In this blog post we explain hirsutism, the causes for it, and the treatment you can initiate if you have this issue.

Hirsutism is an excessive, unwanted hair growth in areas where hair is usually not present in a female, owing to an underlying hormonal or endocrinal imbalance, especially after puberty. Hirsutism causes hair to grow in a male pattern distribution in a female. The hair growth in women affected by this condition is dark, thick and coarse. The areas in which the unwanted hair is present are- chin, jawline, upper lips, face, neck, chest, lower back and lower abdomen.

Causes:

  1. Hormones: It is largely due to an increase in male hormones or androgens in a female. The androgens are normally produced by the female body, but in excessive amounts, they cause hirsutism. It may also be an outcome of absence of ovulation.
    • Ovarian cystsThe most common endocrine disorder causing this condition is polycystic ovarian disease (PCOD)Polycystic ovarian disease presents itself with obesity, acne, excessive body and facial hair (hirsutism), patches on skin, disturbances in menstrual cycle which include- irregular menstrual cycles, heavy menstruation or even amenorrhea, along with pelvic pain. Women affected with PCOD also have problems during gestation. PCOD may be due to genetic or environmental factors, other than obesity. It is closely associated with type 2 diabetes, heart diseases, sleep apnoea, mood disorders and endometrial cancer.
    • Cushing’s Syndrome: Another less common cause of hirsutism is Cushing’s Syndrome, caused due to high levels of stress hormone, cortisol, which is secreted by adrenal glands in the body. Excess cortisol is produced by the body in response to stress. It may also be produced in response to medications, like glucocorticoids or steroids.
    • Ovarian tumoursTumours in the adrenal glands or the pituitary gland and birth defects may also be a contributory factor to Cushing’s syndrome, causing excess of androgens.
    • Insulin: Low levels of insulin circulating in the blood, increase the risk of high blood sugar levels and obesity, which are both closely linked to polycystic ovarian disease and thus cause hirsutism.
  2. Genetic or familial: Many times there may be a family history of polycystic ovarian disease, which can cause hirsutism or there might be a genetic influence.
  3. Drug related: Usage of certain drugs interferes with the hormonal system of the body, which then causes hirsutism. The following are those drugs:
    • Minoxidil
    • Anabolic steroids
    • Phenytoin
  4. Idiopathic: Sometimes, the actual cause of hirsutism remains unknown, despite all the investigations.

Diagnosis:

Usually one would present with this condition in the view of a cosmetic relief. These women may be looking forward to a permanent hair removal and may have tried waxing, shaving, threading, epilatory creams or devices and plucking to get rid of the unwanted hair.These are temporary methods and the hair always grows back, pointing towards an internal cause that must be identified and treated before permanent hair removal. Laser hair removal may worsen the condition if the cause for excessive androgen production is not treated.

Investigations include Ferriman-Gallwey score, to evaluate hirsutism on the amount and location of hair growth; blood tests for thyroid stimulating hormone (TSH), prolactin, androgens, testosterone as well as ultrasounds of the pelvic area and ovaries, to ascertain ovulation and the cause of the condition.

Treatment:

Depending on the cause, treatment must be initiated. In case of any underlying disorders like polycystic ovarian disease, Cushing’s Syndrome, etc treatment must be along those lines. The various treatment modalities are:

  1. Medications: 
    • Medications mostly include anti-androgens like: Spironolactone, Cyproterone Acetate, Flutamide, which control excessive secretion of male androgens in females.
    • In case of polycystic ovarian disease, which is the most common cause of hirsutism, it must be treated with medications specific to it, which include hormonal contraceptives, which are a combination of estrogen and progestin, and are a functional anti-androgen. Diet and lifestyle changes are also required to eliminate this disease, rooting to obesity.
    • If the cause of hirsutism is under production of insulin, like in a diabetic or obese individual, anti-hyperglycemics must be considered. Oral or injectable antihyperglycemics can be given to control diabetes, depending upon the blood sugar levels. Metformin is the most commonly used oral drug and it also helps to control hirsutism in addition.
  2. Diet and lifestyle changes: Consuming a healthy diet along with regular exercise, helps in weight management and controls obesity, which is the root cause of polycystic ovarian disease, which in turn is the most common reason for hirsutism. A healthy stress-free lifestyle is also equally important to maintain normal cortisol levels. This can be achieved by yoga, meditation and exercise.
  3. Permanent Hair Removal: Only when the excess androgen production is under control, the laser hair removal must be considered. Treatment of the internal condition is a medical necessity while hair reduction serves only the cosmetic purpose. But the psychological impact of facial hair can cause distress in many women. Laser hair reduction is the only way to get rid of the unwanted hair and treat the anxiety associated with it in women. It removes the unwanted hair by exposing them to light, completely destroying the hair follicles. It works in sessions in order to destroy hair follicles in all phases of its growth. A session can be undertaken every 4 to 5 weeks till the hair growth is reduced. 4 to 6 sessions are given, depending on the type of hair and skin colour. With every session, the hair gets thinner and lighter. This also works best for thick and dark hair. White, light coloured hair is not targeted by lasers.

Do you have hirsutism? With Remedico, you can consult with a certified dermatologist wherever you are, all from your smartphone. We will send you a personalised treatment plan within 24 hours, and provide you regular follow ups and answers to all your questions.

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