A 28-year-old woman comes to your office because of hirsutism. She has dealt with this problem for the past 4 months mainly by the use of waxing and bleaching, but the hirsutism now involves her chest and she is rapidly developing male-pattern balding. She has no other past medical history, is unmarried, and has no children. She takes no medications. She scores 18 on the Ferriman- Gallwey hirsutism scale (normal <8). What is the initial step in her evaluation? (AIIMS May 2013)
|A||Dexamethasone suppression test|
|B||Measurement of total testosterone level|
|C||Trial of laser phototherapy|
|D||Trial of oral contraceptive pills|
Trial of laser phototherapy
1). There are three phases in the cycle of hair growth—the growth, involution, and rest.
2). Androgen excess in women leads to increased hair growth in most androgen-sensitive sites. In the scalp, however, hair loss occurs because androgens cause the hair to spend less time in the growth phase.
3). Male-pattern balding may cause stress but is primarily caused by high androgen levels.
4). Androgen levels are equally distributed throughout the body; it is the local environment that dictates the end-organ effect. Sun-exposed areas, such as the face and arms, are as androgen-sensitive as nonexposed areas.