Serving Charleston, SC since 1976

Introduction

Hirsutism is the growth of long, coarse hair on the face, chest, lower abdomen, back, upper arms, and upper legs of women in a pattern similar to that found in men. Besides being cosmetically distressing, hirsutism may also signal the presence of a hormone imbalance or a hormone producing tumor. Although excessive facial and body hair is a common problem, few women feel comfortable seeking help. However, once the disorder is discovered, it will frequently improve with medical management. Your physician must first distinguish excessive hair growth from normal hair growth. The causes are then investigated and treated, and the remaining excess hair can be cosmetically removed with electrolysis.

Normal Hair Growth

Hair serves to protect against cold and irritants. Each hair grows from a follicle deep in the skin. As long as these follicles are not completely destroyed, hair will continue to grow even if the shaft, which is the part of the hair that appears above the skin, is plucked or removed. Hair follicles cover all areas of the body except the soles of the feet and the palms of the hands, and one fifth of the approximately 50 million follicles covering the body are located on the scalp. The number of hair follicles does not increase after birth but does slowly decrease after age 40. Men and women of the same ethnic group have the same number of hair follicles.

Adults have two types of hair, vellus and terminal. Vellus hair is soft, fine, colorless, and usually short. Terminal hairs are the longer, coarser, darker, and sometimes curly hairs that grow on the scalp, pubic, and armpit areas in both adult men and women. The facial and body hair in men is mostly of the terminal type. While the arms and legs have a mixture of vellus and terminal hairs, the number of terminal hairs on the forearms and lower legs is usually not affected by hormone status. Hair growth occurs in cycles, but the hairs usually do not grow at the same time. While some grow, others rest and some fall out. This process gives the impression of continual growth. Rapid hormonal changes, such as when oral contraceptives are administered or during pregnancy; could cause the growth cycles of many hairs to shift and occur at the same time. Therefore, it may appear that your hair is "shedding." If this does happen, the hair growth pattern will eventually return to normal.

What Causes Excess Facial and Body Hair?

Most often, excess facial and body hair is a result of abnormally high levels of androgens or male hormones in the blood. Androgens are present in both men and women, but men have much higher levels. These hormones cause hairs to change from vellus to terminal. Once a vellus hair has been transformed to the coarser terminal hair, it usually does not change back. The circumstances described below can lead to high androgen levels, which in turn can cause hirsutism.

1) Menopause

Around the time of menopause, your ovaries stop producing estrogen but continue to produce androgens. Since the relative effect of androgens is then greater, there may be an increase in the number of dark terminal hairs, especially on the face.

2) Genetics

There are very obvious family and racial differences in hirsutism patients. In some women, the skin is very sensitive to even low levels of androgens and their follicles produce primarily terminal (coarse and dark) hairs. If your mother or grandmother experienced the disorder, then you are at a greater risk of developing it. Also, women from different racial backgrounds are more likely to develop hirsutism. For example, Mediterranean people have more hair follicles per surface area than Nordics or Anglo-Saxons. Caucasians have more hair than Negroes, while Oriental and American Indian people have the least amount of hair.

3) Medication Side Effects

If you are taking male hormones or drugs with characteristics of androgens, you may experience hirsutism. Danazol, a drug used to treat endometriosis, and anabolic steroids, used in bodybuilding, are both chemically related to androgens. However, these drugs are usually prescribed in very small dosages that do not cause hirsutism.

4) Polycystic Ovarian Syndrome

Polycystic ovarian syndrome causes the ovaries to develop many small cysts and to overproduce male hormones. The disorder is often associated with hirsutism, irregular ovulation, menstrual disturbances, infertility, and obesity.

5) Ovarian Tumors

On rare occasions, androgen-producing ovarian tumors cause hirsutism. When this is the case, hirsutism progresses rapidly. An ovarian mass can usually be detected during a pelvic examination, and in some instances, your doctor may order tests to make sure that tumors are not present when male hormone levels are high.

6) Adrenal Disorders

The adrenal glands, which are located just above each kidney, also produce androgens. The most common disease of the adrenal gland that can result in hirsutism is an inherited disorder called late-onset adrenal hyperplasia.

