Endocrinol 1999; 141:361-367.
65. Ferriman D, Gallwey JD. Clinical assessment of body hair growth in women. J Clin Endocrinol Metab 1961;21:1440-1447.
66. Frank-Raue K, Junga G, Raue F, Vecsei P, Ziegler R. [Therapy of hirsutism in females with adrenal enzyme defects of steroid hormone biosynthesis: comparison of dexamethasone with cyproterone acetate]. Klin Wochenschr 1990;68:597-601.
67. Fruzzetti F, Bersi C, Parrini D, Ricci C, Genazzani AR. Treatment of hirsutism: comparisons between different antiandrogens with central and peripheral effects. Fertil Steril 1999;71:445-451.
68. Fuchs E, Merrill BJ, Jamora C, DasGupta R. At the roots of a never-ending cycle. Dev Cell 2001;1:13-25.
69. Gambineri A, Pelusi C, Genghini S, Morselli-Labate AM, Cacciari M, Pagotto U, Pasquali R. Effect of flutamide and metformin administered alone or in combination in dieting obese women with polycystic ovary syndrome. Clin Endocrinol (Oxf) 2004;60:241-249.
70. Gambineri A, Patton L, Vaccina A, Cacciari M, Morselli-Labate AM, Cavazza C, Pagotto U, Pasquali R. Treatment with flutamide, metformin, and their combination added to a hypocaloric diet in overweight-obese women with polycystic ovary syndrome: a randomized, 12-month, placebo-controlled study. J Clin Endocrinol Metab 2006;91:3970-3980.
71. Ganie MA, Khurana ML, Eunice M, Gupta N, Gulati M, Dwivedi SN, Ammini AC. Comparison of efficacy of spironolactone with metformin in the management of polycystic ovary syndrome: an open-labeled study. J Clin Endocrinol Metab 2004;89:2756-2762.
72. Garn SM. Types and distribution of the hair in man. Ann N Y Acad Sci 1951; 53:498-507.
73. Girman CJ, Rhodes T, Lilly FR, Guo SS, Siervogel RM, Patrick DL, Chumlea WC. Effects of self-perceived hair loss in a community sample of men. Dermatology 1998;197:223-229.
74. Glintborg D, Henriksen JE, Andersen M, Hagen C, Hangaard J, Rasmussen PE, Schousboe K, Hermann AP. Prevalence of endocrine diseases and abnormal glucose tolerance tests in 340 Caucasian premenopausal women with hirsutism as the referral diagnosis. Fertil Steril 2004;82:1570-1579.
75. Goodarzi MO, Shah NA, Antoine HJ, Pall M, Guo X, Azziz R. Variants in the 5alpha-reductase type 1 and type 2 genes are associated with polycystic ovary syndrome and the severity of hirsutism in affected women. J Clin Endocrinol Metab 2006;91:4085-4091.
76. Goverde AJ, van Koert AJ, Eijkemans MJ, Knauff EA, Westerveld HE, Fauser BC, Broekmans FJ. Indicators for metabolic disturbances in anovulatory women with polycystic ovary syndrome diagnosed according to the Rotterdam consensus criteria. Hum Reprod 2009;24:710-717.
77. Grigoriou O, Papadias C, Konidaris S, Antoniou G, Karakitsos P, Giannikos L. Comparison of flutamide and cyproterone acetate in the treatment of hirsutism: a randomized controlled trial. Gynecol Endocrinol 1996;10:119-123.
78. Guido M, Romualdi D, Giuliani M, Suriano R, Selvaggi L, Apa R, Lanzone A. Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: a clinical, endocrinological, metabolic pilot study. J Clin Endocrinol Metab 2004;89:2817-2823.
79. Haedersdal M, Gotzsche PC. Laser and photoepilation for unwanted hair growth. Cochrane Database Syst Rev 2006;CD004684.
80. Haedersdal M, Wulf HC. Evidence-based review of hair removal using lasers and light sources. J Eur Acad Dermatol Venereol 2006;20:9-20.
