SUMMARY Male-like hair growth and masculinization of women and the ambiguity of genders has fascinated mankind for millennia, frequently appearing in mythology and the arts. The earliest reports of androgen excess, beginning 400 years BC, focused on the appearance of male-like hair growth and features in women, often accompanied by menstrual cessation. The first etiologies identified as a cause of androgenization in the female were adrenal disorders, primarily adrenocortical neoplasms, but also eventually adrenal hyperplasia. The first report of a patient with nonclassic adrenal hyperplasia (NCAH) was made in 1957. The Achard-Thiers syndrome, which was originally reported in 1921 and was felt to primarily affect postmenopausal women, included the development of diabetes mellitus, hirsutism, and menstrual irregularity or amenorrhea in conjunction with adrenocortical disease. Androgen production by the ovary was not recognized until the early 1900s, with the first case of a patient with glucose intolerance, hirsutism, and ovarian pathology reported by Tuffier in 1914. As early as the mid-18th century, the presence of sclerocystic or multicystic ovaries was recognized, although this pathology was felt to be primarily associated with pelvic pain and/or menorrhagia. It was not until the seminal report of Drs. Stein and Leventhal of 1935 that the association of polycystic ovaries and amenorrhea, and possibly obesity and/or hirsutism, was noted. Subsequent investigations have elucidated the ovarian source of the androgens the gonadotropic abnormalities, the insulin resistance, and the high prevalence of the disorder, currently known as the polycystic ovary syndrome (PCOS). This syndrome was initially treated by ovarian wedge resection, but subsequent ovulatory therapies, including clomiphene citrate, menopausal gonadotropins, and most recently insulin sensitizers, have replaced this surgery as the treatment of choice for fertility improvement in PCOS. Notwithstanding, laparoscopic ovarian drilling retains a place in our current therapeutic armamentarium for these patients
