Hirsutism is a common endocrine disorder affecting 5–10% of women of reproductive age and is commonly associated with acne and oily skin. It may be a source of social embarrassment and can negatively affect quality of life. A thorough history, physical examination and selected laboratory evaluations will confirm the diagnosis. This article reviews various causes and management of hirsutism. The most common cause of hirsutism is polycystic ovary syndrome, accounting for three out of every four cases. Pharmacologic interventions can suppress ovarian or adrenal androgen production and block androgen receptors in the hair follicle. Hair removal methods and lifestyle modifications may improve the therapeutic response. Considering the long life cycle of a hair follicle, prolonged treatment with pharmaceutical agents is required to produce improvement in hirsutism.