{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T08:01:25Z","timestamp":1791360085945,"version":"4.3.1"},"reference-count":110,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2022,8,9]],"date-time":"2022-08-09T00:00:00Z","timestamp":1660003200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Brazilian National Institute of Hormones and Women\u2019s Health\/Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","award":["465482\/2014-7"],"award-info":[{"award-number":["465482\/2014-7"]}]},{"name":"Brazilian National Institute of Hormones and Women\u2019s Health\/Conselho Nacional de Desenvolvimento Cient\u00edfico e Tecnol\u00f3gico","award":["17\/2551-0000519-8"],"award-info":[{"award-number":["17\/2551-0000519-8"]}]},{"name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Rio Grande do Sul","award":["465482\/2014-7"],"award-info":[{"award-number":["465482\/2014-7"]}]},{"name":"Funda\u00e7\u00e3o de Amparo \u00e0 Pesquisa do Rio Grande do Sul","award":["17\/2551-0000519-8"],"award-info":[{"award-number":["17\/2551-0000519-8"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Hirsutism is defined as the presence of terminal hair with male pattern distribution in women. While in the general population, hirsutism affects around 4\u201311% of women, it is the main manifestation of hyperandrogenism in women with polycystic ovary syndrome (PCOS), with a prevalence estimated at 65\u201375%. Hirsutism in PCOS is associated with both androgen excess and individual response of the pilosebaceous unit to androgens. The modified Ferriman\u2013Gallwey (mFG) scoring system has been widely used in clinical practice to visually score excessive terminal hair, thus standardizing hirsutism evaluation and facilitating data comparison. Although a universal mFG score cutoff would be useful for comparisons, ethnic variations, as well as skin type and other factors, should be considered when evaluating hirsutism in distinct populations. In turn, androgen levels, measured by conventional techniques, have been shown to correlate poorly with the severity of hirsutism. Indeed, while most women with PCOS and hirsutism also have higher than reference values for serum androgen levels, some of them may not present with biochemical hyperandrogenism, representing a challenge to the diagnosis of PCOS. In this article, we critically review this not uncommon condition in women with PCOS presenting with hirsutism but normal androgen levels.<\/jats:p>","DOI":"10.3390\/diagnostics12081922","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T02:42:53Z","timestamp":1660099373000},"page":"1922","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":84,"title":["Hirsutism, Normal Androgens and Diagnosis of PCOS"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6734-7688","authenticated-orcid":false,"given":"Poli Mara","family":"Spritzer","sequence":"first","affiliation":[{"name":"Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil"},{"name":"Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil"},{"name":"Department and Post-Graduate Program in Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucas Bandeira","family":"Marchesan","sequence":"additional","affiliation":[{"name":"Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil"},{"name":"Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bet\u00e2nia Rodrigues","family":"Santos","sequence":"additional","affiliation":[{"name":"Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil"},{"name":"Department and Post-Graduate Program in Physiology, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tayane Muniz","family":"Fighera","sequence":"additional","affiliation":[{"name":"Gynecological Endocrinology Unit, Division of Endocrinology, Hospital de Cl\u00ednicas de Porto Alegre, Porto Alegre 90035-903, RS, Brazil"},{"name":"Post-Graduate Program in Endocrinology, Medicine School, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil"},{"name":"Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1111\/cen.13795","article-title":"Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome","volume":"3","author":"Teede","year":"2018","journal-title":"Clin. Endocrinol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2578","DOI":"10.1056\/NEJMcp033496","article-title":"Clinical practice. Hirsutism","volume":"353","author":"Rosenfield","year":"2005","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1093\/humupd\/dmp024","article-title":"Visually scoring hirsutism","volume":"16","author":"Yildiz","year":"2010","journal-title":"Hum. Reprod Update"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1016\/0002-9343(79)91061-1","article-title":"Plasma free androgen patterns in hirsute women and their diagnostic implications","volume":"66","author":"Rosenfield","year":"1979","journal-title":"Am. