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Despite decades of study, major gaps persist in understanding local androgen metabolism, the role of insulin resistance, and individualized treatment responses. This review aims to provide a contemporary update that integrates recent molecular, diagnostic, and therapeutic advances.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To critically appraise the current understanding of hirsutism, with an emphasis on: (1) emerging concepts in local androgen action and follicular sensitivity, (2) evolving assessment methods, (3) updated pharmacologic and mechanical treatment options aligned with current endocrine and dermatologic evidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Search methods<\/jats:title>\n                    <jats:p>A narrative review of the literature was conducted in PubMed, Scopus, and Web of Science for studies published between January 2000 and September 2025, using the terms: \u201chirsutism,\u201d \u201chyperandrogenism,\u201d \u201candrogen excess,\u201d \u201cidiopathic hirsutism,\u201d \u201cPCOS,\u201d \u201c5\u03b1-reductase,\u201d \u201cantiandrogens,\u201d \u201coral contraceptives,\u201d \u201claser hair removal,\u201d and \u201cinsulin resistance.\u201d<\/jats:p>\n                    <jats:p>Inclusion criteria: human studies, English language, adult females, and peer-reviewed original or review articles.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Wider implications<\/jats:title>\n                    <jats:p>An integrated understanding of systemic and local androgenic activity is transforming the management of hirsutism from a purely cosmetic issue to a complex endocrine disorder with metabolic and psychological dimensions. This review proposes a personalized, multidisciplinary framework that bridges endocrinology, gynecology, and dermatology. Future directions should focus on elucidating local androgen metabolism, tissue-specific enzyme activity, and the role of insulin resistance in idiopathic cases to refine both diagnostic precision and treatment efficacy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11154-026-10057-2","type":"journal-article","created":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T04:46:04Z","timestamp":1780461964000},"page":"1041-1057","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Where are we in the diagnosis and treatment of hirsutism? 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