81. Hamilton JB. Age, sex and genetic factors in the regulation of hair growth in man. A comparison of Caucasian and Japanese populations. In: Montagna W, Ellis RA (eds). The Biology of Hair Growth. New York: Academic Press, 1958.
82. Hamzavi I, Tan E, Shapiro J, Lui H. A randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women. J Am Acad Dermatol 2007;57:54-59.
83. Harborne L, Fleming R, Lyall H, Sattar N, Norman J. Metformin or antiandrogen in the treatment of hirsutism in polycystic ovary syndrome. J Clin Endocrinol Metab 2003;88:4116-4123.
84. Hatch R, Rosenfield RL, Kim MH, Tredway D. Hirsutism: implications, etiology, and management. Am J Obstet Gynecol 1981;140:815-830.
85. Headington JT. Transverse microscopic anatomy of the human scalp. A basis for a morphometric approach to disorders of the hair follicle. Arch Dermatol 1984; 120:449-456.
86. Henzl MR, Loomba PK. Transdermal delivery of sex steroids for hormone replacement therapy and contraception. A review of principles and practice. J Reprod Med 2003;48:525-540.
87. Hoeger KM, Kochman L, Wixom N, Craig K, Miller RK, Guzick DS. A randomized, 48-week, placebo-controlled trial of intensive lifestyle modification and/or metformin therapy in overweight women with polycystic ovary syndrome: a pilot study. Fertil Steril 2004;82:421-429.
88. Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab 2008;93:4299-4306.
89. Horrocks PM, London DR. Effects of long term dexamethasone treatment in adult patients with congenital adrenal hyperplasia. Clin Endocrinol (Oxf) 1987;27:635-642.
90. Hsu YC, Pasolli HA, Fuchs E. Dynamics between stem cells, niche, and progeny in the hair follicle. Cell 2011;144:92-105.
91. Hussain M, Polnikorn N, Goldberg DJ. Laser-assisted hair removal in Asian skin: efficacy, complications, and the effect of single versus multiple treatments. Dermatol Surg 2003;29:249-254.
92. Ibanez L, Valls C, Ferrer A, Ong K, Dunger DB, De Zegher F. Additive effects of insulin-sensitizing and anti-androgen treatment in young, nonobese women with hyperinsulinism, hyperandrogenism, dyslipidemia, and anovulation. J Clin Endocrinol Metab 2002;87:2870-2874.
93. Ibanez L, Jaramillo A, Ferrer A, de Zegher F. Absence of hepatotoxicity after long-term, low-dose flutamide in hyperandrogenic girls and young women. Hum Reprod 2005;20:1833-1836.
94. Jackson J, Caro JJ, Caro G, Garfield F, Huber F, Zhou W, Lin CS, Shander D, Schrode K. The effect of eflornithine 13.9% cream on the bother and discomfort due to hirsutism. Int J Dermatol 2007;46:976-981.
95. Jick SS, Hernandez RK. Risk of non-fatal venous thromboembolism in women using oral contraceptives containing drospirenone compared with women using oral contraceptives containing levonorgestrel: case-control study using United States claims data. Br Med J 2011;342:d2151.
96. Johnstone EB, Rosen MP, Neril R, Trevithick D, Sternfeld B, Murphy R, Addauan-Andersen C, McConnell D, Pera RR, Cedars MI. The polycystic ovary post-rotterdam: a common, age-dependent finding in ovulatory women without metabolic significance. J Clin Endocrinol Metab 2010;95:4965-4972.
97. Jonard S, Robert Y, Dewailly D. Revisiting the ovarian volume as a diagnostic criterion for polycystic ovaries. Hum Reprod 2005;20:2893-2898.
98. Kelestimur F, Sahin Y. Comparison of Diane 35 and Diane 35 plus spironolactone in the treatment of hirsutism. Fertil Steril 1998;69:66-69.
99. Kelestimur F, Everest H, Unluhizarci K, Bayram F, Sahin Y. A comparison between spironolactone and spironolactone plus finasteride in the treatment of hirsutism. Eur J Endocrinol 2004;150:351-354.
