Excessive Hair Growth (Hirsutism)
What is hirsutism?
Hirsutism is a common condition in which a person develops an excessive growth of hair. It affects 5% to 10% of women of child-bearing potential.
Women will often develop coarse, dark hair growth on the upper lip, chin, chest, abdomen, or back, instead of the fine hair sometimes referred to as “peach fuzz” that normally grows in those areas. Although this condition can cause much distress, it can be treated.
Symptoms and Causes
What causes hirsutism?
In many cases, the exact cause of hirsutism is not known. However, there are several conditions that are known to cause hirsutism. These conditions include:
- The natural production of male hormones (androgens). Women naturally produce androgen, however, if a woman's androgen levels are higher than normal, or if her hair follicles are more sensitive to androgens, she may develop hirsutism.
- Polycystic ovarian syndrome (PCOS) is a common hormonal condition that causes a woman to produce too many androgens. Women with PCOS may also have acne, irregular or absent menstrual periods, diabetes, weight gain, and/or problems with fertility.
- The hormonal changes of menopause may lead to increased facial hair (mustache and whiskers).
- Other more serious conditions. Hirsutism that occurs suddenly along with other male characteristics, such as a deeper voice, acne or increased muscle mass, may be caused by a more serious condition, such as disorders of the adrenal glands or ovaries.
- Medications. The following medications can cause hirsutism:
- Anabolic steroids
- Cyclosporine (Sandimmune®)
- Minoxidil (Loniten®, Rogaine®)
- Danazol (Danocrine®)
- Phenytoin (Dilantin®)
What are the symptoms of hirsutism?
The main symptom of hirsutism is thick, coarse, dark hair that grows on parts of the body where it would normally grow as fine, thin hair. For example, hair may grow thicker and coarser on the face, chest, back, lower abdomen, upper arms, or upper legs of women.
Diagnosis and Tests
How is hirsutism diagnosed?
Your doctor will conduct a physical examination to determine the extent of the abnormal hair growth, as well as any other physical signs that may be accompanying the hair growth, such as acne.
If your hair growth is diagnosed as hirsutism, your doctor may perform a variety of tests, including blood tests to check hormone levels, ultrasound to visualize the ovaries and uterus, certain X-rays and additional tests to evaluate your ovaries and adrenal glands, in order to rule out other conditions.
Management and Treatment
How is hirsutism treated?
The first step would be weight loss. If you are overweight, even losing 5% of your body weight can lower androgen levels and help a lot. Also, mild hirsutism can be treated with a variety of techniques for hair removal. These techniques do not address the cause of the problem, only the excessive hair.
Temporary hair removal
- Shaving is the most common method of hair removal. It is very simple and safe, but must be done very regularly to prevent stubble.
- Bleaching products can be used to lighten unwanted hair. Caution: Some bleaching products, especially if left on for too long, can cause skin irritation.
- Waxing and plucking (tweezing) the hair is effective, but may irritate the hair follicle and cause pimples.
- Depilatories are products that dissolve hair. These products can irritate sensitive facial skin.
Hair growth reduction
- Eflornithine hydrochloride (Vaniqa®) cream is a topical product that does not remove hair but acts to slow down how fast the hair grows. Noticeable results take about 6 to 8 weeks, and once the cream is discontinued, hair starts to grow at the normal rate it was growing pre-treatment. It is often used in conjunction with other therapies.
Long lasting hair removal
- Electrolysis is a technique that uses a tiny needle and a mild electrical zap to destroy hair roots one by one. Because each hair follicle needs to be treated, it may not be practical to use electrolysis over a large area of the body. This process can be somewhat painful, time-consuming, and expensive. If you choose this technique, make sure your provider is licensed. Home electrolysis products are not effective or recommended.
- Photoepilation (laser) treatments use a beam of light to destroy the hair follicle. This technique is long-lasting and can be used over larger areas of the body. Photoepilation is effective, but can be painful and expensive, and it requires several treatments.
- Weight loss is essential. If you are overweight, even losing 5% of your body weight can lower androgen levels and help decrease unwanted hair.
- Birth control pills (oral contraceptives) are the most common form of medical treatment for hirsutism. Birth control pills lower androgen levels, regulate the menstrual cycle and prevent pregnancy. Most women will notice an improvement in hirsutism in 6 to 12 months.
- Medications that suppress androgens may be used in combination with birth control pills.
- Spironolactone (Aldactone®) is a diuretic, or "water pill," that is normally used as a blood pressure medication but can also be used at lower doses for hirsutism. It blocks the effects of androgens and reduces hair growth. Side effects may include dry skin, heartburn, irregular vaginal bleeding, dizziness and fatigue.
- Finasteride is another anti-androgen drug that has been effective for hirsutism. It is reported to be as effective as spironolactone.
- Flutamide is another anti-androgen drug that is used in the treatment of hirsutism. One major concern with this drug is the side effect of causing damage to the liver. It is not considered a first line agent for hirsutism .
- Topical creams with anti-androgen effect exist but do not work very well for hirsutism.
- Low-dose steroid medications may be used if hirsutism is caused by overactive adrenal glands.
- Insulin-lowering drugs such as metformin and thiazolidinediones reduce blood levels of both insulin and androgens, but this treatment is controversial and not considered a first-line treatment as they have significant adverse side effects.
- Gonadotropin-releasing hormone (GnRH) agonists act by decreasing androgen production by the ovaries. This therapy however requires injections and is expensive. Moreover, it does not offer any more benefits than do birth control pills.
Outlook / Prognosis
What is the prognosis (outlook) for people who have hirsutism?
Hirsutism will require ongoing treatment. None of the treatments make the hair go away completely, but they make hair grow more slowly and help to significantly decrease the amount of unwanted hair. Most women are happy with their results once they find an effective treatment regimen that works for them. Once an effective treatment is established, it may be continued indefinitely.
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