BACKGROUND: Hirsutism is a prevalent androgen-dependent condition that significantly affects women's physical and psychological health. 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. OBJECTIVE: 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. SEARCH METHODS: 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: "hirsutism," "hyperandrogenism," "androgen excess," "idiopathic hirsutism," "PCOS," "5α-reductase," "antiandrogens," "oral contraceptives," "laser hair removal," and "insulin resistance." INCLUSION CRITERIA: human studies, English language, adult females, and peer-reviewed original or review articles. WIDER IMPLICATIONS: 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.
Yeşiladalı et al. (Wed,) studied this question.