What Is Hirsutism?
Hirsutism is the presence of excessive hair in androgenic dependent areas of the female body. It is seen in 5 % to 10 % of women of reproductive age. In this condition, women develop hair growth that is coarse and dark; on the upper lip, chin, chest, abdomen, or back. The condition is a marker for androgen excess, although many women have no detectable hormone abnormalities. In addition to androgens secreted into the circulation by the adrenal glands and ovaries, peripheral fat also gets converted into circulating androgens, of which the most important is testosterone.
An individual may have other features of androgen excess along with hirsutism, like acne vulgaris or androgenic alopecia, and evidence of PCOS (polycystic ovarian syndrome) such as irregular menstruation or infertility. Although this condition usually causes much distress, it can be treated.
What Is Hirsutism?
There are several conditions that cause hirsutism. However, in most cases, the exact cause remains unknown. These conditions are as follows:
The female body naturally produces androgen. However, if the androgen levels are more than the normal, or if a woman’s hair follicles are more sensitive to androgens, then hirsutism develops.
Polycystic ovarian syndrome (PCOS) is a common condition of hormonal imbalance that leads to increased production of androgens in women. PCOS is seen in 60 % of cases. Women suffering from PCOS may also exhibit symptoms like acne vulgaris, irregular or absent menstrual periods, diabetes, obesity, or infertility.
The change in hormonal levels at menopause may also cause increased abnormal hair growth.
Other endocrine disorders like Cushing's disease and thyroid disorder, or birth abnormalities like congenital adrenal hyperplasia may lead to the development of other male characteristics, like deeper voice, acne vulgaris, or increased muscle mass.
Drugs such as oral contraceptives, anabolic, androgenic steroids, and antiseizure drugs may cause hirsutism. Other medications that can give rise to hirsutism are:
Idiopathic, which means no cause is found. It is seen in 10 % of cases.
Gestational, which means pregnancy-induced.
What Are the Symptoms of Hirsutism?
The common symptoms of hirsutism are thick, coarse, dark hair growth at sites where normally fine, thin hair would grow. For instance, in women, body hair may appear thicker and coarser on the face, chest, back, belly, upper arms, or upper legs.
How Is Hirsutism Diagnosed?
The doctor conducts a physical examination to find out the extent and severity of the abnormal hair growth, and other accompanying physical signs, such as acne. In cases of mild hirsutism, with regular menstruation and no other features of androgen excess, such as acne vulgaris or androgenic alopecia, or PCOS; no investigation is needed.
In cases of moderate to severe hirsutism, with or without menstrual abnormalities, the doctor may perform a variety of tests. Serum testosterone and SHBG (sex hormone-binding globulin) is measured on the second day of menstruation as well as dehydroepiandrosterone (DHEA) level of LH (Luteinizing Hormone) and FSH (Follicle-Stimulating Hormone) are estimated. The ratio of LH and FSH of more than 2:1 indicates PCOS. Ultrasonography is done to visualize the ovaries and uterus; X-rays, and some additional tests are done to evaluate the ovaries and adrenal glands so that other conditions can be ruled out.
How Is Hirsutism Treated?
The first step to treat hirsutism is weight loss. If a person is overweight, even losing 5 % of the body weight can lower androgen levels and decrease the symptoms. Also, mild hirsutism can be treated with several techniques available for hair removal. However, these techniques do not address the cause of the issue and only remove the excessive hair.
Temporary hair removal methods are shaving; bleaching, or lightening unwanted hair; waxing, plucking (tweezing), and using depilatories. Hair growth reduction can be done with topical agents like Eflornithine hydrochloride, which does not remove hair but slows down hair growth. It shows results by using it twice daily for six to eight weeks but may lead to local irritation. Long-lasting hair removal techniques like electrolysis and photo epilation (laser) treatments can also be chosen. They are expensive yet, dramatically alter the outlook of the patient.
Medical treatment with drugs like birth control pills (oral contraceptives) is the most commonly used drug treatment option for hirsutism. Birth control pills decrease androgen levels and regulate the menstrual cycle. Other drugs that suppress male hormones may also be used in conjunction with birth control pills. Spironolactone is a diuretic that can be used for hirsutism at lower doses. It blocks the action and effects of androgens and decreases hair growth. Its adverse effects include dry skin, heartburn, irregular and abnormal vaginal bleeding, dizziness, and fatigue.
Finasteride is another anti-androgen drug that is taken for treating hirsutism. It is found to have the same efficacy as Spironolactone. Flutamide is also used in the treatment of hirsutism. However, it may cause damage to the liver and it is not considered a first-line drug for treating hirsutism.
Low-dose corticosteroids may be used if hirsutism occurs due to overactive adrenal glands.
Insulin-lowering drugs like Metformin and Thiazolidinediones decrease blood levels of insulin as well as androgens, but this treatment is controversial as they have significant adverse effects.
Gonadotropin-releasing hormone (GnRH) agonists act by lowering the production of androgen by the ovaries. This therapy is however given through injections and is expensive. Moreover, it provides the same benefit as birth control pills.
What Is the Prognosis for People Who Have Hirsutism?
Hirsutism needs ongoing treatment. None of the treatment options make the hair go away completely, but they may slow down the hair growth and may aid in significantly decreasing the amount of unwanted hair. Most women become happy and satisfied with the results, once they find an effective and appropriate treatment regimen. An effective treatment option can also be continued indefinitely.
With the increasing awareness and concern for esthetics, hirsutism is a major challenge. However, with the right diagnosis and treatment, it can be managed well. There are different treatment choices available, ranging from cheap to expensive. As per the individual’s needs, a suitable treatment can be taken and this challenge can be faced with confidence.
Frequently Asked Questions