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Group REA-SPCW (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertil. Steril., 81, 19\u201325.","DOI":"10.1016\/j.fertnstert.2003.10.004"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1590\/0004-2730000003051","article-title":"Polycystic ovary syndrome: Reviewing diagnosis and management of metabolic disturbances","volume":"58","author":"Spritzer","year":"2014","journal-title":"Arq. Bras. Endocrinol. Metabol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1111\/j.1529-8019.2008.00214.x","article-title":"Androgens and hair growth","volume":"21","author":"Randall","year":"2008","journal-title":"Dermatol. Ther."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1419","DOI":"10.1111\/jocd.14313","article-title":"Prevalence of idiopathic hirsutism: A systematic review and meta-analysis","volume":"21","author":"Amiri","year":"2022","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"16057","DOI":"10.1038\/nrdp.2016.57","article-title":"Polycystic ovary syndrome","volume":"2","author":"Azziz","year":"2016","journal-title":"Nat. Rev. Dis Primers"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1093\/humupd\/dmr042","article-title":"Epidemiology, diagnosis and management of hirsutism: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society","volume":"18","author":"Carmina","year":"2012","journal-title":"Hum. Reprod. Update"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"5603","DOI":"10.2174\/1381612822666160720151243","article-title":"Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and Management","volume":"22","author":"Spritzer","year":"2016","journal-title":"Curr Pharm. Des."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1038\/s41392-020-00441-y","article-title":"Functional hair follicle regeneration: An updated review","volume":"6","author":"Ji","year":"2021","journal-title":"Signal. Transduct. Target Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"899095","DOI":"10.3389\/fcell.2022.899095","article-title":"Morphogenesis, Growth Cycle and Molecular Regulation of Hair Follicles","volume":"10","author":"Lin","year":"2022","journal-title":"Front. Cell Dev. Biol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"720879","DOI":"10.3389\/fcell.2021.720879","article-title":"The Roles of Non-coding RNA in the Development and Regeneration of Hair Follicles: Current Status and Further Perspectives","volume":"9","author":"Yang","year":"2021","journal-title":"Front. Cell Dev. Biol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1111\/j.1749-6632.1951.tb31960.x","article-title":"Quantitative measurement of a secondary sex character, axillary hair","volume":"53","author":"Hamilton","year":"1951","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1210\/edrv.21.4.0404","article-title":"Role of hormones in pilosebaceous unit development","volume":"21","author":"Deplewski","year":"2000","journal-title":"Endocr. Rev."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.mce.2017.09.009","article-title":"Androgens and androgen receptor action in skin and hair follicles","volume":"465","author":"Ceruti","year":"2018","journal-title":"Mol. Cell Endocrinol."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Grymowicz, M., Rudnicka, E., Podfigurna, A., Napierala, P., Smolarczyk, R., Smolarczyk, K., and Meczekalski, B. (2020). Hormonal Effects on Hair Follicles. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21155342"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"641","DOI":"10.1016\/S0039-128X(03)00093-X","article-title":"Gene expression of type 2 17 beta hydroxysteroid dehydrogenase in scalp hairs of hirsute women","volume":"68","author":"Oliveira","year":"2003","journal-title":"Steroids"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1530\/EJE-15-0460","article-title":"Is idiopathic hirsutism (IH) really idiopathic? mRNA expressions of skin steroidogenic enzymes in women with IH","volume":"173","author":"Taheri","year":"2015","journal-title":"Eur. J. Endocrinol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1447","DOI":"10.1590\/S0100-879X2003001000024","article-title":"The 5alpha-reductase type 1, but not type 2, gene is expressed in anagen hairs plucked from the vertex area of the scalp of hirsute women and normal individuals","volume":"36","author":"Oliveira","year":"2003","journal-title":"Braz. J. Med. Biol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"564","DOI":"10.1111\/j.1365-2230.2006.02146.x","article-title":"Content of 5-alpha-reductase (type 1 and type 2) mRNA in dermal papillae from the lower abdominal region in women with hirsutism","volume":"31","author":"Kazimierczak","year":"2006","journal-title":"Clin. Exp. Dermatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"4085","DOI":"10.1210\/jc.2006-0227","article-title":"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","volume":"91","author":"Goodarzi","year":"2006","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"606","DOI":"10.3109\/09513590.2011.650760","article-title":"17-Hydroxysteroid dehydrogenase type 5 gene polymorphism (-71A\/G HSD17B5 SNP) and treatment with oral contraceptive pills in PCOS women without metabolic comorbidities","volume":"28","author":"Maier","year":"2012","journal-title":"Gynecol. Endocrinol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1159\/000339317","article-title":"Aromatase gene polymorphism does not influence clinical phenotype and response to oral contraceptive pills in polycystic ovary syndrome women","volume":"74","author":"Maier","year":"2012","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1007\/s43032-021-00515-4","article-title":"The Role of Genetics, Epigenetics and Lifestyle in Polycystic Ovary Syndrome Development: The State of the Art","volume":"29","author":"Bruni","year":"2022","journal-title":"Reprod. