We have come both a long way and full circle in our understanding of the causes of hirsutism. Two decades ago, most cases were considered "idiopathic" because our methods of assessment of androgenicity, primarily 24-hour urinary collections, were poorly reflective of the underlying physiologic state. At that time, cases of hirsutism were considered to have increased end-organ sensitivity to androgens. The next breakthrough in the understanding of the hormonal causes of hirsutism came in the past decade with the advent of more sensitive and accurate means of measurement of serum levels of steroid hormones. It became evident that, indeed, more than 80% of women with excessive hair had some underlying elevation of a serum or plasma androgen.1 Similarly, endocrine causes of treatment-resistant, late-onset, or persistent acne were subsequently investigated and found in at least 50% of the patients studied.2 Reams of literature subsequently have accumulated and are
Lucky AW. Androgens and the Skin: Another Journey Around the Circle. Arch Dermatol. 1987;123(2):193–195. doi:10.1001/archderm.1987.01660260063014
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