Hormonal Disorders

Hirsutism

In the practice of reproductive medicine hormonal disorders are sometimes encountered. One of the most common results in excessive hair growth which is called Hirsutism.

Basic Facts

Except for certain areas (such as the lip, palms of the hand, and the soles of the feet), most skin on the bodies of both men and women are "hair bearing." The amount and texture of the hair in each area depends on the individual body part. Some women experience excess hair growth on the face (particularly on the lips, sideburn areas and chin) or other parts of the body (such as the chest, back, and lower abdomen) which can be the result of a condition called hirsutism.

Hirsutism is defined as an over abundance of "terminal hair" in women in a pattern that is more commonly seen in males. Terminal hairs are the long, stiff, pigmented, and sometimes curly hair that are typically seen in the armpits and pubic area in women and the face of men. This is in contrast to "vellus" hair, the short, colorless, soft hair that normally covers most of the body. Vellus hair may become terminal hair when exposed to "androgens" or male hormones. Both men and women have circulating estrogens and androgens, and androgens are important in reproductive function even in healthy women. But when circulating levels of androgens are higher than normal (or hair follicles are more sensitive than normal to the effects of androgens) more of the vellus hair will differentiate into terminal hair.

Causes of Hirsutism

Hirsutism is relatively common and effects about 10% of North American women. The causes of hirsutism can be divided into four types:

  1. Familial
  2. Idiopathic
  3. Androgen excess
  4. Drug induced

Familial hirsutism is hereditary and is particularly common in certain ethnic groups, especially those of Middle Eastern or Mediterranean decent. By contrast most Asians and Native Americans have relatively little terminal hair. If a woman's mother and sister have hirsutism, she may be more prone to also developing excess hair growth. In many of these individuals, the excess hair growth is considered normal and not a sign of a disorder.

Idiopathic hirsutism is hirsutism that results without any known underlying medical condition. This occurs in patients without any evidence of hormone imbalances, underlying disease, or a family history of hirsutism. Most of these individuals probably have enzyme systems in the hair follicle which make their hair cells more sensitive to normal levels of circulating androgens.

Drug induced hirsutism is not common, but some prescription drugs can cause hirsutism in women. Minoxidil is a drug used to treat high blood pressure that contains the main ingredient in Rogaine (used to treat balding men) and can cause unwanted hair growth in women. Some of the anti-seizure medications used to treat epilepsy, anabolic steroids, and some immunosuppressant drugs are also associated with excess hair growth in women. A careful medical history should be able to determine if drug-induced hirsutism may be a consideration for any individual patient.

Androgen excess represents the most common cause of hirsutism. Androgen excess may be due to a number of conditions including polycystic ovary syndrome. This is the most common cause of androgen excess in otherwise healthy reproductive age women. PCOS may also lead to irregular or absent menstrual periods, high blood pressure, acne, increased body weight, and infertility. In vary rare cases, excess androgen production may be caused by ovarian or adrenal tumors. This type of hirsutism is usually rapid in its onset and more severe than that found in patients with PCOS. Other adrenal disorders such as adrenal hyperplasia or Cushing's syndrome can also cause hirsutism.

Evaluating Hirsutism

Women who feel they may suffer from hirsutism should seek the advice of a reproductive endocrinologist. A thorough history and physical examination will often yield the underlying cause for the hirsutism. For most women, a simple blood test and occasionally ultrasound or X-ray exams may be done in an effort to find the underlying cause. Most of these tests are simple and relatively painless.

Treatment

Once the underlying cause of the hirsutism has been identified, your physician can discuss what treatment options are available to you. Oral contraceptives provide the mainstay of therapy, as these pills will lower circulating androgen levels and help prevent cysts from developing on the ovaries. If androgen excess results from an ovarian or adrenal tumor, your doctor may recommend surgery to correct these conditions. In the case of drug induced hirsutism, a simple change in medications often will alleviate the problem.

In addition to oral contraceptives, other drugs may be recommended to you. There are other anti-androgen drugs available as well as other hormonal manipulations which can be used to significantly reduce the clinical effects of hirsutism with very minimal side-effects.

Be advised that all medical therapies for hirsutism will work slowly. Any effect may not be seen for approximately six months. This is because the medications will only effect the growth of new hair but will not slow the growth of hair that has already started, even if it is still below the level of the skin. While waiting for the drugs to take effect, your doctor may recommend non-medical therapies such as waxing, depilatory creams, or electrolysis. More recently laser therapy has become available as well.

Final word of hope

If you feel you have hirsutism, do not be alarmed. Most causes are not dangerous and can be treated effectively, inexpensively, and with very few side effects. New drugs and therapies are available frequently to help most women overcome this condition.