Hirsutism

Overview

Hirsutism (HUR-soot-iz-um) is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.

With hirsutism, extra hair growth often arises from excess male hormones (androgens), primarily testosterone.

Self-care methods and effective treatment options are available for women who wish to treat hirsutism.

Symptoms

Hirsutism is stiff or dark body hair, appearing on the body where women don't commonly have hair — primarily the face, chest, lower abdomen, inner thighs and back. People have widely varying opinions on what's considered excessive.

When 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

When to see a doctor

If you think you have too much coarse hair on your face or body, talk with your doctor about treatment options.

Excess facial or body hair is often a symptom of an underlying medical problem. See your doctor for assessment if over a few months you experience severe or rapid hair growth on your face or body or signs of virilization. You may be referred to a doctor who specializes in hormone disorders (endocrinologist) or skin problems (dermatologist).

Causes

Hirsutism may be caused by:

• Polycystic ovary syndrome (PCOS). This condition, which often begins with puberty, causes an imbalance of sex hormones. Over years, PCOS may slowly result in excess hair growth, irregular periods, obesity, infertility and sometimes multiple cysts on the ovaries.
• Cushing 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 minoxidil (Minoxidil, Rogaine); danazol, which is used to treat women with endometriosis; testosterone (Androgel, Testim); and dehydroepiandrosterone (DHEA). If your partner uses topical products containing androgens, you can be affected as well, through skin-to-skin contact.

Often hirsutism occurs with no identifiable cause.

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 have more body hair 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 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 testosterone-like hormones, might help determine whether elevated androgen levels are causing your hirsutism.

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

Treatment

Treatment of hirsutism with no sign of endocrine disorder is not necessary. For women who do need or seek treatment, it may involve treating any underlying disorder, developing a self-care routine for unwanted hair, and trying various therapies and medications.

Medications

If cosmetic or self-care methods of hair removal haven't worked for you, talk with your doctor about drugs that treat hirsutism. With these medications it usually takes up to six months, the average life cycle of a hair follicle, before you see a significant difference in hair growth. Options 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 nausea and headache.

• 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, CaroSpir). The results are modest and take at least six months to be noticeable. Possible side effects include menstrual irregularity. 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 twice a day. It 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

Hair removal methods whose results may last longer than self-care methods — and which may be combined with medical therapy — include:

• Laser therapy. A beam of highly concentrated light (laser) is passed over your skin to damage hair follicles and prevent hair from growing (photoepilation). You might need multiple treatments. For people whose unwanted hair is black, brown or auburn, photoepilation is usually a better option than electrolysis.

  Talk with your doctor about the risks and benefits of the various lasers used for this hair removal method. People with tanned or darkly pigmented skin are at increased risk of side effects from certain lasers, including a darkening or lightening of their usual skin tones, blistering, and inflammation.

• 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. For people with naturally blond or white hair, electrolysis is a better option than laser therapy.

  Electrolysis is effective but can be painful. A numbing cream spread on your skin before treatment might reduce discomfort.

Self care

Self-care methods such as the following temporarily remove or reduce the visibility of unwanted facial and body hair. There is no evidence that self-removal of hair leads to heavier hair growth.

• Plucking. Plucking is a good method to remove a few stray hairs, but is not useful for removing a large area of hair. Plucked hair usually regrows. This hair removal method may be done with tweezers, thin threads (threading) or other devices designed for this purpose.
• Shaving. Shaving is quick and inexpensive, but it needs to be repeated regularly.
• 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.
• Depilation. Chemical depilatories are applied to the affected skin, where they dissolve hair. These products are available in a variety of forms, such as gel, cream or lotion. They may irritate the skin and cause dermatitis. You'll need to repeat depilation regularly to maintain the effect.
• Bleaching. Bleaching lightens hair color, making it less noticeable on people with light skin. Hair-bleaching products, which usually contain hydrogen peroxide, may cause skin irritation. Test any product you use on a small area of skin first.

Preparing for your appointment

When you make your appointment, ask if you should avoid removing your unwanted hair so the doctor can better evaluate your condition. Make a list of:

• Key personal information, including other medical conditions and changes in your menstrual cycle or sex drive
• All medications, vitamins and other supplements you take, including doses
• Questions to ask your doctor

For hirsutism, some questions to ask your doctor include:

• What's likely causing my symptoms?
• What are other possible causes for my symptoms?
• What tests do I need?
• Is my condition likely temporary or chronic?
• What's the best course of action?
• What are the alternatives to the primary approach you're suggesting?
• I have other health conditions. How can I best manage them together?
• Should I see a specialist?
• Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

• When did your symptoms begin?
• Has your menstrual cycle changed, or have you stopped having your period?
• Have you gained weight?
• Have you developed new acne?
• Has the size of your breasts changed?
• Have others commented that your voice has changed?
• Are you planning to become pregnant soon?