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1210\/jcem.87.1.8137","article-title":"The androgen receptor CAG repeat polymorphism and X-chromosome inactivation in Australian Caucasian women with infertility related to polycystic ovary syndrome","volume":"87","author":"Hickey","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"3484","DOI":"10.1210\/jcem.85.9.6832","article-title":"Androgen receptor gene CAG trinucleotide repeats in anovulatory infertility and polycystic ovaries","volume":"85","author":"Mifsud","year":"2000","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1939","DOI":"10.1210\/jc.2008-0038","article-title":"Association of androgen receptor CAG repeat polymorphism and polycystic ovary syndrome","volume":"93","author":"Shah","year":"2008","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Weintrob, N., Eyal, O., Slakman, M., Segev Becker, A., Ish-Shalom, M., Israeli, G., Kalter-Leibovici, O., and Ben-Shachar, S. (2018). Correction: The effect of CAG repeats length on differences in hirsutism among healthy Israeli women of different ethnicities. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0203181"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1271","DOI":"10.1007\/s40618-020-01215-7","article-title":"The role of androgen receptor CAG repeat polymorphism in androgen excess disorder and idiopathic hirsutism","volume":"43","author":"Polat","year":"2020","journal-title":"J. Endocrinol. Investig."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"669","DOI":"10.1080\/09513590802342841","article-title":"Shorter CAG repeats in the androgen receptor gene may enhance hyperandrogenicity in polycystic ovary syndrome","volume":"24","author":"Stoop","year":"2008","journal-title":"Gynecol. Endocrinol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1093\/molehr\/gas024","article-title":"Negative association between androgen receptor gene CAG repeat polymorphism and polycystic ovary syndrome? A systematic review and meta-analysis","volume":"18","author":"Wang","year":"2012","journal-title":"Mol. Hum. Reprod."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1016\/j.gene.2013.04.040","article-title":"Association of the CAG repeat polymorphisms in androgen receptor gene with polycystic ovary syndrome: A systemic review and meta-analysis","volume":"524","author":"Zhang","year":"2013","journal-title":"Gene"},{"key":"ref_35","first-page":"1735","article-title":"The role of the CAG repeat polymorphism in the androgen receptor gene and of skewed X-chromosome inactivation, in the pathogenesis of hirsutism","volume":"85","author":"Calvo","year":"2000","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.jsbmb.2011.11.006","article-title":"CAG repeat polymorphism in androgen receptor gene is not directly associated with polycystic ovary syndrome but influences serum testosterone levels","volume":"128","author":"Skrgatic","year":"2012","journal-title":"J. Steroid Biochem. Mol. Biol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1056\/NEJM199908123410706","article-title":"The biology of hair follicles","volume":"341","author":"Paus","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1016\/j.ijwd.2017.02.007","article-title":"Endocrine evaluation of hirsutism","volume":"3","author":"Mihailidis","year":"2017","journal-title":"Int. J. Womens Dermatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"5305","DOI":"10.1210\/jc.2010-1123","article-title":"Total testosterone assays in women with polycystic ovary syndrome: Precision and correlation with hirsutism","volume":"95","author":"Legro","year":"2010","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1440","DOI":"10.1210\/jcem-21-11-1440","article-title":"Clinical assessment of body hair growth in women","volume":"21","author":"Ferriman","year":"1961","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1136\/pgmj.59.687.17","article-title":"The aetiology of oligomenorrhoea and\/or hirsuties: A study of 467 patients","volume":"59","author":"Ferriman","year":"1983","journal-title":"Postgrad. Med. J."