Hirsutism: Symptoms, Causes, Treatment

What are the symptoms of hirsutism?

Hirsutism refers to excessive hair growth in areas where hair is typically minimal or absent in women, primarily due to increased androgen (male hormone) levels. Symptoms of hirsutism include:

1. Excessive Hair Growth: Particularly on the face (upper lip, chin), chest, back, and abdomen. The hair is often coarse and dark.
2. Pattern of Growth: Hair growth follows a male pattern (like a beard or chest hair) rather than the fine, vellus hair typically found in women.
3. Associated Signs: Other signs may include acne, deepening of the voice, balding, or increased muscle mass, which are signs of increased androgen levels.
4. Emotional Impact: Hirsutism can lead to emotional distress or low self-esteem due to the social stigma associated with excessive hair growth in women.

It’s important to note that hirsutism can vary in severity and may be a symptom of an underlying medical condition such as polycystic ovary syndrome (PCOS), adrenal gland disorders, or certain medications. Consulting a healthcare provider is crucial for proper diagnosis and management.

What are the causes of hirsutism?

Hirsutism can have several underlying causes, primarily related to hormonal imbalances that lead to increased androgen (male hormone) levels. Some common causes include:

1. Polycystic Ovary Syndrome (PCOS): This is one of the most common causes of hirsutism. PCOS is a hormonal disorder characterized by enlarged ovaries with small cysts and irregular menstrual cycles. It often leads to elevated levels of androgens.
2. Idiopathic Hirsutism: In some cases, the exact cause of hirsutism may not be identified, and it’s termed idiopathic. This typically means there’s no specific underlying medical condition causing the excess hair growth.
3. Medications: Certain medications can cause hirsutism as a side effect. These may include steroids, testosterone, danazol, and some medications used to treat psychiatric conditions.
4. Adrenal Gland Disorders: Conditions such as congenital adrenal hyperplasia and adrenal tumors can cause hirsutism by increasing androgen production.
5. Cushing’s Syndrome: This condition results from prolonged exposure to high levels of cortisol, which can lead to increased androgen production and hirsutism.
6. Genetic Predisposition: Some families may have a genetic predisposition to hirsutism, where there is an increased sensitivity of hair follicles to androgens.
7. Rare Causes: Rarely, hirsutism may be caused by conditions such as ovarian or adrenal tumors that produce androgens, or by certain metabolic disorders.

Diagnosing the specific cause of hirsutism typically involves a thorough medical history, physical examination, and sometimes hormone testing to measure levels of androgens and other hormones. Treatment options depend on the underlying cause and may include medications to reduce androgen levels, oral contraceptives to regulate hormones, or procedures like electrolysis or laser hair removal for cosmetic management.

How is the diagnosis of hirsutism made?

Diagnosing hirsutism involves a comprehensive approach that typically includes the following steps:

1. Medical History: The healthcare provider will take a detailed history, including questions about the pattern and duration of hair growth, menstrual history, family history of hirsutism or related conditions, medications being taken, and any other symptoms such as acne or voice changes.
2. Physical Examination: A thorough physical exam will be conducted to assess the distribution and severity of hair growth, as well as to check for signs of underlying conditions such as acne, balding, or signs of virilization (development of male secondary sexual characteristics).
3. Blood Tests: Blood tests may be ordered to measure hormone levels, including testosterone, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and sometimes cortisol. These tests help identify hormonal imbalances that may be contributing to hirsutism.
4. Imaging Studies: In some cases, imaging studies such as ultrasound may be performed to evaluate the ovaries and adrenal glands for any structural abnormalities or tumors that could be causing excess androgen production.
5. Exclusion of Other Conditions: Since hirsutism can sometimes be a symptom of underlying medical conditions such as polycystic ovary syndrome (PCOS), adrenal disorders, or certain tumors, additional tests or consultations with specialists may be needed to rule out these conditions.
6. Scoring Systems: Healthcare providers may use scoring systems like the Ferriman-Gallwey score to quantitatively assess the extent of hirsutism based on hair growth patterns in specific body areas.

Once a diagnosis is made, the healthcare provider will discuss appropriate treatment options based on the underlying cause and the patient’s preferences and health goals.

What is the treatment for hirsutism?

Hirsutism is a condition characterized by excessive hair growth in women, typically on the face, chest, back, and buttocks. The treatment for hirsutism depends on the underlying cause and severity of the condition. Here are some common treatments for hirsutism:

1. Hormonal birth control pills: Combined oral contraceptives (COCs) or progesterone-only pills can help regulate hormone levels and reduce androgen levels, which can lead to hair growth. COCs can also improve acne and reduce excessive hair growth.
2. Anti-androgen medications: Medications like spironolactone (Aldactone) and flutamide (Eulexin) can block the production of androgens, which contribute to excessive hair growth.
3. Anti-hair growth medications: Medications like finasteride (Propecia) and dutasteride (Avodart) can slow down hair growth by inhibiting the conversion of testosterone to dihydrotestosterone (DHT), a hormone that promotes hair growth.
4. Electrolysis: This permanent hair removal method involves inserting a fine needle into each hair follicle to destroy the root, preventing future growth.
5. Laser hair removal: Laser hair removal uses high-intensity light to target and damage hair follicles, reducing future growth.
6. Waxing, tweezing, or threading: These temporary hair removal methods can be used to remove excess hair from specific areas, such as the face, arms, or legs.
7. Topical creams: Creams containing eflornithine (Vaniqa) can slow down hair growth by inhibiting an enzyme that promotes hair growth.
8. Hormonal therapies: In cases where hirsutism is caused by polycystic ovary syndrome (PCOS), hormonal therapies like clomiphene citrate (Clomid) or letrozole (Femara) may be used to regulate hormone levels.
9. Pharmacological treatments: In rare cases, pharmacological treatments like glucocorticoids or danazol may be used to treat hirsutism caused by Cushing’s syndrome or congenital adrenal hyperplasia.

It’s essential to consult with a healthcare provider to determine the best course of treatment for hirsutism based on individual circumstances and underlying causes. They may recommend a combination of treatments for optimal results.