Hirsutism Defined as excessive growth of androgen-responsive terminal hair in women excess hair growth in areas where hair growth is normally minimal Virilization Defined as masculinization of a woman Presentation clitoromegaly (pathognomonic) acne deepening voice ↑ muscle Associated conditions Ovarian (↑ testosterone) polycystic ovarian syndrome ovarian tumors (Sertoli-Leydig cell tumors) Adrenal (↑ DHEA-sulfate) congenital adrenal hyperplasia Cushing's syndrome adrenal tumors Drug-related cyclosporine phenytoin minoxidil Idiopathic presumed to be caused by increased androgen-receptor sensitivity Obesity due to ↓ in steroid-hormone binding globulin (SHBG) results in ↑ concentration of free testosterone Hypothyroidism same cause as obesity Aromatase deficiency inability to convert testosterone to estrogen leads to maternal virilization when present in fetus