Hyperandrogenism is a medical condition characterized by high levels of androgens. Elevated levels of androgens are associated with different degrees of dyslipidemia, insulin resistance, metabolic syndrome and other metabolic abnormalities. Hirsutism, defined as the excessive growth of terminal hair in a man-like pattern in a female, is the result of elevated levels of androgens and is therefore the most commonly used clinical predictor of hyperandrogenism. Hirsutism is a distressing and relatively common problem, affecting 5 to 10% of women in Western societies. Hirsutism is not only the most important clinical manifestation of hyperandrogenism, but it is also highly associated with social and psychological difficulties itself, including anxiety, depression and even psychotic symptoms.

Currently, the diagnostic evaluation of hirsutism involves clinical examination using the modified Ferriman-Gallwey (mFG) score and biochemical evaluation of testosterone and androstenedione. Although the mFG-score is the standard scoring system to assess the severity and distribution of terminal hair, it has some major drawbacks. Current assessment using the mFG-score requires restraint from hair removal methods and previous studies have shown large inter-observer variations when using the mFG-score. This could be improved by digital trichoscopy which measures thickness and density of hair. Regarding the biochemical evaluation, measurement of DHT-degradation products could increase detection of hyperandrogenism for instance in women with idiopathic hirsutism. In my PhD project I aim to evaluate the added value of these new diagnostic approaches.