Hirsutism

Hirsutism is a medical condition in which there is abnormal growth of hair on a woman’s body. It affects 5 - 10% of women in the U.S. The type of hair growth is similar to that seen in men.

Hirsutism leads to excessive amounts of stiff and pigmented hair on body areas where men typically grow hair — face, chest, stomach and back.

One of the causes of hirsutism is an increase in androgens (male hormones) like testosterone. Hirsutism may also be due to a family trait.

Hirsutism is a medical sign rather than a disease and may be a sign of a more serious medical condition, especially if it develops after puberty.
A combination of self-care and medical therapies provides effective treatment for many women with hirsutism.

Excessive body hair, particularly in locations where women normally do not develop terminal hair during puberty (chest, abdomen, back, face) is the main symptom of hirsutism.

The medical term for excessive hair growth that affects any gender is hypertrichosis.

When excessively high androgen levels cause hirsutism, other signs may develop over time, a process called virilization.

Some of the signs of virilization include:

• deepening of the voice,
• loss of hair especially on the scalp,
• acne,
• reduction in breast size,
• occasionally an enlargement of the clitoris.

The primary cause of hirsutism is an increase in androgens (male hormones) like testosterone. It can also occur due to an increased sensitivity of hair follicles to androgens.

Other diseases like Cushing's disease and polycystic ovary syndrome can increases the risks of developing hirsutism. This is due to the fact that these diseases are accompanied by high levels of androgens.

Certain medications like corticosteroids and some anticonvulsive drugs like Phenytoin can also cause hirsutism. Some women have a genetic predisposition to developing hirsutism especially if a relative has it.

Diagnosis of hirsutism can include the following:

• A physical examination, mostly inspection to determine the areas where there is abnormal growth. A scale, Ferriman-Gallwey score , is used to measure the amount and location of hair of the body.
• Knowledge of the menstrual cycle is also important.  
• Another examination is an ultrasound of the ovaries.
• Blood tests that show the levels of certain hormones, mostly testosterone, thyroid-stimulating hormone and prolactin, can also be performed.

For the best treatment effect, it is necessary to know the exact cause of hirsutism.

Once the primary cause has been identified, the following treatments can be given (depending on the cause):  

• Medications that lower the levels of androgens or inhibit the body from producing them. Examples are Spironolactone, Metformin ,Flutamide and Cyproterone acetate.
• Other treatments are waxing ,shaving, laser hair removal and electrolysis. Electrolysis is a procedure in which electricity is used to generate heat within the hair follicles. This prevents the growth of hair. This method is rarely used because it can cause scarring of the skin.

Avoiding certain drugs like Phenytoin can help in preventing the development of hirsutism.

Lifestyle modifications are necessary in order to cope with hirsutism.

Although hirsutism can be treated, it may require long term therapy.

Lifestyle changes include:

• losing of weight in obese people,
• regular exercise,
• reducing caloric intake,
• regular monitoring levels of hormones especially androgens.

The complications associated with hirsutism do not arise due to hair growth but by the rise in the levels of androgens.

Women with hirsutism can have irregular periods and can even develop Polycystic Ovary Syndrome. This is a condition in which the levels of a woman's sex hormones is out of balance. It leads to the growth of masses in the ovaries (cysts) and can even cause infertility.

Birth defects can occur in pregnant women who take drugs to treat hirsutism. Therefore, pregnant women should not take these drugs.