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Excessive Hair Growth (Hirsutism)

Hirsutism is defined as excessive hair growth in various body areas commonly known as “androgen-dependent” sites.

Androgens are a group of hormones present in both the male and female, but the levels are much higher in the male (ie. testosterone).

Androgen dependent body sites refer to body areas where males have more hair, including the upper and lower back, lower abdomen, thighs and legs, between breasts, chin and the face.

Excessive hair can be observed in healthy women on the chin, sideburns and above the upper lip.

Severe form of hirsutism is called virilization which presents with deepening of the voice, male type balding, changes in body habitus and enlargement of the clitoris.

Virilization is due to excessive amount of androgen production and generally related to tumors releasing androgenic hormones (adrenal hyperplasia, androgen producing tumors of the ovary and the adrenal gland).

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What Causes Excessive Hair Growth?

Women naturally produce male hormones (androgens). Elevated levels of androgens can cause fine, “villous” hair follicles to produce larger, darker “terminal” hair, which leads to hirsutism.

When a woman has more male hormones than normal, it is most often due to a disorder called polycystic ovary syndrome (PCOS).

Hirsutism may be caused by other disorders of male hormone overproduction, but these are not common. Medications such as anabolic steroids that contain male hormones can cause hirsutism.

When a woman has hirsutism but does not have high levels of androgens, this is called “idiopathic hirsutism” because the specific cause of the excessive hair growth cannot be identified.

Another rare disease called Cushing’s syndrome can also result in hirsutism, although other signs and symptoms are common and include high blood pressure, diabetes, muscle weakness, fatigue, red stretch marks and obesity.

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Diagnosis Of Hirsutism

It is important to exclude all causes of androgen access especially if there is virilization because the cause may be due to a tumor.

In almost all cases of excessive androgen production related to tumor growth, clinical signs require advanced testing to identify the tumor.

Specific and advanced hormone testing is indicated in such clinical presentations to rule out Cushing syndrome from hirsutism.

Treatment of excessive hair growth

Weight loss is associated with slight improvement in unwanted hair growth. Women with hirsutism and PCOS should consider making lifestyle changes to improve their overall health.

The choice of treatment depends on patient’s age, desire for pregnancy or contraception and co-existing metabolic disorders such as insulin resistance.

In most cases, visible effects of hirsutism such as undesired facial and body hair are the most disturbing to the patient.

Most women start with an oral contraceptive (birth control pill) and if they are not pleased with the improvement after six months, a second medication called an antiandrogen can be added. All birth control pills work about the same for hirsutism.

Finasteride is a 5-alpha reductase inhibitor and blocks the production of DHT from testosterone. Testosterone levels are generally not changed and the side effects are rare. Hair growth is less stimulated with finasteride use because the most potent androgen DHT is produced in lower quantities.

Eflornithine (Vaniqa) is an enzyme blocker (ornithine decarboxylase) that has an important role in the development of the hair follicle. Its use has been limited to the face initially, but now it is commonly used in other body areas as well.

The side effects are burning and tingling of the skin, but the drug is generally well tolerated. Once the drug is discontinued beneficial effects are diminished within 8 weeks, which is also the case with other agents.

Mechanical hair removal should be combined with hormonal or non-hormonal treatments and can include shaving, bleaching, using depilatory agents, electrolysis and laser hair removal.

Laser hair removal has been one of the most popular methods recently with high success rates.

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