HIRSUTISM

Hirsutism (HUR-soot-iz-um) is a condition of unwanted, male-pattern hair growth in

women. Hirsutism results in excessive amounts of dark, course hair on body areas where
men typically grow hair — face, chest and back.

The amount of body hair you have is largely determined by your genetic makeup. There's
a wide range of normal hair distribution, thickness and color due to differences in heredity.
However, hirsutism is a medical condition that can arise from excess male hormones
called androgens, primarily testosterone. It can also be due to a family trait.

A combination of self-care and medical therapies provides treatment for many women
with hirsutism.

Symptoms

Hirsutism is stiff and dark body hair, appearing on the body where women don't commonly
have hair — primarily the face, chest and back. What's considered excessive can vary
depending on ethnicity and culture.

When excessively high androgen levels cause hirsutism, other signs might develop over
time, a process called virilization. Signs of virilization might include:

 Deepening voice
 Balding
 Acne
 Decreased breast size
 Increased muscle mass
 Enlargement of the clitoris

Causes

At puberty, a girl's ovaries begin to produce a mix of female and male sex hormones,
causing hair to grow in the armpits and pubic area. Hirsutism can occur if the mix becomes
unbalanced with too high a proportion of male sex hormones (androgens).

Hirsutism can be caused by:

 Polycystic ovary syndrome. This most common cause of hirsutism is caused by

an imbalance of sex hormones that can result in irregular periods, obesity, infertility
and sometimes multiple cysts on your ovaries.
  Cushing's syndrome. This occurs when your body is exposed to high levels of
the hormone cortisol. It can develop from your adrenal glands making too much
cortisol or from taking medications such as prednisone over a long period.
 Congenital adrenal hyperplasia. This inherited condition is characterized by
abnormal production of steroid hormones, including cortisol and androgen, by your
adrenal glands.
 Tumors. Rarely, an androgen-secreting tumor in the ovaries or adrenal glands can
cause hirsutism.
 Medications. Some medications can cause hirsutism. These include danazol,
which is used to treat women with endometriosis; systemic corticosteroids and
fluoxetine (Prozac) for depression.

Sometimes, hirsutism can occur with no identifiable cause. This happens more frequently
in certain populations, such as in women of Mediterranean, Middle Eastern and South
Asian ancestry.

Risk factors

Several factors can influence your likelihood of developing hirsutism, including:

 Family history. Several conditions that cause hirsutism, including congenital

adrenal hyperplasia and polycystic ovary syndrome, run in families.
 Ancestry. Women of Mediterranean, Middle Eastern and South Asian ancestry
are more likely to develop hirsutism with no identifiable cause than are other
women.
 Obesity. Being obese causes increased androgen production, which can worsen
hirsutism.

Complications

Hirsutism can be emotionally distressing. Some women feel self-conscious about having
unwanted body hair. Some develop depression. Also, although hirsutism doesn't cause
physical complications, the underlying cause of a hormonal imbalance can.

If you have hirsutism and irregular periods, you might have polycystic ovary syndrome,
which can inhibit fertility. Women who take certain medications to treat hirsutism should
avoid pregnancy because of the risk of birth defects.
Prevention

Hirsutism generally isn't preventable. But losing weight if you're overweight might help
reduce hirsutism, particularly if you have polycystic ovary syndrome.

Diagnosis

Tests that measure the amount of certain hormones in your blood, including testosterone
or other testosterone-like hormones, might help determine whether elevated androgen
levels are causing your hirsutism. If so, your doctor might recommend an ultrasound or a
CT scan to check your ovaries and adrenal glands for tumors or cysts.

Your doctor might also examine your abdomen and do a pelvic exam to look for masses
that could indicate a tumor.

Treatment

Treatment for hirsutism often involves a combination of treating the underlying disorder,
if there is one, self-care methods, hair-removal therapies and medications.

Medications

Medications taken for hirsutism usually take up to six months, the average life cycle of a
hair follicle, before you see a significant difference in hair growth. Medications include:

 Oral contraceptives. Birth control pills or other hormonal contraceptives, which

contain estrogen and progestin, treat hirsutism caused by androgen production.
Oral contraceptives are a common treatment for hirsutism in women who don't
want to become pregnant. Possible side effects include dizziness, nausea,
headache and stomach upset.
 Anti-androgens. These types of drugs block androgens from attaching to their
receptors in your body. They're sometimes prescribed after six months on oral
contraceptives if the oral contraceptives aren't effective enough. The most
commonly used anti-androgen for treating hirsutism is spironolactone
(Aldactone). Because these drugs can cause birth defects, it's important to use
contraception while taking them.
 Topical cream. Eflornithine (Vaniqa) is a prescription cream specifically for
excessive facial hair in women. It's applied directly to the affected area of your face
and helps slow new hair growth, but doesn't get rid of existing hair. It can be used
with laser therapy to enhance the response.
Procedures

To remove unwanted hair permanently, options include:

 Electrolysis. This treatment involves inserting a tiny needle into each hair follicle.
The needle emits a pulse of electric current to damage and eventually destroy the
follicle. You might need multiple treatments. Electrolysis is effective but can be
painful. A numbing cream spread on your skin before treatment might reduce
discomfort.
 Laser therapy. A beam of highly concentrated light (laser) is passed over your
skin to damage hair follicles and prevent hair from growing. You might need
multiple treatments. You might develop skin redness and swelling after laser
therapy. Laser therapy for hair removal is expensive and carries a risk of burns
and skin discoloration, especially in people with tanned or dark skin.

Lifestyle and home remedies

Self-care methods to remove unwanted facial and body hair include:

 Plucking. Using tweezers is a good method to remove a few stray hairs, but is not
useful for removing a large area of hair.
 Shaving. Shaving is quick and inexpensive, but it needs to be repeated regularly
since it removes the hair only at the surface of your skin.
 Waxing. Waxing involves applying warm wax on your skin where the unwanted
hair grows. Once the wax hardens, you pull it from your skin to remove hair.
Waxing removes hair from a large area quickly, but it may sting temporarily and
sometimes causes skin irritation and redness.
 Chemical depilatories. Generally available as gels, lotions or creams that you
spread on your skin, chemical depilatories work by breaking down the protein
structure of the hair shaft. Some people are allergic to the chemicals used in
depilatories.

Bleaching

Instead of removing unwanted body hair, some women use bleaching. Bleaching
removes the hair color, making the hair less visible. Bleaching can cause skin irritation,
so test the bleach on a small area first. Also, bleaching can make hair stand out on dark
or tanned skin.