What Is Hirsutism and How to Treat It?
Most of our skin contains hairs, except the palms and soles. Hirsutism and hypertrichosis are the most common changes in body hair associated with systemic conditions. Are you interested in knowing what hirsutism is and how to treat it? We’ll tell you!
This is a common endocrine disease in women during their reproductive years, and is characterized by abnormal growth of body hair. It’s usually the result of an increase in androgen levels or sensitivity to them.
Some studies affirm that hirsutism is a common problem that affects between 5% to 15% of women. Diagnosis is based on finding an abnormal hair growth pattern and clinical signs of virilization. On the other hand, treatment seeks to restore hormonal balance.
What is hirsutism?
Hirsutism is the excessive growth of body hair in women in areas considered androgenic. In general, it tends to follow a pattern of development similar to that of men. In this way, hair grows on the face, at the level of the upper lip, chin, and inside the ears.
Similarly, hair is also evident on the chest, mammary areolas, shoulders, abdomen, buttocks, groin, thighs, and back. The affected areas usually contain hairy areas dependent on androgens and sensitive to their activity.
In this condition, the hair becomes thick, dark, and hard, unlike normal hair that tends to be thin and without much pigment. This pathology is often confused with hypertrichosis. However, the latter is characterized by an increase in the amount of hair in any part of the body, which can be localized or generalized.
Associated symptoms
Hirsutism is usually a reflection of an increase in circulating levels of androgenic substances or hormones. In this sense, it’s accompanied by several signs of virilization, which are the result of hormonal imbalance and the sensitivity of the tissues. Some of the symptoms associated with hirsutism are the following:
- Acne
- Increased muscle mass
- A deeper voice
- Decreased breast volume
- Enlargement of the clitoris
In severe cases, there may be a deregulation of the menstrual cycle that manifests itself with the absence of menstruation or infertility. Similarly, affected people often have hair loss or androgenic baldness.
On the other hand, it’s common to find grease increasing in the hair, as well as seborrhea due to the sebaceous glands being affected. Also, in young girls, excess androgens can promote accelerated growth with early closure of the growth plates. For this reason, it’s common for these girls to be short.
Causes of hirsutism
Hair growth depends on a balance between estrogens and androgens, such as testosterone and dihydrotestosterone (DTH). These promote the development and differentiation of the hair in its different phases.
Hirsutism can be the result of an overproduction of androgens, increased skin sensitivity to them, or a mixture of both. Studies suggest that hyperandrogenism is usually the result of an increase in ovarian, adrenal, or even tumor synthesis.
In addition, it can be caused by an increase in the conversion of testosterone to DHT, as well as by a decrease in androgen protein transportation in the blood. Some of the most common causes of this condition are the following:
- Polycystic ovary syndrome
- Congenital adrenal hyperplasia
- Androgen-secreting tumors
- Cushing’s syndrome
- Obesity
- Hypertecosis
- Hypothyroidism
- Hyperprolactinemia
On the other hand, there’s a wide variety of drugs that can act as inducers of hirsutism. Corticosteroids, oral contraceptives, danazol, minoxidil, carmcarbamazepined clonazepam are some of the culprits.
Women from the Mediterranean, the Middle East, and South Asia are more likely to suffer from this condition due to family inheritance. Also, pregnancy and menstruation can be accompanied by hirsutism as a result of a temporary hormonal imbalance.
Diagnosis
The diagnosis of this disorder is based on the patient’s medical history, the analysis of the hormonal or metabolic profile, and the evaluation of the ovulatory function. In this sense, the doctor must make a detailed assessment of the patient’s symptoms, as well as the personal and family history associated with the disease.
A thorough physical examination may provide significant information about the distribution of hair and the severity of the condition. In addition, it’s useful for the identification of typical signs of virilization, such as acne and an increase in the size of the clitoris.
On the other hand, the treating physician may ask for various tests to measure the levels of hormones in the blood. Some of the most common tests are the following:
- Free and total testosterone
- Sex steroid transport globulin (SHBG)
- Dehydroepiandrosterone (DHEA)
- Follicle Stimulating Hormone (FSH) and Luteinizing Hormone (LH)
- Prolactin levels
High levels of testosterone and low levels of DHEA often lead to hirsutism of ovarian origin. On the other hand, the excess of testosterone associated with an elevation of DHEA increases the suspicion of adrenal origin. In addition, the elevation of LH and decrease of FSH indicates that the diagnosis is polycystic ovary syndrome.
Treatment
The therapeutic goal in hirsutism is to fix the underlying cause responsible for the hormonal imbalance. Similarly, affected people can correct the abnormal presence of body hair through different types of treatment.
Laser hair removal, thermolysis, and electrolysis are some of the methods used to remove hair. Topical application of eflornithine 13.9% reduces hair growth, making it shorter, thinner, and less pigmented. In addition, it prolongs the interval between hair removal sessions.
On the other hand, it’s essential to establish anti-androgen therapy progressively in order to slow down the hormonal effects. Birth control pills are the first line of treatment for hirsutism of ovarian origin. These reduce the release of androgens and reduce free levels in the blood.
The doctor may indicate the use of oral spironolactone or flutamide at varying doses. Other hormonal treatment options include oral finasteride and cyproterone acetate for at least 10 days.
The use of glucocorticoids is recommended in the management of virilizing forms of congenital adrenal hyperplasia. On the other hand, gonadotropin-releasing hormone (GnRH) agonist drugs are used in some types of hyperandrogenism under medical supervision.
A warning sign of a hormonal imbalance
Hirsutism is the abnormal growth of body hair in different areas of the body that are sensitive to androgens. This manifestation reflects an underlying hormonal imbalance with serious consequences. E l Polycystic ovary syndrome is the most common cause of this condition.
For this reason, it’s necessary to seek medical attention as soon as possible with an endocrinologist when there’s evidence of hirsutism and typical signs of virilization. An early professional assessment is associated with a better prognosis and a higher quality of life for the patient.
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