Serving Charleston, SC since 1976

Before an electrologist can begin treatments on a new client, a client case-history form has to be completed. The more comprehensive this document is, the better, because the practitioner must be aware of everything that might point to the underlying cause of the client's hair growth problem. Is the cause genetic? Or is it due to a health disorder? Is it what the medical profession calls idiopathic hirsutism ("cause unknown"), or does it originate with a medication that has been prescribed by the client's physician or a different health problem? What-ever the case, as much background information as possible has to be ascertained before the electrologist can provide proper treatment. Understanding the cause of the hirsutism is an important part of the cure. One of the most important entries in the case history record (more important perhaps than many electrologists realize), is the question that determines what prescription drugs, if any, the client is taking for non-hair-related disorders. Excessive hair growth that can be directly attributed to medical drug therapy is called "iatric hirsutism" (iatric being a Greek word pertaining to medicine or to a physician). And those drugs in the pharmaceutical directory that officially include "excessive hair growth" (or similar) in the list of possible side effects, are certainly of serious interest to electrologists. Research by International Hair Route to produce a complete and authoritative account of all the proprietary drugs that can cause iatric hirsutism has resulted in a list of 526 brand names. Among the many different terms used by the drug manufacturing companies to describe the hair growth effect are: hirsutism, hypertrichosis, "facial hair," "excessive hair growth," "excessive hairiness," "abnormally excessive growth of hair," "growth of face, back, chest, or stomach hair" and "increased body hair." The term "Cushingoid state" or "Cushing's syndrome" - a disease of the adrenal glands that results from the over-secretion of adrenal hormones and includes excessive hairiness among its many unpleasant symptoms - is also given as a possible adverse reaction to some drugs. In International Hair Route's drug lists, all of the foregoing descriptive terms for excessive hair growth are covered by the single word, "hirsutism".

Drugs and Hormones

     Any discussion of the relationship between drugs and hair growth must begin with a brief review of the body's endocrine system, for it is from this source - with only a few rare exceptions - that all cases of women's hirsutism originates.
     It is quite normal for young females to have a strong, healthy scalp hair, eyebrows and eyelashes, and - following the onset of puberty - on the genitals and in the armpits. Also acceptable under the definition of normal is a certain amount of terminal hair on the legs and forearms, even though a woman might consider such hair abnormal and want it removed.
     The pattern of hair growth for a young male is the same as that of the female until puberty, when higher concentrations of the so-called "male sex hormones" (present in both men and women) and heredity conspire to expand the sexual hair of the man to include the upper lip, beard area, neck, chest and escutcheon. The degree of hairiness on the extremities of men is also usually greater too, and may be widely distributed to include the thighs, the upper arms, nape of the neck, shoulders and back.
      These are, more or less, the normal patterns of hair growth for humans; and physicians, electrologists and cosmetologists who specialize in hair removal do not enter the picture unless an individual comes to the conclusion that the type or amount of hair on his or her body is either unhealthy, uncomfortable, or socially unacceptable.
     The hair of the scalp, eyebrows and eyelashes is mostly androgen independent, meaning that it is not totally reliant on the male hormones for its growth. The opposite is true for the sexual hair that appears at puberty. It is very dependent on androgens, especially testosterone, the major hormone affecting the growth of hair.
     When things are working as they should, testosterone is converted in the hair follicle to another hormone, dihydrotestosterone, by the enzyme 5 alpha reductase. If for any reason there is a dysfunction of the endocrine system or its individual glands - thereby raising or decreasing androgen production -the normal patterns of hair growth are inevitably disrupted. Too little testosterone (an extreme example would be the eunuch) will result in the loss of sexual hair. Too much testosterone will lead to an excess of sexual hair, the condition we call hirsutism.
     The sheer complexity of the endocrine system makes it vulnerable to breakdown. Endocrine hyperfunction and hypo-function may originate with the pituitary - the master gland - or with any of the target glands themselves. Tumors can also appear in other parts of the body, like the lungs or stomach, and produce hormones that cause endocrine dysfunction. Multiple cysts on the ovaries could possibly be the cause of a woman's hirsutism, or maybe the medication she is taking for high blood pressure is at the root of her problem. These and countless other conditions can interfere with the ability of the sex hormone-producing glands - the ovaries (in women), the testes (in men) and the adrenals of either gender - to secrete the optimum amount of testosterone into the system.

