Hirsutism

Hirsutism is a condition characterized by excessive hair growth in women in areas where hair is typically more common in men, such as the face, chest, back, and abdomen. While some degree of hair growth in these areas is normal, hirsutism refers to hair growth that is excessive, coarse, and dark, often resulting in psychological distress and self-esteem issues.

Symptoms

Symptoms of hirsutism include:

• Excessive Hair Growth: Hair growth in areas such as the upper lip, chin, chest, back, abdomen, and thighs.
• Coarse and Dark Hair: Hirsute hair is often thicker, coarser, and darker than the fine vellus hair that typically grows in these areas in women.
• Patterned Growth: Hair growth may follow a pattern similar to male pattern hair growth, such as a beard or chest hair.
• Associated Symptoms: Hirsutism may be accompanied by other symptoms of androgen excess, such as acne, irregular menstrual periods, or male-pattern baldness (androgenic alopecia).

Causes

Hirsutism can be caused by various factors, including:

• Hormonal Imbalance: Excess androgens (male hormones) such as testosterone can stimulate hair growth in areas where it is typically sparse in women.
• Polycystic Ovary Syndrome (PCOS): A common hormonal disorder characterized by irregular menstrual periods, ovarian cysts, and often hirsutism due to elevated androgen levels.
• Idiopathic Hirsutism: In some cases, no underlying cause can be identified, and hirsutism is termed idiopathic.
• Medications: Certain medications, such as corticosteroids, danazol, or testosterone, can cause hirsutism as a side effect.
• Tumors: Rarely, tumors of the ovaries or adrenal glands can produce excess androgens, leading to hirsutism.
• Congenital Adrenal Hyperplasia (CAH): A group of inherited disorders characterized by enzyme deficiencies in the adrenal glands, leading to androgen excess and hirsutism.

Diagnosis

Diagnosis of hirsutism involves:

1. Medical History: The healthcare provider will inquire about the onset, duration, and progression of excessive hair growth, as well as any associated symptoms or medical conditions.

2. Physical Examination: Evaluation of hair growth patterns and distribution, as well as signs of androgen excess such as acne or male-pattern baldness.

3. Hormonal Evaluation: Blood tests may be ordered to measure hormone levels, including testosterone, dehydroepiandrosterone sulfate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid hormones.

4. Imaging Studies: Ultrasound or other imaging tests may be performed to evaluate the ovaries and adrenal glands for abnormalities or tumors.

Treatment

Treatment of hirsutism depends on the underlying cause and severity of symptoms:

1. Medications:

   • Oral Contraceptives: Combined oral contraceptives containing estrogen and progestin can help regulate menstrual cycles and reduce androgen production.
   • Antiandrogens: Medications such as spironolactone or cyproterone acetate can block the effects of androgens on hair follicles, reducing hair growth.
   • 5-Alpha Reductase Inhibitors: Finasteride or dutasteride can inhibit the conversion of testosterone to its more potent form, dihydrotestosterone (DHT), and reduce hirsutism.
   • Insulin-Sensitizing Agents: Metformin may be used in women with PCOS to improve insulin sensitivity and reduce androgen levels.

2. Topical Treatments:

   • Hair Removal Creams: Depilatory creams containing chemicals such as thioglycolate can dissolve hair at the skin's surface.
   • Shaving: Regular shaving can temporarily remove unwanted hair, but it does not affect hair growth at the root.
   • Waxing or Sugaring: Pulling hair out by the root using wax or sugar-based pastes can provide longer-lasting hair removal but may be painful.
   • Laser Hair Removal: Laser therapy targets the pigment in hair follicles, destroying them and reducing hair growth over time.

3. Cosmetic Procedures:

   • Electrolysis: Electrolysis involves inserting a tiny needle into each hair follicle and delivering an electrical current to destroy the follicle, leading to permanent hair removal.
   • Intense Pulsed Light (IPL) Therapy: IPL therapy uses pulses of light to target hair follicles and inhibit hair growth.

Management

In addition to medical and cosmetic treatments, lifestyle modifications may help manage hirsutism:

• Weight Management: Maintaining a healthy weight through diet and exercise can help improve insulin sensitivity and reduce androgen levels in women with PCOS.
• Hair Removal Techniques: Regular hair removal methods such as shaving, waxing, or laser therapy can help manage excessive hair growth and improve self-esteem.
• Psychological Support: Counseling or support groups may be beneficial for women experiencing psychological distress or self-esteem issues related to hirsutism.

Complications

Complications of hirsutism may include:

• Psychological Distress: Excessive hair growth can lead to embarrassment, low self-esteem, and social withdrawal.
• Skin Irritation: Hair removal methods such as shaving or waxing may cause skin irritation, ingrown hairs, or folliculitis.
• Menstrual Irregularities: In women with hormonal imbalances such as PCOS, hirsutism may be accompanied by irregular menstrual periods or fertility issues.