In women, terminal facial hair alone may suggest

• A. An excess of androgen
• B. Polycystic ovarian syndrome
• C. Hormonal imbalance due to estrogen deficiency
• D. Normal aging

Answer: (A)

Coarse terminal facial hair in women signals elevated androgens or increased sensitivity of facial follicles to androgens. Androgens drive the transformation of fine vellus hairs into thicker terminal hairs, especially on the face, through conversion to DHT by 5-alpha-reductase, which enhances hair growth in androgen-sensitive areas. While conditions like polycystic ovarian syndrome can cause this along with other signs, the presence of terminal facial hair most directly points to excess androgens overall rather than to estrogen deficiency or normal aging, which don’t typically produce this pattern.