Hirsutism can be one of the most distressing conditions for women. It is a symptom that is occasionally underlined by serious pathology, hence the importance of thorough history, examination and investigation. This article first examines the underlying physiology associated with human hair growth and relevant to the understanding of the causes and treatment of hirsutism. Causes of hirsutism are discussed, the most common being polycystic ovarian syndrome. Other causes of disordered androgen metabolism are also discussed. Treatment of hirsutism includes treatment of the underlying cause and often lifestyle modifications such as weight loss are needed. Cosmetic measures are needed for existing hair while prevention of new hair growth often requires pharmacological intervention. This is most commonly achieved using the combined oral contraceptive pill, while anti-androgens and GnRH agonists are reserved for more severe and resistant cases.