Hirsutism: what is it, symptoms and treatment

Hirsutism is a disorder characterized by excessive hair growth in women, with a distribution following the male pattern: chin, sideburns, areolas, neck, upper or lower navel area, chest, back or thighs.

Hair growth depends on the balance produced in our body between androgens and estrogens. Androgens are responsible for the growth of thick, dark hair.

Hirsutism manifests itself with the appearance of excess hair in some parts of the female body.

Prognosis of the disease

Hirsutism usually affects approximately 10% of women of childbearing age. In addition, it is usually a mild disorder, so it can rarely develop into a serious disorder. If the prognosis becomes severe, the disorder can affect other systems, such as the regulation of menstruation, causing alterations or the absence of menstruation, and can even lead to infertility.

The treatment usually takes about 6 months to become noticeable, since this is when the hair begins to become thinner and shorter and the need for possible hair removal is spaced out over time.

Sometimes a second course of treatment is necessary six months after finishing the first one, and a third course may also be required.

Symptoms of Hirsutism

When high levels of androgens cause hirsutism, various symptoms such as acne, increased oiliness of the hair or seborrhea may occur. These would be characterized as mild symptoms of the disorder that occur when other hormones are elevated in other tissues due to excess androgens in the body.

Obesity promotes androgenic activity through various mechanisms, so it is more common in obese women than in thin women. More rarely, aggravation of voice tone, excessive muscle development or clitoral hypertrophy may occur as part of what is known as a virilization syndrome, which usually translates as a profound hormonal disorder of androgen secretion.

In addition, since androgens antagonize the effects of estrogens, defeminization with involution of breast development may occur.

Medical tests for Hirsutism

Hirsutism is diagnosed by taking a medical history that allows to know the date of the beginning of hair growth or acne or hair loss, as well as the subsequent evolution, the date of the first menstruation and the periodicity of the following ones.

A thorough physical examination is necessary to quantify the intensity, length and thickness of the hair and hair, evaluating it by zones according to international criteria and making determinations between the second and ninth day of the menstrual cycle of the hormones that may be involved, according to the clinical history and examination. In general terms, testosterone, dehydroepiandrosterone-sulfate, androstenedione, 17-hydroxyprogesterone, sex hormone transport protein, glucuronide, luteinizing hormone and follicle-stimulating hormone are usually needed.

Likewise, if there is a suspicion of late adrenal hyperplasia, an ACTH stimulation test should also be performed.

What are the causes of Hirsutism?

This manifestation is related to androgenization, which is due to a global production of available free androgens, which can be produced by several pathologies:

Polycystic ovary syndrome: this is a very common condition caused by an imbalance of sex hormones, which can lead to other symptoms such as obesity, irregular periods, formation of multiple cysts in the ovaries and infertility. It is the most common cause of hirsutism. Polycystic Ovary Syndrome usually begins at puberty, although the exact cause is unknown. It results in underdeveloped ovarian follicles, leading to chronic anovulation with immature follicles, as well as elevated androgen production.
Ovarian hyperthecosis: is a disease of the ovaries in which there is a proliferation of islands of theca cells. Unlike Polycystic Ovary, it presents with normal LH and FSH values, but nevertheless androgen levels are higher.
Cushing’s syndrome: is a condition characterized by exposure to a high level of the hormone cortisol, which alters the balance of sex hormones in the body.
Congenital adrenal hyperplasia: causes abnormal production of steroid hormones such as cortisol. It is caused by a lack of one of the enzymes necessary for the synthesis of cortisol, which causes an increase in a pituitary hormone, ACTH, which stimulates the production of adrenal androgens.
Tumors: although it occurs rarely, a tumor in the ovaries or adrenal glands may be another cause.
Medications: some drugs used to treat endometriosis can cause hirsutism.
Idiopathic or familial hirsutism: consists of an increased sensitivity of the skin to androgens, or increased activity at cutaneous level, of an enzyme called 5-alpha-reductase, by family propensity to have a greater number of hair follicles per unit area of skin. It starts with puberty, being normal menstruation, circulating hormones and fertility.

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Can it be prevented?

Normally, hirsutism cannot be prevented, but, if the cause is polycystic ovary syndrome, a prevention of insulin resistance and obesity may help to have lower levels of androgens and hirsutism.

Treatments for Hirsutism

Hirsutism can be treated with medical therapies, although much depends on the patient’s perception of excessive hair from an aesthetic or social point of view.

On the one hand, excessive hair growth that is not androgen-dependent should be treated with hair removal by laser hair removal, for example.

If the growth depends on androgens, there are different treatments that can be carried out:

Oral contraceptives: inhibit the production of androgens by the ovaries.
Corticosteroids: they are used to suppress the production of adrenal androgens.
Anti-androgen drugs: block androgens.
Topical cream: applied directly to the affected area of the face, it helps to slow down the growth of new hair, but does not remove existing hair.

Physical measures, including staining and depilation, are effective and can be combined with pharmacological treatment. As far as possible, treatment should be targeted to the cause.

Reducing weight and excess body fat, in the case of excessive body fat, is a preferential therapeutic objective that requires hygienic dietary measures and a healthy lifestyle.

If the objective is the symptomatic treatment of hirsutism, anti-androgen drugs can be used, such as cyproterone acetate, which are usually combined with estrogenic preparations that facilitate menstrual periodicity, although artificial, and increase the efficacy of the treatment.

What specialist treats it?

This pathology can be treated by a specialist in Endocrinology and Nutrition.

What is Hirsutism?