Hirsutism -- Excess Facial and Body Hair
from the book How to Have a Baby:
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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Hirsutism is the growth of long, coarse hair on the face and body of women in
a pattern similar to that found in men. Besides being cosmetically distressing,
hirsutism may also signal the presence of a hormone imbalance or a
Normal hair growth
Each hair grows from a follicle deep in the skin. As long as these follicles
are not completely destroyed, hair will continue to grow even if the shaft,
which is the part of the hair that appears above the skin, is plucked or
Adults have two types of hair, vellus and terminal. Vellus hair is soft,
fine, colorless, and usually short. In most women, vellus hairs grow on the
face, chest, and back and give the impression of "hairless" skin.
Terminal hairs are the longer, coarser, darker, and sometimes curly hairs that
grows on the scalp, pubic, and armpit areas in both adult men and women. The
facial and body hair in men is mostly of the terminal type.
What causes hirsutism?
Most often, excess facial and body hair is the result of abnormally high
levels of androgens or male hormones in the blood. Androgens are present in both
men and women, but men have much higher levels. These hormones cause hairs to
change from vellus to terminal. Once a vellus hair has been transformed to the
coarser terminal hair, it usually does not change back. Androgens also cause
terminal hairs to grow faster and thicker. Both the ovaries and the adrenals
produce androgens. To some degree, estrogens and progesterone, female hormones,
prevent the effect of androgens.
The circumstances described below can lead to high androgen levels, which in
turn can cause hirsutism.
There are very obvious family and racial differences in hirsutism patients.
In some women, the skin is very sensitive to even low levels of androgens and
their follicles produce primarily terminal (coarse and dark) hairs. If your
mother , grandmother or sister experienced the disorder, then you are at a
greater risk of developing it.
Polycystic ovarian syndrome
This is the commonest reason for hirsutism in infertile women. Polycystic
ovarian syndrome causes the ovaries to develop many small cysts and to
overproduce male hormones. The disorder is often associated with hirsutism,
irregular ovulation, menstrual disturbances and obesity.
On rare occasions, androgen-producing ovarian tumors cause hirsutism. When
this is the case, hirsutism progresses rapidly; and may even cause virilisation
- in which the woman starts developing masculine characteristics, such as a deep
voice and an enlarged clitoris. An ovarian mass may be detected during a pelvic
examination. Tests may also need to be done to make sure that tumors are not
present when male hormone levels are high.
The adrenal glands, which are located just above each kidney, also produce
androgens. The most common disease of the adrenal gland that can result in
hirsutism is an inherited disorder called late onset adrenal hyperplasia.
Adrenal tumours and other adrenal diseases such as Cushing's disease can also
cause overproduction of androgens.
Determining the cause
When trying to determine the cause of hirsutism, several blood tests need to
be done to measure androgen levels. These tests are done by radioimmunoassay in
a specialised laboratory - and include levels of: testosterone; androstendione;
17-hydroxyprogesterone; and DHEA-S ( dehydroepiandrosterone sulphate). These
tongue-twisters are simply the chemical names of androgens produced in the body.
Which particular hormone is increased will tip off the doctor as to where the
problem lies -whether in the ovaries or in the adrenal glands. A pelvic
ultrasound or special x-ray studies may also need to be done to detect ovarian
or adrenal tumors. Hormone suppression or stimulation tests which further
evaluate the function of the ovaries and adrenal glands may also be required.
During these tests, blood is measured for hormone levels both before and after
the administration of a specific hormone medication. For example, the ACTH (adrenocorticotropic
hormone) stimulation test is conducted in order to check for the presence of
late onset adrenal hyperplasia.
Of course, the priority will be to correct the problem of infertility - thus
for example, if the problem of hirsutism is due to anovulation due to polycystic
ovarian syndrome , the primary goal will be to induce ovulation.
Low doses of steroids called dexamethasone or prednisone may also be
prescribed if the adrenal gland is overactive. This medicine is usually taken at
bedtime and serves to suppress production of the ACTH hormone which stimulates
the adrenal gland.
Hormone treatment may prevent new hairs from developing. However, it usually
takes many years for the excess hair to develop, and a significant decrease in
the rate of hair growth will not be seen for at least six months of hormone
treatment. Once a hormone treatment has proven to be effective, it may be
continued indefinitely. However, terminal hairs that are already present will
not fall out or disappear with hormonal therapy and must be removed by other
For temporary hair removal, many women with mild hirsutism pluck the unwanted
hairs. Waxing, another alternative, is essentially the same as plucking.
Depilating agents are chemicals that dissolve the hair shafts on both facial
and body hair and may also be used to remove unwanted hair. These chemicals can
cause irritation and facial skin is particularly sensitive.
Shaving is probably the simplest and safest temporary hair removal procedure.
Although frequently required, it is virtually painless and seldom has side
effects. Contrary to popular belief, shaving does not make hair grow faster. An
electric razor produces less skin irritation than a blade.
Electrolysis is the only permanent way to remove unwanted hair. During this
procedure, a very fine needle is placed next to the hair shaft into the
follicle. A mild electric current is sent through the needle and permanently
kills the hair follicle. It is not possible to use this technique to remove
hairs from very large areas of the body because each hair must be treated
individually. In addition, the technique, although quite effective, is
expensive, time consuming, and moderately uncomfortable. If hormonal therapy is
being started, it is best to delay electrolysis for at least six months so that
the growth of new terminal hairs will be reduced.
The latest cosmetic technique to remove hair uses a laser to kill the hair
follicles very precisely, and this is now becoming increasingly popular. Laser
depilation is speedy, relatively painless, efficient and possibly permanent. A
Ruby Laser produces red light which is highly absorbed by the melanin pigment in
the hair and only minimally absorbed in skin. This means that the hair is
selectively targeted by the light and hence destroyed without any damage to the
skin around the hair follicle.
by Dr. Aniruddha Malpani, MD and Dr. Anjali Malpani, MD.
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