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At the heart of general practice since 1960

Treating glue ear

Dr Nigel Stollery passes on his tips gained from many years' experience as a GP with a special interest in dermatology ­ he practises in

Kibworth, Leicestershire

1. Though hirsutism is common it is always worth checking a serum total testosterone level. Anyone with a level over 2ng/ml (normal <1.1ng l)="" needs="" referral="" to="" an="" endocrinologist="" for="" a="" full="">

2. Fear of turning into a man is the biggest distress in most cases of hirsutism rather than the hair itself.

Advising to shave does not help.

A kind and sympathetic approach with exploration of fears and appropriate reassurance is needed.

three

4. Hirsutism is more common after the menopause and in those taking oral steroids. In postmenopausal women the 5 alpha reductase inhibitor finasteride may be useful; this is contraindicated in premenopausal women because of its potential effects if a fetus is exposed to it in the first trimester.

5. By the time medical help is sought many women will have tried many treatments. One that can be very useful and easy is simple bleaching with hydrogen peroxide or lemon juice, leaving hairs white and a lot less noticeable.

6. If the menstrual cycle is normal it is very unlikely that there is an underlying hormonal cause.

7. Virilisation as well as hirsutism should always be investigated thoroughly as the cause may be an underlying androgen-secreting tumour. In children this may indicate congenital adrenal hyperplasia.

8. The only permanent treatment for hirsutism is electrolysis. This can be expensive and time consuming though in some areas will be available on the NHS via the local dermatology department.

9. In a number of cases hirsutism will be caused by polycystic ovary syndrome. If this is suspected an ultrasound scan would be a worthwhile investigation.

10. Cyproterone shouldn't be used in smokers, hypertensives or those with a strong family history of breast cancer or CHD.

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