Determining the Cause of Hirsutism

When determining the cause of hirsutism, your physician may perform several blood tests to examine your androgen levels. You may also undergo a pelvic ultrasound or special x-ray studies that detect ovarian or adrenal tumors. Furthermore, your physician may recommend hormone suppression or stimulation tests which evaluate the function of the ovaries and adrenal glands. During these tests, blood is measured for hormone levels both before and after the administration of a specific hormone medication. One such procedure, the ACTH (adrenocorticotropic hormone) stimulation test, is conducted in order to check for the presence of late-onset adrenal hyperplasia.

How is Hirsutism Treated?

1) Cosmetic Therapy

For temporary hair removal, many women with mild hirsutism, pluck the unwanted hairs. However, this could irritate sensitive skin, and if the shafts become infected, the hair may curl into the skin and possibly cause pimples or acne. Waxing, another alternative, is essentially the same as plucking. Depilating agents are chemicals that dissolve the hair shafts on both facial and body hair and may also be used to remove unwanted hair. Keep in mind that facial skin is particularly sensitive and that these chemicals can cause irritation. Shaving is probably the simplest and safest temporary hair removal procedure. Although frequently required, it is virtually painless and seldom has side effects. Contrary to popular belief, shaving does not make hair grow faster. If you choose to shave, you'll find that an electric razor produces less skin irritation than a blade. Electrolysis, Light and Laser are the only permanent methods to remove unwanted hair.

2) Medical Therapy

There are several drugs used to treat hirsutism. The most commonly suggested hormonal treatment is birth control pills. Estrogens in the pill make the liver produce and release more of the protein-binding globulin that traps androgens and causes them to be less effective. In addition to slowing the growth of excessive hair, the pills may provide the added advantages of regulating the menstrual cycle and protecting against unwanted pregnancies.

Spironolactone is a drug that directly blocks the effect of androgens in the skin. About two-thirds of the women on high dose spironolactone will have a significant decrease in hirsutism. However it is a medication you will have to take continually.

Your physician may prescribe low doses of drugs called dexamethasone orprednisone if the adrenal gland is overactive. This medicine is usually taken at bedtime to prevent the increase in endogenous ACTH, which stimulates the adrenal gland. Some women taking dexamethasone experience difficulty falling asleep and dizziness during the day. However, the usual doses are very low, and the side effects are minimal after the first few days. In high doses, these drugs have more serious side effects including weight gain, thinning of the skin and bones, and decreased defense against infection. But these side effects are seldom seen at the doses used for treating hirsutism.

Gonadotropin releasing hormone (GnRH) analogs are a new treatment for hirsutism. These drugs are taken through nasal sprays or injections. They decrease the secretion of male hormones from the ovaries and prevent hormonal stimulation of the hair follicles. In most cases, no new hair will grow and some of the existing excess hair will become softer and finer.

A side effect of GnRH analogs is called "medical menopause." This happens when production of estrogen, the female hormone, is decreased. In order to prevent you from having hot flashes and other postmenopausal symptoms, your doctor will probably prescribe estrogen and progesterone, the female hormones, to take along with the GnRH analogs.

Hormone treatment may prevent new hairs from developing. However, terminal hairs that are already present will not fall out or disappear with hormonal therapy and must be removed later with electrolysis/light/laser. Most likely, it took many years for the excess hair to develop, and you should not expect to see a significant decrease in the rate of growth before six months of hormone treatment. Once a hormone treatment has proven to be effective, it may be continued indefinitely and electrolysis/light/laser can be used to permanently remove any remaining hair.

What to Expect From Hirsutism Treatment

In most cases, it is not possible to cure the hormonal problem that causes hirsutism. Therefore, if you quit taking a successful medical treatment, excessive hair growth will usually return in time. But sometimes the hair growth does not return, and doctors often advise decreasing the dose or ending the medical therapy after one to two years to determine whether or not the hirsutism will reappear.

Summary

Hirsutism is a common disorder that can usually be successfully diagnosed and treated. There are several cosmetic methods designed to remove unwanted hair. Your physician may also prescribe corrective hormone treatments. Frequently, hirsutism is simply a result of hereditary factors. If your mother/father or grandmother/grandfather experienced excessive hair growth, you should watch for early signs of hirsutism. Also, it is important to watch for excess hair in your children, especially during adolescence. In other cases, the disorder may be an indication of a more serious endocrine problem. You should always see your doctor when you notice any sign of unusual hair growth.