Hirsutism

A woman with hirsutism, as depicted in the Nuremberg Chronicle (1493)

Hirsutism (from Latin hirsutus = shaggy, hairy) is the excessive hairiness^[1] on humans in those parts of the body where terminal hair does not normally occur or is minimal - for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a symptom rather than a disease and may be a sign of a more serious medical condition, especially if it develops well after puberty.

Causes

Hirsutism can be caused by either an increased level of androgens, the male hormones, or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the growth and pigmentation of hair. Other symptoms associated with a high level of male hormones include acne and deepening of the voice and increased muscle mass.

Growing evidence implicates high circulating levels of insulin in women to the development of hirsutism. This theory is speculated to be consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin levels will lead to a reduction in hirsutism.

It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.

The following may be some of the conditions that may increase a woman's normally low level of male hormones:

• Polycystic ovary syndrome (the most common)^[2]
• Congenital adrenal hyperplasia, in turn mostly caused by 21-α hydroxylase deficiency
• Cushing's disease
• Tumors in the ovaries or adrenal gland (cancer)
• Certain medications
• Insulin resistance
• Stromal Hyperthecosis - in postmenopausal women
• Obesity: As there is peripheral conversion of androgens to estrogen in these patients, this is the same mechanism of PCOS
• Use of drugs like Tetrahydrogestrinone

Appearance and evaluation

Hirsutism affects women and sometimes men, since the rising of androgens causes a male pattern of body hair, sometimes excessive, particularly in locations where women normally do not develop terminal hair within their puberty (chest, abdomen, back and face). The medical term for excessive hair growth that affect both men and women is hypertrichosis.

One method of evaluating hirsutism is the Ferriman-Gallwey score which gives a score based on the amount and location of hair growth on a woman.^[3]

Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound (because of the high prevalence of polycystic ovary syndrome, as well as 17-hydroxyprogesterone (because of the possibility of finding nonclassic 21-hydroxylase deficiency.^[4]

Other blood value that may be evaluated in the workup of hirsutism include:

• the androgens testosterone and dehydroepiandrosterone sulfate
• thyroid-stimulating hormone
• prolactin

If no underlying cause can be identified, the condition is considered idiopathic.

Treatment

Many women with unwanted hair seek methods of hair removal. However, the causes of the hair growth should be evaluated by a physician, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the treatment.

Pharmacological treatment

Spironolactone: Antialdosterone antiandrogenic compound.^[5]
Cyproterone acetate: A progestin that also has strong antiandrogenic action. In addition to single form, it is also available in some formulations of combined oral contraceptives.
Finasteride: 5 alpha reductase inhibitor that inhibits conversion of testosteron to more active 5 alpha hydroxy testosterone.
Metformin: Antihyperglycemic drug used for diabetes mellitus. However, it is also effective in treatment of hirsutism associated with insulin resistance (e.g. polycystic ovary syndrome)
Eflornithine: Blocks putrescin that is necessary for the growth of hair follicles.
Flutamide: Androgen receptor antagonist.

Other methods

Epilation
Waxing
Shaving

See also

• androgenic hair
• pubic hair
• hypertrichosis
• hair removal
• laser hair removal
• bearded lady
• trichophilia

References

External links

• Why the Bearded Lady Was Never a Laughing Matter: Hirsutism