Hirsutism – Complete Guide for Patients

Hirsutism is a medical condition that affects females.

They experience excessive growth of facial or body hair in this condition.

You can recognize it as coarse, dark hair that might appear on the upper legs, upper arms, abdomen, back, face, and chest.

Hirsutism is caused due to Androgen imbalance in the body. 

Androgens are produced in both sexes, but males have much higher levels.

In women higher Androgen levels could lead to Polycystic ovarian syndrome (PCOS).

Hirsutism often improves with medical supervision.

Immediate medical attention can help you prevent the disorder to the most extent.

Delaying the treatment makes it more challenging to treat.

Overview of normal hair growth

Hair growth initiates from a follicle deep in your skin.

Until these follicles are not completely destroyed, you will witness continuous hair growth, even if the shaft.

The shaft is the part of the hair that appears above the skin.

Even if you pluck or remove the shaft, you will still experience the hair coming out of the follicle.

Hair follicles cover most of the surface of your body except your palms and feet.

Excessive hair due to ethnic variation and genetics are located in the feet, legs, hands, and arms.

Vellus and terminals are the two hair types found in adults.

Vellus hair is usually short, fine, soft, and generally colorless.

Whereas terminal hair is coarse, dark, long, and sometimes curly.

In most women, Vellus hair covers the back, chest, and face. This gives the conviction of hairless skin.

In the case of men, terminal hair covers the face and body.

This hair grows on the armpit, pubic, and scalp region in both men and women.

A combination of both hair types covers the lower arms and legs in both sexes.

If you have excessive hair growth on your forearms and lower legs,  it is not considered Hirsutism.

This way, you are not subjected to hormonal therapy.

Hair growth follows a specific cycle.

While some hair follicles grow, others rest and shed over time.

In women, hormonal changes due to pregnancy or birth control pills impact hair growth.

As a result, their hair may grow and fall more than usual.

It is a temporary condition and the hair growth pattern usually returns to its original state within 6 to 12 months.

Effects of Androgens on hair growth

Excessive Androgens in your body might result in surplus facial and body hair.

All genders have Androgens, but men have higher levels of active Androgens.

Estrogen reduces the effect of Androgens in women to some extent.

In case your hair follicles are hormone-sensitive, Androgens may impact the vellus strands to change to terminal hairs.

This terminal hair is dense, coarse, dark, and longer than vellus hair.

Once a vellus hair changes to terminal hair, there is no reverse way possible.

Diagnosing Hirsutism

Healthcare experts for Hirsutism and related problems generally include medical and reproductive endocrinologists.

You can also find some general practitioners, dermatologists, and gynecologists with the necessary expertise in this field.

During the initial days of your medical consultation, your doctor will project a clear difference between the growing pattern of both terminal and vellus hair.

Doctors may also inform you of the difference in hair growth due to ethnic origin or genetics. 

Also, terminal hairs grow in a male pattern indicating Hirsutism.

After the diagnosis with Hirsutism, your doctor might perform –

• Ultrasound
  
• Blood tests
  
• Special x-rays
  
• Hormone tests

These tests check the function of your adrenal glands and ovaries.

Based on the clinical reports, your healthcare provider will suggest appropriate treatment.

Causes of Hirsutism

There could be several reasons behind the cause of Hirsutism.

Some of those are as follows,

Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a hormonal disorder.

It affects 10% of females.

PCOS is variable in nature.

Its diagnosis involves a combination treatment which includes ultrasound, clinical, and laboratory features.

This condition is associated with hormonal imbalances.

As a result of which, there is an overproduction of Androgens by the ovaries.

This excessive amount of Androgens is a common cause of Hirsutism. 

Later on, in this information column, you will be able to get detailed information on PCOS.

Non-classical Adrenal Hyperplasia

Non-Classical Adrenal Hyperplasia (NCAH) is an inherited disorder of the adrenal glands.

This can result in Hirsutism.

Due to this condition, there is an overproduction of Androgens by the adrenal glands.

NCAH is associated with irregular menstrual cycles.

Reproductivefacts says, It is a genetic disorder that can be seen in certain ethnic groups, including

• Eskimos
  
• Ashkenazi Jews
  
• French-Canadians

A well-known characteristic of NCAH is the elevation of the hormone 17 alpha-hydroxyprogesterone.

The hormone 17-hydroxyprogesterone is a building block for producing the hormone cortisol.