100. Kelly CJ, Gordon D. The effect of metformin on hirsutism in polycystic ovary syndrome. Eur J Endocrinol 2002;147:217-221.
101. Kemmeren JM, Algra A, Grobbee DE. Third generation oral contraceptives and risk of venous thrombosis: meta-analysis. Br Med J 2001;323:131.
102. Kim JJ, Chae SJ, Choi YM, Hwang SS, Hwang KR, Kim SM, Yoon SH, Moon SY. Assessment of hirsutism among Korean women: results of a randomly selected sample of women seeking pre-employment physical check-up. Hum Reprod 2011;26:214-220.
103. Kligman AM. The human hair cycle. J Invest Dermatol 1959;33:307-316.
104. Kligman AM, Peters L. Histologic changes of human hair follicles after electrolysis: a comparison of two methods. Cutis 1984;34:169-176.
105. Kriplani A, Periyasamy AJ, Agarwal N, Kulshrestha V, Kumar A, Ammini AC. Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome. Contraception 2010;82:139-146.
106. Kristensen SL, Ramlau-Hansen CH, Ernst E, Olsen SF, Bonde JP, Vested A, Toft G. A very large proportion of young Danish women have polycystic ovaries: is a revision of the Rotterdam criteria needed? Hum Reprod 2010;25:3117-3122.
107. Kushnir MM, Blamires T, Rockwood AL, Roberts WL, Yue B, Erdogan E, Bunker AM, Meikle AW. Liquid chromatography-tandem mass spectrometry assay for androstenedione, dehydroepiandrosterone, and testosterone with pediatric and adult reference intervals. Clin Chem 2010;56:1138-1147.
108. Kuttenn F, Rigaud C, Wright F, Mauvais-Jarvis P. Treatment of hirsutism by oral cyproterone acetate and percutaneous estradiol. J Clin Endocrinol Metab 1980; 51:1107-1111.
109. Lakryc EM, Motta EL, Soares JM Jr, Haidar MA, de Lima GR, Baracat EC. The benefits of finasteride for hirsute women with polycystic ovary syndrome or idiopathic hirsutism. Gynecol Endocrinol 2003;17:57-63.
110. Landay M, Huang A, Azziz R. Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS. Fertil Steril 2009;92:643-647.
111. Lapidoth M, Dierickx C, Lanigan S, Paasch U, Campo-Voegeli A, Dahan S, Marini L, Adatto M. Best practice options for hair removal in patients with unwanted facial hair using combination therapy with laser: guidelines drawn up by an expert working group. Dermatology 2010;221:34-42.
112. Legro RS, Schlaff WD, Diamond MP, Coutifaris C, Casson PR, Brzyski RG, Christman GM, Trussell JC, Krawetz SA, Snyder PJ et al. Total testosterone assays in women with polycystic ovary syndrome: precision and correlation with hirsutism. J Clin Endocrinol Metab 2010;95:5305-5313.
113. Lemay A, Dodin S, Turcot L, Dechene F, Forest JC. Rosiglitazone and ethinyl estradiol/cyproterone acetate as single and combined treatment of overweight women with polycystic ovary syndrome and insulin resistance. Hum Reprod 2006;21:121-128.
114. Lin KK, Kumar V, Geyfman M, Chudova D, Ihler AT, Smyth P, Paus R, Takahashi JS, Andersen B. Circadian clock genes contribute to the regulation of hair follicle cycling. PLoS Genet 2009;5:e1000573.
115. Longcope C. Adrenal and gonadal androgen secretion in normal females. Clin Endocrinol Metab 1986;15:213-228.
116. Lord JM, Flight IH, Norman RJ. Insulin-sensitising drugs (metformin, troglitazone, rosiglitazone, pioglitazone, D-chiro-inositol) for polycystic ovary syndrome. Cochrane Database Syst Rev 2003;CD003053.
117. Luque-Ramirez M, Alvarez-Blasco F, Botella-Carretero JI, Martinez-Bermejo E, Lasuncion MA, Escobar-Morreale HF. Comparison of ethinyl-estradiol plus cyproterone acetate versus metformin effects on classic metabolic cardiovascular risk factors in women with the polycystic ovary syndrome. J Clin Endocrinol Metab 2007;92:2453-2461.
