| name | endo-hirsutism-avoid-test-androgen-local-hair |
| description | The skill recommends against testing for elevated androgen levels in eumenorrheic women with only unwanted local hair growth and no abnormal hirsutism score. Trigger phrases include statements like, “She only has stray facial hair but regular periods; do we need androgen labs?” |
Avoid androgen testing in isolated local hair growth
STEP 1 — Gather Information
Collect menstrual history (regular cycles), assess hair growth pattern (localized, non‑sexual), estimate Ferriman–Gallwey score (or confirm score <8), and screen for other hyperandrogenic signs (acne, alopecia, menstrual irregularity, infertility, virilization).
→ If eumenorrheic, local hair only, FG score <8, and no other hyperandrogenic signs, proceed to Step 2; otherwise consider androgen testing.
STEP 2 — Rule In / Rule Out
Is there an abnormal hirsutism score (FG ≥8) or any clinical evidence of hyperandrogenism?
- Yes → Rule in: order androgen labs (total testosterone, free testosterone, DHEAS, 17‑OHP as indicated).
- No → Rule out: proceed to Step 3.
STEP 3 — Classify or Stratify
Classify as isolated local hair growth with low likelihood of underlying androgen excess; no further endocrine workup needed.
→ Proceed to Step 4.
STEP 4 — Decide
Decide to forego androgen testing; manage with cosmetic measures (shaving, bleaching, photoepilation or electrolysis) based on patient preference.
→ End of algorithm.
Clinical Guardrails / Mimics / Pitfalls
Do not order testosterone, DHEAS, or 17‑OHP in this scenario; beware of missing subtle hyperandrogenism if cycles become irregular or virilization develops; avoid false reassurance when patient reports only a few hairs but may have subtle PCOS signs.
Concrete Clinical Example
A 22‑year‑old woman presents with a few stray hairs on the chin and upper lip, regular monthly periods, no acne or alopecia, and a self‑estimated Ferriman–Gallwey score of 5. She asks whether she needs testosterone labs. According to the guideline, advise against testing, reassure her, and offer cosmetic options such as shaving, bleaching, or photoepilation if desired.
Source: Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline, Endocrine Society, 2018, DOI:10.1210/jc.2018-00241
TODO: consider adding scripts/calc.py for the endo-hirsutism-avoid-test-androgen-local-hair calculator