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1016\/0002-9378(81)90746-8","article-title":"Hirsutism: Implications, etiology, and management","volume":"140","author":"Hatch","year":"1981","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"4112","DOI":"10.1210\/jc.2004-2243","article-title":"Ferriman Gallwey self-scoring I: Performance assessment in women with polycystic ovary syndrome","volume":"90","author":"Wild","year":"2005","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1210\/jc.2004-2301","article-title":"Degree of facial and body terminal hair growth in unselected black and white women: Toward a populational definition of hirsutism","volume":"91","author":"DeUgarte","year":"2006","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1056\/NEJMcp1514916","article-title":"Clinical Practice. Polycystic Ovary Syndrome","volume":"375","author":"McCartney","year":"2016","journal-title":"N. Engl. J. Med."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.1210\/jc.2018-00241","article-title":"Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline","volume":"103","author":"Martin","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"799","DOI":"10.1016\/j.rbmo.2020.12.006","article-title":"Influence of ethnicity on different aspects of polycystic ovary syndrome: A systematic review","volume":"42","author":"Sendur","year":"2021","journal-title":"Reprod. Biomed. Online"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1111\/cen.13389","article-title":"Association between biochemical hyperandrogenism parameters and Ferriman-Gallwey score in patients with polycystic ovary syndrome: A systematic review and meta-regression analysis","volume":"87","author":"Amiri","year":"2017","journal-title":"Clin. Endocrinol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/j.fertnstert.2014.01.003","article-title":"Prevalence of androgenic alopecia in patients with polycystic ovary syndrome and characterization of associated clinical and biochemical features","volume":"101","author":"Quinn","year":"2014","journal-title":"Fertil. Steril."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1016\/j.fertnstert.2008.06.021","article-title":"Degree of hyperinsulinemia, independent of androgen levels, is an important determinant of the severity of hirsutism in PCOS","volume":"92","author":"Landay","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1159\/000277640","article-title":"Prevalence of polycystic ovary syndrome and related disorders in mexican women","volume":"69","author":"Moran","year":"2010","journal-title":"Gynecol. Obstet. Investig."},{"key":"ref_52","first-page":"966","article-title":"Effects of pregnancy and changes in body weight on polycystic ovary syndrome phenotypes according to the Rotterdam criteria","volume":"142","author":"Echiburu","year":"2014","journal-title":"Rev. Med. Chile"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1016\/j.cca.2008.07.028","article-title":"Association between CAPN10 UCSNP-43 gene polymorphism and polycystic ovary syndrome in Chilean women","volume":"398","author":"Marquez","year":"2008","journal-title":"Clin. Chim. Acta"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"776","DOI":"10.1016\/j.metabol.2016.01.006","article-title":"Metabolic profile in women with polycystic ovary syndrome across adult life","volume":"65","author":"Echiburu","year":"2016","journal-title":"Metabolism"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"4742","DOI":"10.1210\/jc.2007-1252","article-title":"Hormonal profile in women with polycystic ovarian syndrome with or without type 1 diabetes mellitus","volume":"92","author":"Codner","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"179","DOI":"10.6061\/clinics\/2014(03)06","article-title":"Association of glucocorticoid receptor polymorphisms with clinical and metabolic profiles in polycystic ovary syndrome","volume":"69","author":"Maciel","year":"2014","journal-title":"Clinics"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"1691","DOI":"10.1007\/s10815-017-1030-3","article-title":"Haptoglobin levels, but not Hp1-Hp2 polymorphism, are associated with polycystic ovary syndrome","volume":"34","author":"Carvalho","year":"2017","journal-title":"J. Assist. Reprod. Genet."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"814","DOI":"10.3109\/09513590.2010.508852","article-title":"Dyslipidemia in women with polycystic ovary syndrome: Incidence, pattern and predictors","volume":"27","author":"Rocha","year":"2011","journal-title":"Gynecol. Endocrinol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1590\/S0100-72032012000800003","article-title":"Frequency and risk factors for metabolic syndrome in adolescents and adults women with polycystic ovary syndrome","volume":"34","author":"Pedroso","year":"2012","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_60","first-page":"107","article-title":"Ferriman-Gallwey Score correlates with obesity and insulin levels in Polycystic Ovary Syndrome: An observational study","volume":"13","author":"Sales","year":"2015","journal-title":"Rev. Soc. Bras. Cl\u00edn. M\u00e9d."