118. Luque-Ramirez M, Mendieta-Azcona C, del Rey Sanchez JM, Maties M, Escobar-Morreale HF. Effects of an antiandrogenic oral contraceptive pill compared with metformin on blood coagulation tests and endothelial function in women with the polycystic ovary syndrome: influence of obesity and smoking. Eur J Endocrinol 2009;160:469-480.
119. Maciel GA, Soares Junior JM, Alves da Motta EL, Abi Haidar M, de Lima GR, Baracat EC. Nonobese women with polycystic ovary syndrome respond better than obese women to treatment with metformin. Fertil Steril 2004;81:355-360.
120. Manso G, Thole Z, Salgueiro E, Revuelta P, Hidalgo A. Spontaneous reporting of hepatotoxicity associated with antiandrogens: data from the Spanish pharmacovigilance system. Pharmacoepidemiol Drug Saf 2006;15:253-259.
121. March WA, Moore VM, Willson KJ, Phillips DI, Norman RJ, Davies MJ. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Hum Reprod 2010;25:544-551.
122. Marshall WA, Tanner JM. Variations in pattern of pubertal changes in girls. Arch Dis Child 1969;44:291-303.
123. Martikainen H, Heikkinen J, Ruokonen A, Kauppila A. Hormonal and clinical effects of ketoconazole in hirsute women. J Clin Endocrinol Metab 1988;66:987-991.
124. Martin KA, Chang RJ, Ehrmann DA, Ibanez L, Lobo RA, Rosenfield RL, Shapiro J, Montori VM, Swiglo BA. Evaluation and treatment of hirsutism in premenopausal women: an endocrine society clinical practice guideline. J Clin Endocrinol Metab 2008;93:1105-1120.
125. McLellan AR, Rentoul J, MacKie R, McInnes GT. Lack of effect of spironolactone on hair shaft diameter in hirsute females. Postgrad Med J 1989;65:459-462.
126. Meyer C, McGrath BP, Teede HJ. Effects of medical therapy on insulin resistance and the cardiovascular system in polycystic ovary syndrome. Diabetes Care 2007; 30:471-478.
127. Miller WL. Androgen synthesis in adrenarche. Rev Endocr Metab Disord 2009; 10:3-17.
128. Moghetti P, Tosi F, Tosti A, Negri C, Misciali C, Perrone F, Caputo M, Muggeo M, Castello R. Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: a randomized, double blind, placebo-controlled trial. J Clin Endocrinol Metab 2000a;85:89-94.
129. Moghetti P, Castello R, Negri C, Tosi F, Perrone F, Caputo M, Zanolin E, Muggeo M. Metformin effects on clinical features, endocrine and metabolic profiles, and insulin sensitivity in polycystic ovary syndrome: a randomized, double-blind, placebo-controlled 6-month trial, followed by open, long-term clinical evaluation. J Clin Endocrinol Metab 2000b;85:139-146.
130. Moncada E. Familial study of hirsutism. J Clin Endocrinol Metab 1970;31:556-564.
131. Moran C, Azziz R, Weintrob N, Witchel SF, Rohmer V, Dewailly D, Marcondes JA, Pugeat M, Speiser PW, Pignatelli D et al. Reproductive outcome of women with 21-hydroxylase-deficient nonclassic adrenal hyperplasia. J Clin Endocrinol Metab 2006;91:3451-3456.
132. Moran C, Tena G, Moran S, Ruiz P, Reyna R, Duque X. Prevalence of polycystic ovary syndrome and related disorders in Mexican women. Gynecol Obstet Invest 2010;69:274-280.
133. Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database Syst Rev 2011;2:CD007506.
134. Morin-Papunen LC, Vauhkonen I, Koivunen RM, Ruokonen A, Martikainen HK, Tapanainen JS. Endocrine and metabolic effects of metformin versus ethinyl estradiol-cyproterone acetate in obese women with polycystic ovary syndrome: a randomized study. J Clin Endocrinol Metab 2000;85:3161-3168.
