Hirsutism – Causes, Symptoms and Treatment

Hirsutism is the development of dark or coarse hair on the body and face of women in a male-like pattern. It arises due to an excess of male hormones called androgens in a female’s body. Your doctor is most likely to refer you to an endocrinologist (hormonal disorders) and dermatologist (skin-related issues) for the treatment.

This is a common condition that affects 5-10% of women. While it can cause a lot of stress for the patient, this condition can be fully treated

Symptoms of Hirsutism

It is essential to see a doctor if you have symptoms of hirsutism. They are:

• Presence of stiff and dark body hair where women do not have hair commonly, like face, chest, inner thighs, etc.
• Increased growth of facial hair on women.
• Deepening of the voice.
• Balding
• Development of acne.
• Reduced breast size.
• A rise in muscle mass.
• Enlargement in the size of the clitoris.
• Disorders like PCOD, Cushing syndrome and some tumors are capable of causing hirsutism.

When to see a doctor

When the patient suffers from excessive facial hair or notices an increase in facial hair over the short period of time, it’s highly recommended to seek medical attention as excessive facial hair can also indicate the presence of an underlying medical condition.

Causes of Hirsutism

• Polycystic ovary syndrome: PCOS involves multiple cysts in ovaries, obesity, irregular periods, and infertility. You are likely to have excessive hair growth on the body due to the imbalance of your sex hormones.
• Cushing syndrome: The syndrome occurs owing to high levels of cortisol hormone in your body.
• Congenital adrenal hyperplasia: This is an inherited condition characterized by abnormal production of steroid hormones, such as androgen and cortisol, by our adrenal glands.
• Tumors: Though rarely, a tumor secreting androgen in the adrenal glands or ovaries can cause hirsutism.
• Medications: Some drugs including minoxidil (Minoxidil, Rogaine); testosterone (Androgel, Testim); danazol (which is used to treat women with endometriosis); and
• dehydroepiandrosterone (DHEA): may cause hirsutism. you can also be affected through skin-to-skin contact if your partner uses topical products having androgens.

Risk Factors

The following factors are known to increase the likelihood of developing hirsutism:

• Family history – If the patient has a family history of conditions that can cause hirsutism, like polycystic ovary syndrome, the chances are high for the patient to develop this condition as well.
• Lineage – Women who are from the Middle Eastern, Mediterranean, South Asian regions, are at an increased risk of developing this condition.
• Bodyweight / Obesity – Women who are overweight, or obese, can cause an increase in androgen production, which can lead to hirsutism.

Complications of Hirsutism

Hirsutism can cause emotional depression and make you feel self-conscious. It is not known to cause any physical complications. However, hormonal imbalance can lead to hormone-related disorders.

Your doctor is likely to diagnose PCOS if you are suffering from irregular periods along with Hirsutism. Some medications used to treat Hirsutism increases the risk of birth defects. The doctor will advise you to avoid pregnancy during the treatment process.

Diagnosis of Hirsutism

Hirsutism is diagnosed using blood tests that help detect hormones causing the condition. These tests help in assessing:

• Testosterone
• Testosterone-causing hormones
• Androgen levels

Treatment of Hirsutism

Your doctor will perform some diagnostic tests to confirm the cause.

Medications

Oral contraceptives (OC)

Hirsutism is caused by additional androgen production in your body which estrogen and progestin containing medicines can treat. They are known as birth control pills. It is given to those women who do not want to become pregnant. Nausea and headaches are common side-effects.

Anti-androgens

The primary motive of anti-androgens is to prevent androgens from attaching to its receptors in your body. Your doctor will prescribe them after a six month course of OCs if needed. Generally, anti-androgen spironolactone used to treat hirsutism. Results are usually modest and may take at least six months to become noticeable. Menstrual irregularity is the possible side-effect. And, as these medications may cause birth defects, it is very important to use contraception while taking them.

Topical cream

A cream called Eflornithine (Vaniqa) works specifically for excess growth of facial hair on women. Your doctor will advise you to apply the cream on the affected area of your face twice a day. Many patients use this with laser therapy to increase the responsiveness of the treatment.

Procedures

Procedures provide results that last longer than self-care methods.

Laser therapy

This procedure uses a highly concentrated beam of light which is passed over your skin to damage the hair follicles to prevent any further growth of hair. You may need to have multiple treatments. This is known as photo epilation and is preferable for black, brown, and auburn-haired women.

Electrolysis

Your doctor will insert a tiny needle into each hair follicle which emits an electric current. This electric current destroys the hair follicles. This process also requires multiple treatments. It is a preferable option for naturally blond or white-haired women.

It is a painful yet effective way of treatment. Your doctor will likely apply a numbing cream to reduce the discomfort.

Many women also follow a self-care approach to get rid of unwanted hair and try various methods such as

• Plucking.
• Shaving.
• Waxing.
• Depilation.
• Bleaching.

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Precautions

Hirsutism is not preventable, but some common precautionary measures you must be aware of are:

• Consult your doctor immediately if you witness any changes in your body weight after taking the prescribed medications.
• Oral contraceptives (OC) should be taken by women who do not want to become pregnant in the course of treatment.
• OCs can cause uterine bleeding.
• Some cosmetic measures like bleaching and chemical depilatories can cause skin irritation, folliculitis, and scarring.
• Be aware of the side effects from various lasers if you are dark-skinned or tanned.

Dietary regulations

Your doctor and healthcare provider will ask you to follow a dietary regime.

• Do consume antioxidant food products like fruits and vegetables. Fruits like blueberries, cherries, and tomatoes and vegetables like broccoli, spinach, and potatoes are high in antioxidants.
• Do not over consume refined food products like white bread, pasta, sugar, etc.
• Ensure to use healthy oils for cooking. Olive oil or vegetable oil are healthy oils.
• Eat less red meat.
• Avoid alcohol consumption.
• Say a big no to smoking.
• Do drink 6 to 8 glasses of water per day.
• Reduce the intake of trans-fats found in cookies, cakes, fries, etc.

Frequently Asked Questions (FAQs)

Can Hirsutism be cured permanently?

Yes, Hirsutism can be treated successfully by following the treatment plan provided by your doctor. Oral medications combined with topical treatment and laser or electrolytic procedures are used to permanently reduce or remove the unwanted hair on the body of a woman.

Does Hirsutism get worse with age?

Sex hormones like estrogen and progesterone eventually get better as a woman ages, which eases her PCOS. However, increased androgen levels in the body of a woman persist, and Hirsutism continues even after menopause. Symptoms like unwanted facial hair, body hair, and balding worsen with age.

Can PCOS change your facial features?

The polycystic ovarian syndrome can very well change the facial features by causing increased growth of unwanted facial hair and acne. This is due to an imbalance in the sex hormones.

Does hirsutism always mean PCOS?

Not really. Some patients develop hirsutism without the presence of PCOS as well.

Can hirsutism be cured?

As of now, hirsutism can be managed through hair growth reduction techniques and permanent hair removal procedures. 

Are antiandrogens safe?

It’s important to carefully use antiandrogens, as they are known to produce side-effects such as fatigue, low sex drive and increased proneness towards developing depression.