Hirsutism

Hirsutism: Overview

Hirsutism is the term used for excessive hair growth in women.  It refers to a male pattern of hair, i.e. in the moustache and beard areas, or occurring more thickly than usual on the limbs.  There may be hairs on the chest or an extension of pubic hair on to the abdomen and thighs.  What is considered normal for a woman, and what is considered hirsute, depends on cultural factors and race.  Hirsutism is very common.

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Causes and Development; Contributing Risk Factors

Hirsutism is nearly always genetic in origin.  In families where hirsutism is normal, both female and male relatives may have more hair than average.

Although some women with hirsutism have increased amounts of male hormones (e.g. DHEA or testosterone), most have normal levels.  The problem in these women is that the hairs are more sensitive than normal to small amounts of hormone.  The hairs grow more quickly and thicker in response to it.  The increased growth is usually first noted in late teenage years and tends to gradually get more severe as the woman gets older.  If it occurs either with or without acne after hormone use, it is a sign of elevated DHEA or testosterone levels.

True hirsutism may be due to:

  • Polycystic ovary syndrome
  • Defects in the enzymes made by the adrenal glands
  • Ovarian tumors
  • Adrenal tumors
  • Some forms of Cushing's syndrome
  • Luteoma of pregnancy
  • Certain drugs, including:

    • Minoxidil
    • Cyclosporine
    • Phenytoin
    • Anabolic steroids
    • Diazoxide
    • Progestin-containing medications

Risk factors include:

  • Family members with hirsutism
  • Lack of ovulation
  • Disorders of the adrenal glands
  • Use of androgens
  • Older age

Signs and Symptoms

Symptoms and signs may include:

  • Excess hair growth (on the face, arms, legs, or chest)
  • Abnormal or absent menstrual periods
  • Decreased breast size
  • Male-pattern baldness (in a woman)
  • Deepened voice
  • Increased size of clitoris
  • High blood pressure
  • Enlarged adrenal glands
  • Enlarged ovaries

Diagnosis and Tests

An ultrasound examination of the ovaries may be necessary as one common cause of hirsutism is polycystic ovaries.

Treatment and Prevention

Treatment is directed at the underlying cause of the hirsutism and may include:

  • Medications such as:

    • Spironolactone
    • Finasteride (Proscar, Propecia)
    • Flutamide
    • Oral contraceptives
    • Glucophage (Metformin)
  • Local Hair Removal.  Methods of removing hair include:

    • Shaving
    • Chemical treatment (depilatories)
    • Waxing
    • Electrolysis
    • Laser treatment
    • Bleaching

Signs, symptoms & indicators of Hirsutism:

Symptoms - Female

Symptoms - Hair

Counter-indicators

Symptoms - Reproductive - Female Cycle

Symptoms - Skin - Conditions

Conditions that suggest Hirsutism:

Skin-Hair-Nails

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Risk factors for Hirsutism:

Hormones

Reproductive

Polycystic Ovary Syndrome (PCOS)

It has been a tradition to divide patients with hirsutism into those with no elevation of serum androgen levels and no other clinical features ('idiopathic hirsutism') and those with an identifiable endocrine imbalance (most commonly PCOS or rarely other causes).  However, in recent years it has become apparent that most patients with 'idiopathic hirsutism' have some radiological or biochemical evidence of PCOS on more detailed investigation.

Tumors, Benign

Recommendations for Hirsutism:

Drug

Lab Tests/Rule-Outs

Test for Hormones

Blood, saliva or urine tests may be arranged to make sure that the hirsutism is not due to excessive male hormone levels.

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