135. Morin-Papunen LC, Vauhkonen I, Koivunen R, Ruokonen A, Martikainen H, Tapanainen JS. Metformin versus ethinyl estradiol-cyproterone acetate in the treatment of nonobese women with polycystic ovary syndrome: a randomized study. J Clin Endocrinol Metab 2003;88:148-156.
136. Muderris II, Bayram F, Sahin Y, Kelestimur F. A comparison between two doses of flutamide (250 mg/d and 500 mg/d) in the treatment of hirsutism. Fertil Steril 1997;68:644-647.
137. Muderris II, Bayram F, Guven M. A prospective, randomized trial comparing flutamide (250 mg/d) and finasteride (5 mg/d) in the treatment of hirsutism. Fertil Steril 2000;73:984-987.
138. Noorbala MT, Kefaie P. The prevalence of hirsutism in adolescent girls in Yazd, Central Iran. Iran Red Crescent Med J 2010;12:111-117.
139. Ognibene A, Drake CJ, Jeng KY, Pascucci TE, Hsu S, Luceri F, Messeri G. A new modular chemiluminescence immunoassay analyser evaluated. Clin Chem Lab Med 2000;38:251-260.
140. Onalan G, Goktolga U, Ceyhan T, Bagis T, Onalan R, Pabuccu R. Predictive value of glucose-insulin ratio in PCOS and profile of women who will benefit from metformin therapy: obese, lean, hyper or normoinsulinemic? Eur J Obstet Gynecol Reprod Biol 2005;123:204-211.
141. Ortega-Gonzalez C, Luna S, Hernandez L, Crespo G, Aguayo P, Arteaga-Troncoso G, Parra A. Responses of serum androgen and insulin resistance to metformin and pioglitazone in obese, insulin-resistant women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:1360-1365.
142. Parkin L, Sharples K, Hernandez RK, Jick SS. Risk of venous thromboembolism in users of oral contraceptives containing drospirenone or levonorgestrel: nested case-control study based on UK General Practice Research Database. Br Med J 2011;342:d2139.
143. Pasquali R, Gambineri A, Biscotti D, Vicennati V, Gagliardi L, Colitta D, Fiorini S, Cognigni GE, Filicori M, Morselli-Labate AM. Effect of long-term treatment with metformin added to hypocaloric diet on body composition, fat distribution, and androgen and insulin levels in abdominally obese women with and without the polycystic ovary syndrome. J Clin Endocrinol Metab 2000;85:2767-2774.
144. Paus R, Foitzik K. In search of the 'hair cycle clock': a guided tour. Differentiation 2004;72:489-511.
145. Pazos F, Escobar-Morreale HF, Balsa J, Sancho JM, Varela C. Prospective randomized study comparing the long-acting gonadotropin-releasing hormone agonist triptorelin, flutamide, and cyproterone acetate, used in combination with an oral contraceptive, in the treatment of hirsutism. Fertil Steril 1999; 71:122-128.
146. Pfeifer M, Prezelj J, Kocijancic A. The correlation between clinical and hormonal parameters in androgenisation. Acta Eur Fertil 1989;20:31-33.
147. Porcile A, Gallardo E. Long-term treatment of hirsutism: desogestrel compared with cyproterone acetate in oral contraceptives. Fertil Steril 1991;55:877-881.
148. Practice Committee of the American Society for Reproductive Medicine. The evaluation and treatment of androgen excess. Fertil Steril 2006;86:S241-S247.
149. Prezelj J, Kocijancic A, Andolsek L. Dexamethasone and spironolactone in the treatment of non-tumorous hyperandrogenism. Gynecol Endocrinol 1989; 3:281-288.
150. Pugeat M, Crave JC, Tourniaire J, Forest MG. Clinical utility of sex hormone-binding globulin measurement. Horm Res 1996;45:148-155.
151. Raj SG, Raj MH, Talbert LM, Sloan CS, Hicks B. Normalization of testosterone levels using a low estrogen-containing oral contraceptive in women with polycystic ovary syndrome. Obstet Gynecol 1982;60:15-19.