Drugs Containing Sex Hormones

     It will come as no surprise to electrologists to learn that the drugs which are most likely to list excessive hair growth as a possible adverse reaction are those which contain sex hormones (or their synthetics). They fall mainly into three classes: androgens, the male hormones (fluoxymesterone, methylestosterone and testosterone), and two groups of female hormones, the estrogens (chlorotrianisene, conjugated estrogens, esterified estrogens, estradiol, diethylstilbestrol, estrone, estropipate, ethinyl estradiol, and quinestrol), and the progesterones (hydroxyprogesterone, medroxyprogesterone, megastrol, norethindrone and norgestrel).
    The androgens (Table I) stimulate the hair follicle and the sebaceous glands and are responsible for changing fine, vellus hairs into thick terminal hairs. In males, these powerful hormones are used as replacement therapy for conditions associated with testosterone deficiency, such as impotence, hypogonadism and the male climacteric. They may also be prescribed for females with menorrhagia, senile and idiopathic osteoporosis, delayed bone healing, and frigidity. Among androgen's many undesirable side effects for women are clitoral enlargement, female virilization, seborrhea and acne, male pattern baldness and hirsutism.
     Estrogens, like the androgens, are found in both sexes, but by far the greatest levels are generated by the ovaries of the female. These hormones have the ability to promote estrus and stimulate the development of secondary sex characteristics. In drug therapy they are widely used in the treatment of ovarian failure (or removal) in young women, and for menopausal syndrome, postmenopausal atrophy of genital tissues, and postmenopausal osteoporosis, as well as certain kinds of breast cancer.
     Adverse effects that may be associated with estrogen replacement drugs include breast enlargement, changes in cervical secretion and menstrual flow, changes in sex drive, fluid retention, weight gain or loss, depression, dizziness, skin irritation, darkening of the skin, and - most importantly increased risk of cancer of the uterus after three years of continual use. As is the case with all sex hormones, estrogens list excessive hair growth (and possible hair loss) among their undesirable side effects.
     Along with estrogen, a woman's ovaries produce progesterone (the hormone and its synthetics, generally referred to as progestins). It is the natural function of this substance to prepare the uterus for pregnancy and ready the breasts for lactation, but in hormone therapy its use is extended to include treatment for weight loss, cancer of the breast and uterus, and conception control.
     The possible side effects of progestin therapy are much the same as those given for other female sex hormones: appetite or weight changes, breast tenderness or enlargement, blood clots, menstrual cycle changes, depression, hair loss, and excess hair growth.
     Oral contraceptives , universally known as "The Pill," consist of synthetic forms of estrogen and progestin combined in a single tablet. The so-called "mini-pill," containing progestin only, is much less common. Estrogen and progestin normally regulate a woman's menstrual cycle and the fluctuating levels of these hormones play an essential role in pregnancy. By suppressing pituitary hormones that stimulate ovulation, the pill creates in the blood the same chemical environment that exists during pregnancy, and thus becomes a highly effective form of birth control. However, when the actions of estrogen and progesterone are translated to the pill, a long list of possible side effects (as noted above for female hormones) is generated. Among the 30 to 40 possible "adverse reactions" enumerated, the most important for electrologists are those to do with the skin: hives, acne, itch, skin rash or discoloration (brown blotching), and "excessive growth of hair on the face, back, chest, or stomach." Other hormonal methods of contraception, such as implants and shots, involve the same drugs and have the same potential side effects. To help reduce these side effects, oral contraceptives are available in a wide range of estrogen and progestin concentrations.