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"2493","DOI":"10.1016\/j.fertnstert.2010.02.015","article-title":"Variation in metabolic and cardiovascular risk in women with different polycystic ovary syndrome phenotypes","volume":"94","author":"Wiltgen","year":"2010","journal-title":"Fertil. Steril."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"579","DOI":"10.1016\/j.fertnstert.2018.11.034","article-title":"ACC\/AHA 2017 definition of high blood pressure: Implications for women with polycystic ovary syndrome","volume":"111","author":"Marchesan","year":"2019","journal-title":"Fertil. Steril."},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1007\/s40618-016-0570-1","article-title":"Habitual physical activity is associated with improved anthropometric and androgenic profile in PCOS: A cross-sectional study","volume":"40","author":"Mario","year":"2017","journal-title":"J. Endocrinol. Investig."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1055\/s-0038-1642634","article-title":"Association between Insulin Resistance and Cardiovascular Risk Factors in Polycystic Ovary Syndrome Patients","volume":"40","author":"Wanderley","year":"2018","journal-title":"Rev. Bras. Ginecol. Obstet."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"396","DOI":"10.3109\/09513590.2015.1006187","article-title":"Comparison of the effects of chlormadinone acetate versus drospirenone containing oral contraceptives on metabolic and hormonal parameters in women with PCOS for a period of two -year follow -up","volume":"31","author":"Yildizhan","year":"2015","journal-title":"Gynecol. Endocrinol."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s00404-014-3217-5","article-title":"Comparison of two oral contraceptive forms containing cyproterone acetate and drospirenone in the treatment of patients with polycystic ovary syndrome: A randomized clinical trial","volume":"290","author":"Kahraman","year":"2014","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1016\/j.contraception.2012.07.005","article-title":"Body composition in lean women with polycystic ovary syndrome: Effect of ethinyl estradiol and drospirenone combination","volume":"87","author":"Aydin","year":"2013","journal-title":"Contraception"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"245","DOI":"10.3109\/09513590.2011.613971","article-title":"Effects of ethinyl estradiol\u2013cyproterone acetate treatment on metabolic syndrome, fat distribution and carotid intima media thickness in polycystic ovary syndrome","volume":"28","author":"Karabulut","year":"2012","journal-title":"Gynecol. Endocrinol."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1007\/s00404-012-2425-0","article-title":"A macrophage activation marker chitotriosidase in women with PCOS: Does low-grade chronic inflammation in PCOS relate to PCOS itself or obesity?","volume":"286","author":"Alanbay","year":"2012","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.ejogrb.2010.10.001","article-title":"Modified Ferriman\u2013Gallwey hirsutism score and androgen levels in Turkish women","volume":"154","author":"Coskun","year":"2011","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.ijgo.2008.05.017","article-title":"Clinical and metabolic effects of medroxyprogesterone acetate and ethinyl estradiol plus drospirenone in women with polycystic ovary syndrome","volume":"103","author":"Kiyici","year":"2008","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"1188","DOI":"10.1177\/147323000803600604","article-title":"The relationship between cl\u00ednico-biochemical characteristics and psychiatric distress in young women with polycystic ovary syndrome","volume":"36","author":"Adali","year":"2008","journal-title":"J. Int. Med. Res."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"1729","DOI":"10.1093\/humrep\/17.7.1729","article-title":"Clinical, endocrine and metabolic effects of metformin added to ethinyl estradiol\u2013cyproterone acetate in non-obese women with polycystic ovarian syndrome: A randomized controlled study","volume":"17","author":"Elter","year":"2002","journal-title":"Hum. Reprod."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/j.mefs.2010.06.007","article-title":"Evaluation of serum PSA after cyproterone compound treatment compared with oral contraceptive pill in hirsute polycystic ovary syndrome patients","volume":"15","author":"Taheripanah","year":"2010","journal-title":"Middle East. Fertil. Soc. J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1783\/1471189041261636","article-title":"An observational study of Yasmin\u00ae in the management of women with polycystic ovary syndrome","volume":"30","author":"Mook","year":"2004","journal-title":"J. Fam. Plan. Reprod. Health Care"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Ilie, I.R., Marian, I., Mocan, T., Ilie, R., Mocan, L., Duncea, I., and Pepene, C.E. (2012). Ethinylestradiol 30\u03bcg -drospirenone and metformin: Could this combination improve endothelial dysfunction in polycystic ovary syndrome?. BMC Endocr. Disord., 12.","DOI":"10.1186\/1472-6823-12-9"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"2817","DOI":"10.1210\/jc.2003-031158","article-title":"Drospirenone for the treatment of hirsute women with polycystic ovary syndrome: A clinical, endocrinological, metabolic pilot study","volume":"89","author":"Guido","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"919","DOI":"10.1016\/S0015-0282(02)02993-X","article-title":"Androgen and lipid profiles in adolescents with polycystic ovary syndrome who were treated with two forms of combined oral contraceptives","volume":"77","author":"Mastorakos","year":"2002","journal-title":"Fertil. Steril."