152. Randall VA. Androgens and hair growth. Dermatol Ther 2008;21:314-328.
153. Reingold SB, Rosenfield RL. The relationship of mild hirsutism or acne in women to androgens. Arch Dermatol 1987;123:209-212.
154. Reynolds EL. The appearance of adult patterns of body hair in man. Ann N Y Acad Sci 1951;53:576-584.
155. Richards RN, Meharg GE. Electrolysis: observations from 13 years and 140,000 hours of experience. J Am Acad Dermatol 1995;33:662-666.
156. Rittmaster RS, Givner ML. Effect of daily and alternate day low dose prednisone on serum cortisol and adrenal androgens in hirsute women. J Clin Endocrinol Metab 1988;67:400-403.
157. Romualdi D, Giuliani M, Cristello F, Fulghesu AM, Selvaggi L, Lanzone A, Guido M. Metformin effects on ovarian ultrasound appearance and steroidogenic function in normal-weight normoinsulinemic women with polycystic ovary syndrome: a randomized double-blind placebo-controlled clinical trial. Fertil Steril 2010; 93:2303-2310.
158. Rosenfield RL. Hirsutism. N Engl J Med 2005;353:2578-2588.
159. Rosner W. An extraordinarily inaccurate assay for free testosterone is still with us. J Clin Endocrinol Metab 2001;86:2903.
160. Rosner W, Vesper H. Toward excellence in testosterone testing: a consensus statement. J Clin Endocrinol Metab 2010;95:4542-4548.
161. Rosner W, Auchus RJ, Azziz R, Sluss PM, Raff H. Utility, limitations, and pitfalls in measuring testosterone: an Endocrine Society position statement. J Clin Endocrinol Metab 2007;92:405-413.
162. Sagsoz N, Kamaci M, Orbak Z. Body hair scores and total hair diameters in healthy women in the Kirikkale Region of Turkey. Yonsei Med J 2004; 45:483-491.
163. Sahin Y, Bayram F, Kelestimur F, Muderris I. Comparison of cyproterone acetate plus ethinyl estradiol and finasteride in the treatment of hirsutism. J Endocrinol Invest 1998;21:348-352.
164. Sahin Y, Dilber S, Kelestimur F. Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism. Fertil Steril 2001;75:496-500.
165. Salley KE, Wickham EP, Cheang KI, Essah PA, Karjane NW, Nestler JE. Glucose intolerance in polycystic ovary syndrome-a position statement of the Androgen Excess Society. J Clin Endocrinol Metab 2007;92:4546-4556.
166. Sanam M, Ziba O. Desogestrel + ethinylestradiol versus levonorgestrel + ethinylestradiol. Which one has better effect on acne, hirsutism and weight change. Saudi Med J 2011;32:23-26.
167. Sanchez LA, Perez M, Azziz R. Laser hair reduction in the hirsute patient: a critical assessment. Hum Reprod Update 2002;8:169-181.
168. Sawaya ME, Shalita AR. Androgen receptor polymorphisms (CAG repeat lengths) in androgenetic alopecia, hirsutism, and acne. J Cutan Med Surg 1998;3:9-15.
169. Schneider MR, Schmidt-Ullrich R, Paus R. The hair follicle as a dynamic miniorgan. Curr Biol 2009;19:R132-R142.
170. Shah PN. Human body hair: a quantitative study. Am J Obstet Gynecol 1957; 73:1255-1265.
171. Shroff R, Syrop CH, Davis W, Van Voorhis BJ, Dokras A. Risk of metabolic complications in the new PCOS phenotypes based on the Rotterdam criteria. Fertil Steril 2007;88:1389-1395.
172. Sklar CA, Kaplan SL, Grumbach MM. Evidence for dissociation between adrenarche and gonadarche: studies in patients with idiopathic precocious puberty, gonadal dysgenesis, isolated gonadotropin deficiency, and constitutionally delayed growth and adolescence. J Clin Endocrinol Metab 1980;51:548-556.