HyperAndrogenism, Insulin Resistance, Acanthosis Nigricans (HAIR-AN) Syndrome

Pancreas produce Insulin which controls blood sugar levels.

Excessive insulin can stimulate the ovaries to overproduce Androgens.

As a result, you may face problems of acne, irregular ovulation, and Hirsutism.

Sometimes these conditions are hereditary in nature.

Along with insulin, HyperAndrogenism is the reason behind the majority of these severe cases.

HAIR-AN syndrome may seem similar but is quite different from hyperandrogenism and PCOS.

Cushing Syndrome

Cushing syndrome is a medical condition.

Here the adrenal glands produce excessive amounts of cortisol.

Hirsutism might be expected in patients suffering from Cushing syndrome.

Yet, it is not a primary feature of this disorder.

Cushing syndrome is a rare but severe disease.

Compared to other signs and symptoms of Cushing syndrome, Hirsutism arises late.

Ovarian or Adrenal Tumors

Rarely, tumors producing Androgens may develop in the adrenal glands or ovaries.

These tumors might produce extremely high Androgen levels.

As mentioned in Reproductivefacts, symptoms like Hirsutism usually appear suddenly and progress quickly.

Menopause

During menopause, the ovaries produce Androgens but stop producing Estrogen.

Decreased Estrogen levels allow the Androgens to have a more significant impact.

As a result, there could be an increased number of terminal hairs, especially on the face.

The majority of females complain of mild balding and new facial hair.

Medication side effects

Drugs might cause Hirsutism with characteristics of Androgens.

Anabolic steroids relate to Androgens.

These are used to enhance the muscle mass of debilitated and chronically ill people, along with some bodybuilders.

Generally, patients on these medications develop more frequent acne than Hirsutism.

Natural supplements like Androstenedione and Dehydroepiandrosterone (DHEA) might cause Hirsutism.

Unexplained Hirsutism

For unknown reasons, the hair follicles of some women are sensitive to Androgens.

In these patients, menstrual periods are regular, and Androgens levels are normal.

Even if the same abnormality is not known, this tendency is genetic to develop Hirsutism.

How is Hirsutism treated?

Hirsutism can be treated in multiple ways.

Medical Therapy

Your physician may recommend a variety of medical and surgical treatments.

Yet, these treatments depend on your diagnosis and severity of Hirsutism.

Usually, the US Food and Drug Administration (FDA) approves medications for Hirsutism.

Even so, research has documented their effectiveness.

Birth Control Pills (Oral Contraceptives)

As mentioned above, doctors usually suggest oral contraceptives as a hormonal treatment for Hirsutism.

They decrease the production of Androgens by the ovaries and prevent ovulation.

Due to the presence of Estrogen in the pills, our liver starts to produce and release hormone-binding globulin (SHBG).

SHBG is a protein that binds to Androgens and reduces their action.

The pills help in,

• Slowing excessive hair growth
  
• Regulating the menstrual cycle
  
• Providing protection against unwanted pregnancies

Anti-Androgenic medications

Spironolactone is a combination medicine often prescribed with oral contraceptives.

It is a diuretic or water pill.

It is effective in blocking the effects of Androgens in hair follicles.

Doctors usually recommend this anti-Androgen to treat Hirsutism.

Some common side effects include,

• Fatigue
  
• Dry skin
  
• Heartburn
  
• Headaches
  
• Irregular vaginal bleeding

Approximately eighty percent of Spironolactone users have experienced a significant downfall in Hirsutism.

Another medicine, Flutamide, an anti-Androgen medication, blocks the Androgen receptors.

Side effects of these medications may include harmful but rare effects on the liver. Hence, take it only after consulting your doctor. 

FDA has not approved these medications for the treatment of Hirsutism in women.

Yet it’s a commonly used medication and has been studied for that purpose.

Steroid medications

Doctors might prescribe low doses of steroids in the case of overactive adrenal glands.

During the day, women have experienced side effects like

• Dizziness
  
• Mood swings
  
• Difficulty falling asleep

Yet, these complaints improve after the first few days.

There could be severe side effects like, decreased defense against infection, weight gain, and thinning of the skin and bones.

GnRH Analogs

Gonadotropin-Releasing Hormone (GnRH) may treat severe forms of HyperAndrogenism.

These medications treat Hirsutism by suppressing ovarian Androgens to moderate levels.

