Abstract Hirsutism can be a have a major physical and psychological impact on a woman. To understand the management of the hirsute woman, it is important to understand the hair growth cycle, and the time scale involved in any treatment. Whilst the underlying cause of any hyper-androgenism is important to ascertain, the majority of cases encountered in practice will be idiopathic. Treatment should be directed at the cause of the problem, and in this regard newer treatments such as metformin for polycystic ovarian syndrome show great promise. Combined with conventional depilitory techniques, reducing the androgen levels, or at least the levels of active androgens, will result in a gradual reduction in hair regrowth. As with all medical problems, investigation begins with a careful history, examination and then investigation directed at the possible cause. A careful explanation of the treatment aims should be undertaken, and the patient should not have unrealistic expectations.