173. Sobbrio GA, Granata A, D'Arrigo F, Arena D, Panacea A, Trimarchi F, Granese D, Pulle C. Treatment of hirsutism related to micropolycystic ovary syndrome (MPCO) with two low-dose oestrogen oral contraceptives: a comparative randomized evaluation. Acta Eur Fertil 1990;21:139-141.
174. Sonino N, Fava GA, Mani E, Belluardo P, Boscaro M. Quality of life of hirsute women. Postgrad Med J 1993;69:186-189.
175. Souter I, Sanchez LA, Perez M, Bartolucci AA, Azziz R. The prevalence of androgen excess among patients with minimal unwanted hair growth. Am J Obstet Gynecol 2004;191:1914-1920.
176. Speiser PW, Knochenhauer ES, Dewailly D, Fruzzetti F, Marcondes JA, Azziz R. A multicenter study of women with nonclassical congenital adrenal hyperplasia: relationship between genotype and phenotype. Mol Genet Metab 2000; 71:527-534.
177. Spritzer P, Billaud L, Thalabard JC, Birman P, Mowszowicz I, Raux-Demay MC, Clair F, Kuttenn F, Mauvais-Jarvis P. Cyproterone acetate versus hydrocortisone treatment in late-onset adrenal hyperplasia. J Clin Endocrinol Metab 1990; 70:642-646.
178. Spritzer PM, Lisboa KO, Mattiello S, Lhullier F. Spironolactone as a single agent for long-term therapy of hirsute patients. Clin Endocrinol (Oxf) 2000;52:587-594.
179. Steinberger E, Rodriguez-Rigau LJ, Petak SM, Weidman ER, Smith KD, Ayala C. Glucocorticoid therapy in hyperandrogenism. Baillieres Clin Obstet Gynaecol 1990;4:457-471.
180. Swiglo BA, Murad MH, Schunemann HJ, Kunz R, Vigersky RA, Guyatt GH, Montori VM. A case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin Endocrinol Metab 2008a;93:666-673.
181. Swiglo BA, Cosma M, Flynn DN, Kurtz DM, Labella ML, Mullan RJ, Erwin PJ, Montori VM. Clinical review: antiandrogens for the treatment of hirsutism: a systematic review and metaanalyses of randomized controlled trials. J Clin Endocrinol Metab 2008b;93:1153-1160.
182. Taner C, Inal M, Basogul O, Onoglu A, Karanfil C, Tinar S, Ispahi C. Comparison of the clinical efficacy and safety of flutamide versus flutamide plus an oral contraceptive in the treatment of hirsutism. Gynecol Obstet Invest 2002; 54:105-108.
183. Tartagni M, Schonauer LM, De Salvia MA, Cicinelli E, De Pergola G, D'Addario V. Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism. Fertil Steril 2000;73:718-723.
184. Tartagni M, Schonauer MM, Cicinelli E, Petruzzelli F, De Pergola G, De Salvia MA, Loverro G. Intermittent low-dose finasteride is as effective as daily administration for the treatment of hirsute women. Fertil Steril 2004;82:752-755.
185. Tellez R, Frenkel J. [Clinical evaluation of body hair in healthy women]. Rev Med Chil 1995;123:1349-1354.
186. 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.
187. Thiboutot D, Jabara S, McAllister JM, Sivarajah A, Gilliland K, Cong Z, Clawson G. Human skin is a steroidogenic tissue: steroidogenic enzymes and cofactors are expressed in epidermis, normal sebocytes, and an immortalized sebocyte cell line (SEB-1). J Invest Dermatol 2003;120:905-914.
188. Unluhizarci KK, Everest H, Bayram F, Kelestimur F. Comparison of spironolactone and spironolactone plus finasteride in the treatment of hirsutism. Fertil Steril 2002;78:1331-1333.
189. Unluhizarci K, Gokce C, Atmaca H, Bayram F, Kelestimur F. A detailed investigation of hirsutism in a Turkish population: idiopathic hyperandrogenemia as a perplexing issue. Exp Clin Endocrinol Diabetes 2004;112:504-509.
