Hirsutism, Obesity, and Phenothiazine Therapy

To the Editor.— The report of Phillips et al (241:920, 1979) suggested an association of hirsutism with long-term phenothiazine therapy. The authors mentioned that testosterone levels were either normal or slightly below normal limits, although no numbers were given. In addition, no indication of levels of sex steroid binding globulin or free testosterone is available in the article.

The figures showed the patient to be clearly obese. Obesity has a well-known effect on decreasing sex steroid binding globulin, thus increasing free^1,2 but not necessarily total testosterone levels. It is clear now that this effect is reversible with weight loss produced by either intestinal bypass³ or dietary techniques⁴; thus, obesity would seem the more noteworthy explanation for the patient's hirsutism.