Background: The existence of profuse terminal hair in androgen-dependent areas of a women constitutes hirsutism. The association between insulin resistance & hirsutism, especially when accompanied by ovarian or adrenal hyperandrogenism, has been extensively documented. Nevertheless, the adiponectin role, as an indicator of metabolic consequences, in cases with hirsutism has not been conclusive. Aim: This study aimed to assess serum adiponectin level & insulin resistance in females with idiopathic hirsutism, as well as hirsutism with polycystic ovary syndrome (PCOS), compared to controls. Patients and methods: This case control investigation included twenty-five cases with hirsutism, & 25 age matched non-hirsute control females. Height, body weight, BMI, modified ferrimangallawy (mFG) scale, serum fasting glucose, & insulin were measured. Homeostasis model assessment of insulin resistance (HOMA-IR) & serum adiponectin were evaluated by enzyme-linked immune-sorbent assay. Serum total testosterone has been measured for females with menstrual irregularities. Results: Females with hirsutism either with or without PCOS had significantly lower serum adiponectin level compared to controls (p < 0.001). Serum fasting glucose, HOMA-IR & serum fasting insulin, were significantly greater in cases with hirsutism, especially with polycystic ovary syndrome, than controls (p < 0.001in all comparisons). HOMA-IR was significantly greater in females with lateral hirsutism, progressive course, high testosterone, acne, menstrual irregularities, with a significant positive association with body mass index and mFG scale (p < 0.001in all comparisons). Conclusion: Hirsutism, whether idiopathic or associated with PCOS, is correlated to insulin resistance & low adiponectin level, implying that this metabolic abnormality potentially contributes to the pathogenesis of the illness.