Corticosteroids and Hair Growth

Next to the so-called male and female hormones, the hormones of most importance to electrologists are the corticosteroids, the steroid hormones produced by the body's adrenal gland. In addition to secreting some of the sex hormones (mostly provided by the male testes and the female ovaries), the adrenal cortex produces aldosterone - which causes the kidneys to excrete potassium and retain sodium; cortisol, corticosterone, and cortisone - that together help the body resist stress, metabolize food intake, control immune response and inhibit inflammation. Cortisone is by far the best-known of the adrenal steroids - many people, in fact, refer to all the steroids as cortisone - but it is rarely prescribed today because of its propensity to cause sodium and water retention and potassium deficiencies. However, modern synthetic steroids have fewer of these side effects. Cortisone is largely inactive in the body until it is converted to hydrocortisone. Synthetic versions of hydrocortisone, like their natural counterparts, are not often given internally but are in common use as topical preparations (creams, ointments, gels and solutions) to treat inflammations, allergies, pruritus and collagen diseases. Prednisone is a synthetic steroid derived from cortisone. Its effects are much the same, except it causes less sodium and water retention. Prednisolone is chemically very similar to prednisone, with virtually the same effects. Dexamethasone, methylprednisolone, and triamcinolone are synthetic adrenal steroids closely related to prednisone. All of the steroids (excluding the sex hormones) elaborated by the adrenal cortex and all their synthetic equivalents (including but not limited to: betamethasone, cortisone acetate, desonide, dexamethasone, fluocinolone, fluocinonide, halcinonide, hydrocortisone, meprednisone, methylprednisolone, prednisolone, prednisone, and triamcinolone) are, in this article and its tables, collectively referred to as corticosteroids. The number of brand name drugs in this category is vast. Forty-five years ago, the advent of corticosteroids was heralded as one of the greatest advances in dermatologic therapy, and since that time the list of cortisone-like drugs on the market has skyrocketed. (Of the 526 drugs on International Hair Route's master list of drug products that include hirsutism as a possible adverse reaction, well over half are corticosteroids.) They are administered either orally, parenterally, or topically for the treatment of a wide variety of allergic and inflammatory conditions. All of the preparations - especially the hydrocortisones - carry warnings reminding the consumer that when the drug is used topically, some of it is inevitably absorbed through the skin and enters the bloodstream. Too much absorption can lead to unwanted side effects such as acne-like skin eruptions, blistering or peeling, redness, secondary infection, itching, and burning. Extensive or long-term use can cause glandular problems, high amounts of sugar in the blood or urine, Cushing's syndrome, and excessive hair growth.

Other Hair-Causing Drugs

When discussions about drugs and hair growth have dealt adequately with the subject of sex hormones (androgen, estrogen, and progesterone) manufactured mainly by the gonads, and the many steroids produced by the adrenal cortex (cortisone, methylprednisolone, prednisolone, etc.), there is little else to talk about. There remains only four or five drug classes which appear to have any appreciable influence on hair growth. Falling into the class of diuretics (agents that increase the flow of urine) we have five or six formulations of spironolactone - an anti-androgen that is principally used as a high blood pressure medication, but is sometimes prescribed by doctors to treat hirsutism. In the class of anti-depressants there is one proprietary drug containing fluoxetine hydrochloride - a powerful drug prescribed for the treatment of major depression -which lists carpal tunnel syndrome and hirsutism among its rare side effects. Another drug in this class contains venlafaxine hydrochloride, which is identified as having excessive hair growth as a possible adverse effect. A small group of other drugs contain selegiline hydrochloride, are also used to treat mental depression. When taken in combination with a second drug, selegiline is a treatment for Parkinson's disease. In either case, the drug has the potential to cause excessive hair growth. People who have organ transplant surgery and are put on the immunosuppressant drug cyclosporine, have a 21 - to 45-percent chance of getting an excessive growth of hair. This drug, also used sometimes to treat severe skin disorders, has been thoroughly researched in the last few years to learn whether it would be useful in hair replacement therapy. There are three formulations on the market containing minoxidil, which is used in the treatment of severe high blood pressure, and is a known hair growth stimulant. Among the brand name anticonvulsant drugs on the market there are three or four containing phenytoin or diphenylhydantoin, an antiepileptic medication that lists hypertrichosis as a possible side effect. At least three proprietary drugs containing diazoxide (phenoxybenzamine hydrochloride), a drug used to treat an excess of glucose in the blood due to hyperinsulinism, has the possible side effect of "hairiness of the lanugo type, mainly on the forehead back and limbs."