Hirsutism

1. What is Hirsutism?

Hirsutism refers to the growth of coarse dark hair in areas where women typically grow fine hair or no hair at all — above the lip and on the chin, chest, abdomen, and back. Hirsutism can have a major impact on a woman’s sense of well-being. Even isolated, mild hirsutism can be emotionally distressing to some woman.

2. What causes hirsutism?

All women naturally produce some degree of male hormones (testosterone/androgens). Hirsutism is caused by an excess of androgens or an increased sensitivity to androgens. The development and severity of hirsutism generally depends upon the level of male hormones in the blood and the sensitivity of the hair follicle.

3. What are main conditions causing hirsutism?

In the vast majority of cases, hirsutism is not caused by a serious medical condition; however, the cause of hirsutism should be determined, and underlying conditions may need to be treated. The two most common causes of hirsutism are polycystic ovary syndrome (PCOS) and idiopathic hirsutism. In addition to hirsutism, women with PCOS may have irregular or absent menstrual periods and/or infertility. Acne, obesity, and an increased risk of diabetes are also common in women with PCOS. Medications such as anabolic steroids that contain male hormones can also cause hirsutism. Hirsutism may be caused by other disorders of male hormone overproduction, but these are not common. Idiopathic hirsutism is defined when no cause of hirsutism can be ascertained and all hormonal work up is normal. Sometimes hirsutism may be manifestation of serious underlying conditions like ovarian tumor or adrenal tumor.

Causes of hirsutism can be summarized as follows:

• Excessive production of androgens by the ovaries (PCOS, ovarian tumour)

• Excessive sensitivity of hair follicles to androgens (genetic)

• Excessive production of androgens by the adrenal glands (congenital adrenal hyperplasia [CAH], adrenal tumour, cushing syndrome)

• Insulin resistance

• Menopause

• Medications

4. Whom should patient consult for hirsutism?

Patient should consult Endocrinologist for evaluation/management especially if:

• Hirsutism developing quickly (over 1-2 years), or before puberty;

• Accompanied by menstrual irregularity

• Associated with other androgenic features such as loss of the scalp hair, baldness, or deepening of the voice

• Accompanied by obesity or diabetes.

5. What is the medical treatment of hirsutism?

Hirsutism is very common and often improves with medical management. Prompt medical attention is important because delaying treatment makes the treatment more difficult and may have long-term health consequences. The treatment of hirsutism requires patience, because hair follicles have a life cycle of about six months. Most medications must be taken for six months before a noticeable improvement occurs. In the meantime, the existing hair can be mechanically removed or bleached, and some women continue to use these methods in combination with medication.

Weight loss in overweight women can decrease levels of androgens and lessen hirsutism especially in women with PCOS. Women with menstrual irregularities may also notice that their cycles become more regular after losing weight.

Medications for treating hirsutism include Eflornithine cream and antiandrogens. Antiandrogens for treating hirsutism include oral contraceptives, cyproterone, spironolactone and finasteride. Medications need to be taken under medical supervision only in discussion with your doctor. Because antiandrogens can cause birth defects in unborn baby if you take them while you are pregnant, they must not be taken unless you are using effective contraception.