This chapter explains the causes of hirsutism and virilization in women and the steroid pathways involved. Conditions reviewed include hypertrichosis, polycystic ovarian syndrome, idiopathic hirsutism, androgen-secreting tumors of the ovary, congenital adrenal hyperplasia and Cushing’s syndrome. For each immunoassay analyte of interest in this field the biological function is explained, with the clinical applications of the test and its limitations. Typical assay technology is described. The type of sample and frequency of use are included, with an example reference interval (for background information only). In some cases this information is provided through cross-references to other chapters. The analytes included are luteinizing hormone, follicle-stimulating hormone, anti-Müllerian hormone, testosterone, sex hormone-binding globulin, free testosterone, androstenedione, dehydroepiandrosterone sulfate, 17α-hydroxyprogesterone, dihydrotestosterone and 3α-androstanediol glucuronide.

Dr Michael John Wheeler BSc, MSc, PhD, FRCPath is a Consultant Clinical Biochemist. Until 2005 Dr Wheeler worked at Guy’s and St Thomas’ NHS Foundation Trust. He was deputy head of the Department of Chemical Pathology, Director of the Supra Regional Assay Service for Hormones and Director of the Department of Health Evaluation Service for diagnostic kits and equipment for hormones. From 2005 to 2012 he sat on a number of committees of CPA (UK) Ltd, had a consultancy at the University of Surrey and lectured. He has published over 100 peer reviewed papers and a number of books and book chapters. He currently assesses External Quality Assessment Schemes and Clinical Biochemistry departments for accreditation for CPA (UK) Ltd and the United Kingdom Accreditation Service (UKAS). He is also on the steering committee of the Vitamin D EQAS (DEQAS) and acts as a private consultant in clinical biochemistry and quality assessment.

Hirsutism, virilization, hypertrichosis, polycystic ovarian syndrome, congenital adrenal hyperplasia, Cushing’s syndrome, androgen, female, menstrual cycle, follicle, oocyte, fertilization, luteinizing hormone, follicle-stimulating hormone, anti-Müllerian hormone, testosterone, sex hormone-binding globulin, free testosterone, androstenedione, dehydroepiandrosterone sulfate, 17α-hydroxyprogesterone, dihydrotestosterone, androstanediol.

Mirza, S.S., Shafique, K., Shaikh, A.R., Khan, N.A. & Qureshi, M.A. Association between circulating adiponectin levels and polycystic ovarian syndrome. J. Ovarian Res. 7, 18–24 (2014).

Pinola, P., Morin-Papunen, L.C., Bloigu, A., et al. Anti-Müllerian hormone: correlation with testosterone and oligo- or amenorrhoea in female adolescence in a population-based cohort study. Doi:  10.1093/humrep/deu182. Hum Reprod. 29, 2317–2325 (2014).

Dewailly, D., Andersen, C.Y., Balen, A. et al. The physiology and clinical utility of anti-Mullerian hormone in women. Hum. Reprod. Update 20, 370–85 (2014). doi: 10.1093/humupd/dmt062.