190. Uno H. Biology of hair growth. Semin Reprod Endocrinol 1986;4:131-141.
191. van der Spuy ZM, Tregoning S. Gonadotrophin-releasing hormone analogues for hirsutism (Protocol). Cochrane Database Syst Rev 2008;CD001126.
192. van Hylckama Vlieg A, Helmerhorst FM, Vandenbroucke JP, Doggen CJM, Rosendaal FR. The venous thrombotic risk of oral contraceptives, effects of oestrogen dose and progestogen type: results of the MEGA case-control study. Br Med J 2009;339:b2921.
193. Venturoli S, Marescalchi O, Colombo FM, Macrelli S, Ravaioli B, Bagnoli A, Paradisi R, Flamigni C. A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. J Clin Endocrinol Metab 1999; 84:1304-1310.
194. Vermeulen A, Rubens R. Effects of cyproterone acetate plus ethinylestradiol low dose on plasma androgens and lipids in mildly hirsute or acneic young women. Contraception 1988;38:419-428.
195. Vermeulen A, Verdonck L, Kaufman JM. A critical evaluation of simple methods for the estimation of free testosterone in serum. J Clin Endocrinol Metab 1999; 84:3666-3672.
196. Welt CK, Gudmundsson JA, Arason G, Adams J, Palsdottir H, Gudlaugsdottir G, Ingadottir G, Crowley WF. Characterizing discrete subsets of polycystic ovary syndrome as defined by the Rotterdam criteria: the impact of weight on phenotype and metabolic features. J Clin Endocrinol Metab 2006;91: 4842-4848.
197. Wild RA, Vesely S, Beebe L, Whitsett T, Owen W. Ferriman Gallwey self-scoring I: performance assessment in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2005;90:4112-4114.
198. Wild RA, Carmina E, Diamanti-Kandarakis E, Dokras A, Escobar-Morreale HF, Futterweit W, Lobo R, Norman RJ, Talbott E, Dumesic DA. Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society. J Clin Endocrinol Metab 2010;95:2038-2049.
199. Wolf JE Jr, Shander D, Huber F, Jackson J, Lin CS, Mathes BM, Schrode K. Randomized, double-blind clinical evaluation of the efficacy and safety of topical eflornithine HCl 13.9% cream in the treatment of women with facial hair. Int J Dermatol 2007;46:94-98.
200. Wong IL, Morris RS, Chang L, Spahn MA, Stanczyk FZ, Lobo RA. A prospective randomized trial comparing finasteride to spironolactone in the treatment of hirsute women. J Clin Endocrinol Metab 1995;80:233-238.
201. Wysowski DK, Freiman JP, Tourtelot JB, Horton ML 3rd. Fatal and nonfatal hepatotoxicity associated with flutamide. Ann Intern Med 1993; 118:860-864.
202. Yildiz BO, Bolour S, Woods K, Moore A, Azziz R. Visually scoring hirsutism. Hum Reprod Update 2010;16:51-64.
203. Yilmaz M, Karakoc A, Toruner FB, Cakir N, Tiras B, Ayvaz G, Arslan M. The effects of rosiglitazone and metformin on menstrual cyclicity and hirsutism in polycystic ovary syndrome. Gynecol Endocrinol 2005;21:154-160.
204. Zargar AH, Wani AI, Masoodi SR, Laway BA, Bashir MI, Salahuddin M. Epidemiologic and etiologic aspects of hirsutism in Kashmiri women in the Indian subcontinent. Fertil Steril 2002;77:674-678.
205. Zawadzki JK, Dunaif A. Diagnostic criteria for polycystic ovary syndrome: towards a rational approach. In Dunaif A, Givens JR, Haseltine FP, Merriam GR (eds). Polycystic Ovary Syndrome. Boston: Blackwell Scientific Publications, 1992.
206. Zhao JL, Chen ZJ, Shi YH, Geng L, Ma ZX, Li Y, Tang R. [Investigation of body hair assessment of Chinese women in Shandong region and its preliminary application in polycystic ovary syndrome patients]. Zhonghua Fu Chan Ke Za Zhi 2007; 42:590-594.