A hair's breadth from illness! Hirsutism

Hirsutism – what is it?

Hirsutism is excessive hair growth in women, occurring in androgen-dependent areas. In simpler terms, it is described as "male-pattern hair" (although this is of course a rather stereotypical concept). It more often affects obese people.

Is it dangerous? Usually not – it is rarely a symptom of a serious disease, such as hormonally active tumors (ovarian cancer, kidney cancer, or thyroid cancer).

Is it worrisome? Yes. It's an endocrine problem, difficult to control.

Locating unwanted hairs

Hirsutism comes in many forms. It can be excessive facial hair (beard or mustache), hair on the chest, nipples, inner thighs, as well as excessive hair on the abdomen, back, or vulva .

Interestingly, in hirsutism, male pattern baldness also occurs: in the temple area (popular receding hairline) and on the top of the head. According to sources , people with hirsutism struggle with skin lesions with increased seborrhea, acne on the face and back, menstrual disorders , obesity, infertility and mood disorders (e.g. depression).

Causes of hirsutism

Hirsutism is most often one of the symptoms of hormonal disorders in the body (increased levels of "male" sex hormones), associated with polycystic ovary syndrome (PCOS).

There are situations in which tests confirm normal androgen levels and the cause of hirsutism cannot be determined – this is called idiopathic hirsutism.

In a small number of cases, hirsutism results from a serious disease of the adrenal glands or ovaries. It can also be a genetic cosmetic defect or a side effect of taking certain medications. Excessive hair growth can also be caused by corticosteroids and androgens (used as a means of increasing muscle mass).

Hirsutism and hormones

Pregnant people (when the hormonal balance is changed) and women during menopause (when the ovaries stop producing estrogen and progesterone) often suffer from excessive hair growth .

If you experience hot flashes, blood pressure fluctuations, heart palpitations, headaches, rapid fatigue or osteoporosis, you should consider consulting a gynecologist - it may be necessary to start menopausal hormone therapy.

Hirsutism – diagnosis

The semi-quantitative Ferriman-Gallway point scale is used to make a diagnosis – or more precisely, to assess hairiness . The assessment of the intensity of hirsutism using this scale is subjective, which is why a carefully collected interview and a carefully conducted physical examination, supplemented by laboratory and imaging diagnostics, are essential in the diagnostic process.

When it comes to laboratory diagnostics, it involves determining the concentration of hormones (including testosterone) in the blood.

If androgen levels are increased, your doctor may recommend additional imaging tests (ultrasound, computed tomography) to check the ovaries and adrenal glands for the presence of tumors or cysts.

In some cases, the above actions are not enough to make a diagnosis. In such a situation, it may be helpful to perform a series of hormonal tests - here a consultation with an endocrinologist is necessary.

Treatment of hirsutism

The treatment of hirsutism is always tailored to its cause. It must include not only the relief of hirsutism but also the treatment of the underlying etiology and any metabolic connections.

Treatment of hirsutism caused by a functional disorder is chronic and includes both cosmetic and pharmacological interventions. In the case of nonfunctional disorders, the focus is on resolving the underlying etiology, since hirsutism usually responds to the elimination of the source of excess androgens.

In the case of ovarian or adrenal tumors, the therapy is surgical treatment. Congenital adrenal hyperplasia requires the administration of glucocorticosteroids.

Hirsutism occurring as a result of taking medications should be consulted with a doctor on an ongoing basis with a view to changing or possibly discontinuing the medication.

In fact, in the treatment of hirsutism, it is important to use anti-androgen drugs while mechanically removing hair. Oral contraceptives , ketoconazole, spironolactone, glucocorticosteroids, finasteride, flutamide, nilutamide, GnRH analogues are used . Cream drugs are also allowed, acting directly on areas of increased hair. Unfortunately, you have to wait even several months for the effects.

In the case of hirsutism, depilation does not last long. The troublesome hair is usually thick and dark. To cope with the problem and remove it permanently, cosmetic procedures are used: electrolysis (a painful procedure that involves the destruction of hair follicles using low-voltage current) and repeated laser therapy (laser destruction of hair follicles).

Importantly, none of the above actions will be effective in the long term if we do not take care to normalize the hormonal balance - that is why it is so important for hirsutism to be correctly diagnosed and for a specialist to deal with the problem holistically, selecting comprehensive treatment.

The exceptions may be idiopathic hirsutism (in which androgen levels remain within the norm) or genetically determined hirsutism. In these cases, the only solution is regular hair removal or accepting it as a part of oneself (here too, therapy may be helpful).

Some sources suggest using herbs that lower the concentration of “male” sex hormones (mint, marjoram, fennel, black cohosh, licorice, chasteberry) as a way to naturally treat hirsutism. You can definitely use this, but only under the watchful eye of a doctor, because some herbs affect the action of medications or even inhibit them.

What to do when you notice symptoms?

Hirsutism causes discomfort regardless of age, which is why people who notice abnormalities in their body hair seek help from a primary care physician or dermatologist. After collecting an interview and performing a preliminary examination, the specialist can refer the patient to an endocrinologist, who will address the problem from the perspective of hormonal management.

According to information from the patient portal mp.pl, "patients who have symptoms of hirsutism that appear suddenly after puberty (young adult women) require particularly urgent diagnostics, as this raises the suspicion of a virilizing tumor." So there's no point in waiting!

If you suspect hirsutism, how should you prepare for a conversation with your doctor?

Try to remember how long you have been struggling with the problem of excess hair , and also:

• What parts of the body are covered with the most hair?
• Are there any menstrual irregularities?
• Has there been any weight gain? If so, when?
• Have you noticed any skin changes (acne)?
• Has the tone of your voice changed?
• Do you take any medications on a regular basis? If so, what?
• Is there a case of hirsutism in your family?
• Are you planning a pregnancy in the near future?

IMPORTANT!

Removing hair before a doctor's visit is a bad idea - it is important for the doctor to see it "in all its glory".

Is hirsutism curable?

It also depends on its cause. In the case of an adrenal or ovarian tumor, surgical removal is an effective and permanent solution to the problem. In hirsutism associated with the use of certain medications, the symptoms of hirsutism also disappear after discontinuing them.

The situation is different in the case of congenital adrenal hyperplasia, the treatment of which is chronic and requires constant use of hormonal replacement.

Hirsutism – how to avoid it?

Unfortunately, there is currently no way to prevent hirsutism. However, in the case of patients struggling with polycystic ovary syndrome, a good way to reduce hair is to control body weight (to avoid obesity).

M. Góralska, U. Ambroziak, T. Bednarczuk, Hirsutism, hyperandrogenization syndrome , "mp.pl", https://www.mp.pl/pacjent/endokrynologia/choroby/168996,hirsutism-zespol-hiperandrogenizacji [accessed on 17/10/2021].
Obstetrics and gynecology , vol. 2: Gynecology , scientific ed. GH Bręborowicz, Warsaw 2007, pp. 701-709.
ZM van der Spuy, PA le Roux, Cyproterone acetate for hirsutism , "Cochrane Database of Systematic Reviews" 2003, https://doi.org/10.1002/14651858.CD001125 [accessed on 17/10/2021].