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"249","DOI":"10.3109\/09513590.2011.613965","article-title":"The influence of obesity on androstenedione to testosterone ratio in women with polycystic ovary syndrome (PCOS) and hyperandrogenemia","volume":"28","author":"Misichronis","year":"2012","journal-title":"Gynecol. Endocrinol."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"615","DOI":"10.3109\/09513590.2010.521265","article-title":"Effect of ethinylestradiol\/cyproterone acetate on endothelial function in young non-obese women with polycystic ovary syndrome: A pilot study","volume":"27","author":"Naka","year":"2011","journal-title":"Gynecol. Endocrinol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1530\/eje.1.02024","article-title":"Clinical and psychological correlates of quality -of-life in polycystic ovary syndrome","volume":"153","author":"Hahn","year":"2005","journal-title":"Eur. J. Endocrinol."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"3443","DOI":"10.1093\/humrep\/der302","article-title":"Clinical and biochemical presentation of polycystic ovary syndrome in women between the ages of 20 and 40","volume":"26","author":"Liang","year":"2011","journal-title":"Hum. Reprod."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"1960","DOI":"10.1016\/j.fertnstert.2008.09.003","article-title":"Clinical and biochemical presentations of polycystic ovary syndrome among obese and nonobese women","volume":"92","author":"Liou","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1016\/j.fertnstert.2012.06.035","article-title":"Comparative study of the therapeutic effects of oral contraceptive pills containing desogestrel, cyproterone acetate, and drospirenone in patients with polycystic ovary syndrome","volume":"98","author":"Bhattacharya","year":"2012","journal-title":"Fertil. Steril."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.contraception.2010.02.009","article-title":"Effect of oral contraceptive containing ethinyl estradiol combined with drospirenone vs. desogestrel on clinical and biochemical parameters in patients with polycystic ovary syndrome","volume":"82","author":"Kriplani","year":"2010","journal-title":"Contraception"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"525","DOI":"10.1007\/s00404-012-2568-z","article-title":"Clinical characteristics, metabolic features, and phenotype of Chinese women with polycystic ovary syndrome: A large-scale case\u2013control study","volume":"287","author":"Zhang","year":"2013","journal-title":"Arch. Gynecol. Obstet."},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1080\/09513590802217027","article-title":"Effects of metformin and ethinyl estradiol-cyproterone acetate on clinical, endocrine and metabolic factors in women with polycystic ovary syndrome","volume":"24","author":"Wu","year":"2008","journal-title":"Gynecol. Endocrinol."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"1364","DOI":"10.3389\/fendo.2021.759835","article-title":"Metabolic Features of Women With Polycystic Ovary Syndrome in Latin America: A Systematic Review","volume":"12","author":"Marchesan","year":"2021","journal-title":"Front. Endocrinol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"869","DOI":"10.1001\/archderm.1988.01670060015008","article-title":"The validity and practicality of sun-reactive skin types I through VI","volume":"124","author":"Fitzpatrick","year":"1988","journal-title":"Arch. Dermatol."},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.ijwd.2017.01.006","article-title":"Association of ethnicity, Fitzpatrick skin type, and hirsutism: A retrospective cross-sectional study of women with polycystic ovarian syndrome","volume":"3","author":"Afifi","year":"2017","journal-title":"Int. J. Womens Dermatol."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1097\/AOG.0b013e31823f7135","article-title":"A 20-year follow-up of young women with polycystic ovary syndrome","volume":"119","author":"Carmina","year":"2012","journal-title":"Obstet. Gynecol."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1196\/annals.1365.014","article-title":"Polycystic ovary syndrome: A multifaceted disease from adolescence to adult age","volume":"1092","author":"Pasquali","year":"2006","journal-title":"Ann. N. Y. Acad. Sci."