What is the most common cause of androgen excess and hirsutism?

The most common cause of androgen excess and hirsutism is polycystic ovarian syndrome (PCOS). PCOS is a hormonal disorder that affects women of reproductive age, characterized by irregular menstrual cycles, excessive androgen levels, and the presence of multiple cysts on the ovaries. The elevated androgen levels lead to symptoms such as hirsutism, which is defined as the growth of coarse hair in areas where males typically grow hair, such as the face, chest, and back.

In PCOS, the disruption in normal ovarian function causes increased production of androgens (testosterone being the most notable), resulting in the clinical manifestations of hyperandrogenism including hirsutism. This condition is often associated with insulin resistance, which can further exacerbate the hormonal imbalance.

Other conditions listed can also lead to androgen excess, but they are less common than PCOS. For example, congenital adrenal hyperplasia is a genetic disorder affecting adrenal hormone production, leading to increased androgen levels; however, it occurs less frequently in the general population compared to PCOS. Cushing's syndrome results from excess cortisol, which can lead to hirsutism but is primarily characterized by a variety of systemic symptoms rather than being a direct cause of androgen excess