We should note that hirsutism is one of the more common signs of androgen excess, in particular in PCOS (10), which has significant psychosocial and quality-of-life implications (56,57). The prevalence and degree of hirsutism, however, is dependent on the ethnicity of the patients; apparently it is less prevalent in women with PCOS of East Asian extraction or Pacific Islanders (58,59) but more prevalent in women of Asian Indian origin (e.g., Bengali, Gujarati, or Dravidian Indian) (60). Overall, approximately 70% of white and black women with PCOS will be hirsute, a figure we used to calculate economic burden.
Acne has been reported to affect 12-14% of white PCOS patients (10,60), although the prevalence of this dermatological abnormality also varies with ethnicity. It is reportedly higher in Asian Indians (60) and lower in Pacific Islanders (58). Androgenic alopecia is a recognized sign of PCOS (61-63); however, in a study of 257 androgen excess patients undergoing treatment, only 12 (4.7%) complained of hair loss only (10). Overall, acne and androgenic alopecia apparently have a low prevalence among patients with PCOS. Because studies quantifying and determining the prevalence of acne and androgenic alopecia in a significant number of unselected patients with PCOS are lacking, we did not include these disorders in our calculations of economic burden.
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