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1016\/j.steroids.2013.04.005","article-title":"Changes in the PCOS phenotype with age","volume":"78","author":"Hsu","year":"2013","journal-title":"Steroids"},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"1259","DOI":"10.1016\/j.fertnstert.2011.09.002","article-title":"The phenotype of polycystic ovary syndrome ameliorates with aging","volume":"96","author":"Brown","year":"2011","journal-title":"Fertil. Steril."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2265.1980.tb02125.x","article-title":"Serum steroids and pituitary hormones in female puberty: A partly longitudinal study","volume":"12","author":"Apter","year":"1980","journal-title":"Clin. Endocrinol."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.bpobgyn.2016.05.003","article-title":"Androgen excess: Investigations and management","volume":"37","author":"Lizneva","year":"2016","journal-title":"Best Pract. Res. Clin. Obstet. Gynaecol."},{"key":"ref_97","first-page":"347","article-title":"Idiopathic hirsutism","volume":"21","author":"Azziz","year":"2000","journal-title":"Endocr. Rev."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"857","DOI":"10.1111\/1523-1747.ep12382494","article-title":"Effects of insulin and insulin-like growth factors on cultured human hair follicles: IGF-I at physiologic concentrations is an important regulator of hair follicle growth in vitro","volume":"102","author":"Philpott","year":"1994","journal-title":"J. Investig. Dermatol."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1210\/jcem.76.2.8432767","article-title":"Sex hormone-binding globulin: A marker for hyperinsulinemia and\/or insulin resistance?","volume":"76","author":"Nestler","year":"1993","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"586","DOI":"10.1111\/cen.13936","article-title":"Insulin resistance is associated with hirsutism in unselected reproductive-aged women","volume":"90","author":"Song","year":"2019","journal-title":"Clin. Endocrinol."},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1210\/jc.2003-031626","article-title":"The investigation of insulin resistance in patients with idiopathic hirsutism","volume":"89","author":"Karababa","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1016\/S0300-595X(86)80029-9","article-title":"Pilosebaceous physiology in relation to hirsutism and acne","volume":"15","author":"Rosenfield","year":"1986","journal-title":"Clin. Endocrinol. Metab."},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1111\/j.1365-2265.1994.tb02483.x","article-title":"Androgens and human hair growth","volume":"40","author":"Randall","year":"1994","journal-title":"Clin. Endocrinol."},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1111\/j.1087-0024.2005.10106.x","article-title":"Hirsutism and the variable response of the pilosebaceous unit to androgen","volume":"10","author":"Rosenfield","year":"2005","journal-title":"J. Investig. Dermatol. Symp. Proc."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1210\/jc.2006-1864","article-title":"Position statement: Utility, limitations, and pitfalls in measuring testosterone: An Endocrine Society position statement","volume":"92","author":"Rosner","year":"2007","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"1713","DOI":"10.1158\/1055-9965.EPI-06-0765","article-title":"Standardization of steroid hormone assays: Why, how, and when?","volume":"16","author":"Stanczyk","year":"2007","journal-title":"Cancer Epidemiol. Biomarkers Prev."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1016\/j.fertnstert.2008.06.035","article-title":"The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: The complete task force report","volume":"91","author":"Azziz","year":"2009","journal-title":"Fertil. Steril."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"S12","DOI":"10.1016\/j.fertnstert.2006.07.032","article-title":"O-26, The association of androgen levels with the severity of hirsutism in the polycystic ovary syndrome (PCOS)","volume":"86","author":"Huang","year":"2006","journal-title":"Fertil. Steril."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1210\/jc.2003-031122","article-title":"Androgen excess in women: Experience with over 1000 consecutive patients","volume":"89","author":"Azziz","year":"2004","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1016\/j.cca.2022.03.011","article-title":"Is idiopathic hirsutism idiopathic?","volume":"531","author":"Heijboer","year":"2022","journal-title":"Clin. Chim. Acta"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/8\/1922\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:06:02Z","timestamp":1760141162000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/12\/8\/1922"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,9]]},"references-count":110,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["diagnostics12081922"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics12081922","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,8,9]]}}}