Hirsutism

Hirsutism at a glance

• Hirsutism is a chronic condition that produces unwanted male–pattern hair growth in females.
• Hair may begin to grow in areas such as the chest, back, face, arms and legs. This is due to ethnic background or an increase in the level of androgens.
• According to the American Society for Reproductive Medicine (ASRM), polycystic ovary syndrome (PCOS), a common cause of infertility, is most often the cause of hirsutism.
• Hormone imbalances and medications also may cause hirsutism.
• Treatment can involve drugs, such as oral contraceptives, and mechanical removal of the unwanted hair by plucking, electrolysis, waxing or shaving.

Hirsutism guide

What is hirsutism?
Causes and risk factors of hirsutism
Diagnosis & treatment of hirsutism

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What is hirsutism?

Hirsutism is unintended male-pattern hair growth in women that is commonly due to high levels of the androgen hormones. Typically occurring on the back, face and chest area, the amount of unwanted hair will vary according to each individual. Hirsutism is a common condition that occurs in more than 3 million American women each year, and it’s estimated that up to 10 percent of American women have some form.

Because it’s a chronic condition, it can be a lifelong condition. The hairs are the terminal type, dark and coarse, instead of the more common vellus type of hairs that are fine and light.

The areas of a woman’s body where hirsutism due to androgens is most likely to occur are centrally located, including the upper lip, chin, chest, lower back and inner thighs.

Androgens can induce the vellus hairs to become coarser and transform into terminal hairs. Many things affect androgen’s influence on hair growth, including genetics, weight and medications.

Women with hirsutism may also experience an increase of acne, a deepening voice and decreased breast size.

Causes and risk factors of hirsutism

The causes of hirsutism vary for each woman but the main causes include:

• PCOS – Causes cysts to form on the ovaries and can create a high level of androgens and lead to hirsutism.
• Genetics – A woman is more likely to have this condition if her immediate female family members, such as mother or sisters, also have the condition. Hirsutism is also more common in women of Middle Eastern, Mediterranean and South Asian descent.
• Medications – Certain medicines, such as anabolic steroids and Rogaine (minoxidil), can cause an increase in androgens and hair growth in unwanted places.
• Cushing’s syndrome – Occurs when the body produces too much cortisol and subsequently excess androgens.

Diagnosis & treatment of hirsutism

Reproductive endocrinologists, which include all doctors at RSCBA, have the specific training to diagnose and treat hirsutism. Other physicians may also have received the necessary training. Typically, it is self-diagnosed, but in some cases a physician can help diagnose it.

The physician will try to determine if the terminal hairs are due to hormonal issues or a genetic or ethnic hair pattern. Blood evaluations, hormone tests, ultrasound and x-rays may also be used in the physician’s diagnosis to evaluate the function of the woman’s adrenal glands and ovaries. Once the physician determines the specific cause, treatment can be planned.

There are many options for treatment. Treating hirsutism will be different for each woman and will depend on condition severity and the patient’s preferences and resources. Birth control pills are the most common means of treating hirsutism hormonally. Other prescribed medications include androgen, spironolactone, prednisone and enzyme inhibitors.

If a woman is overweight and she is able to lose weight, she will have less free circulating hormones, which should reduce the amount of unwanted male-pattern hair.

Some other treatments that remove hair, generally done with our without prescribed medications, include:

• Electrolysis – This is a permanent and expensive method that uses an electric current to remove hair. A few treatments are needed to ensure the hair is gone for good.
• Vaniqa – A face cream that includes the medicine eflornithine will slow hair growth.
• Laser hair removal – Lasers and heat are applied to remove undesired hair. This method doesn’t always provide permanent results and may be painful and could cause scarring.
• Shaving – Easy, quick but temporary, shaving will remove unwanted hair. Shaving will need to be completed on a regular basis to keep hair growth unnoticeable.

A physician can help determine which form of treatment is best for each patient.