Besides that, they also suppress Estrogen, which may result in menopause-like symptoms.

Doctors recommend using these medications under the supervision of an expert.

The administration of GnRH analog takes place with either estrogen or progestin.

This prevents the loss of bone density.

Cosmetic therapy

Always refer to your doctor before using cosmetic therapy for the removal of hair.

They may combine cosmetic and medical therapy for hair removal if required.

Temporary hair removal

Most women pluck unwanted hairs for temporary treatment of mild Hirsutism.

They must avoid this, as plucking could tear the living follicle.

Besides, it can also irritate sensitive skin.

If the shaft or hair follicle becomes infected, the hair may curl into the skin.

As a result, this may lead to acne or pimples.

Those who carry out waxing also own the same infection and irritation risks in Androgen-sensitive areas.

As a result, this may cause irritation to sensitive facial skin.

To make excessive hair less noticeable, bleaching can be used in small areas of the body, particularly the upper lip.

But, excessive bleaching might lead to skin damage and irritation.

When it comes to temporarily removing hair, shaving is probably the safest and simplest way, although not satisfying to many women.

Frequent shaving may result in irritating stubble due to the continued growth of the hair.

Compared to blades, an electric razor may produce less skin irritation.

Even regular shaving has medical side effects.

Eflornithine hydrochloride (facial cream) with appropriate cosmetic therapies may limit excessive facial hair.

Some women might develop worsening acne with eflornithine use.

Its effectiveness on other body parts and safety in pregnancy has not been established.

Permanent hair removal

Laser treatment and electrolysis are the two permanent types of hair removal techniques.

During the process of electrolysis, the insertion of an excellent needle takes place into the follicular region of the scalp.

A mild electric current is sent through the needle to destroy the hair follicle’s ability to produce hair permanently.

This process can only be practically carried out to treat some areas of the body.

This is due to the fact that follicles are treated one at a time.

Even though the long-term effectiveness of laser treatments is not well documented as electrolysis, these might be used on large areas of the body.

The process of laser hair treatment involves a beam of light passing through the skin to the hair follicle to destroy it.

This laser hair removal treatment is quite effective for people with light skin and dark hair.

Many treatments could be carried out, if required, depending on the area.

Both methods of hair reduction are moderately painful.

Yet, lasers and electrolysis are effective ways to remove unwanted hair.

Meanwhile, these are not permanent treatments to reduce all hair growth.

New facial hair will emerge without concurrent medical treatment.

Doctors recommend delaying the treatment for at least six months after the initiation of medical treatment.

As per Reproductivefacts, the growth of new terminal hairs will be reduced.

Usually, physicians refer patients to a reputed laser specialist or electrologist.

Home electrolysis kits rarely work because the follicle is planted deep within the skin due to the difficulty of the treatment.

What to expect from treatment of Hirsutism

Hormone treatment might slow the growth rate of existing hairs.

Thereby preventing new terminal hair from developing.

You can expect a significant decrease in the rate of hair growth after six months of hormonal therapy.

Once you get effective results, you can continue with hormone treatment.

Using lasers or electrolysis, you can remove the remaining hair after hormone therapy. 

Ongoing treatment may manage the possibilities of curing the hormonal problem causing Hirsutism.

If you drop the medical treatment, Hirsutism might return.

For the best possible results, a combination of treatment methods is necessary.

Psychological aspects of Hirsutism and PCOS

It can be emotionally challenging to deal with PCOS and Hirsutism.

Some women may feel unfeminine about weight loss and excessive hair growth.

They may even wonder If they will be able to enjoy motherhood.

You may feel embarrassed to share your feelings with your friends and family.

But opening up with your doctor as soon as possible is essential.

This will help you explore the possibilities available in terms of medical and cosmetic treatments.

It is also essential for you to understand that these are very common problems experienced by females.

Conclusion

Hirsutism is a common medical disorder.

Under proper medical supervision, it might be treated successfully.

Medical treatments like electrolysis or laser may help reduce or permanently remove unwanted hair.

If any of your female family members have experienced excessive hair growth in the past, then you should also look for early signs of Hirsutism.

PCOS might be the cause behind Hirsutism.

It may cause infertility, irregular or heavy menstrual periods, acne, or Hirsutism.

When diagnosed at a young age, both PCOS and Hirsutism are easier to treat.

Frequently Asked Questions