What Is It?
Hirsutism is excessive hair growth in certain areas of a woman’s face and body — for example, the mustache and beard area — that creates a “male pattern” of hair. Women normally can have fine, pale, faintly visible hair in these areas, but heavy hair growth in a male pattern with coarse or colored hair is not expected.
Normal patterns of hair growth and hair distribution vary widely, determined to a large extent by racial background. For example, whites as a group have more facial and nonscalp hair growth than do blacks or Asians, and white women of Mediterranean heritage normally have more hair growth than do women from Nordic countries.
Hirsutism in women means that hair follicles are being over-stimulated by testosterone or other androgen hormones. Androgens are the dominant sex hormones in men. Low androgen levels are normally present in women, but abnormally high levels of androgens can lead to excess hair growth in women.
In some cases, the extra androgen effect comes from medications — such as certain progestins used in some brands of birth-control pills — or bodybuilding steroids that contain androgens or have some effects similar to androgens. Other medicines may indirectly cause the body to manufacture extra androgen hormones. These include some medicines to treat nausea, schizophrenia, agitation, epileptic seizures, migraine headaches, bipolar disorder, aggression and high blood pressure, as well as estrogens and opiate medications.
In the vast majority of cases, hirsutism responds to straightforward cosmetic treatment. Occasionally, when additional symptoms suggest that androgens are being overproduced, it is important for a woman to be evaluated by a doctor. Overproduction of androgen hormones can signify an abnormality in the ovaries, the adrenal glands or the pituitary gland of the brain.
Some excessive hair growth does not fit the pattern of growth triggered by androgen hormones (for example, hair between the eyes, on the forehead, on the temples or high on the cheeks of the face). This hair growth, called hypertrichosis, can be caused by thyroid problems or anorexia nervosa. It also can result from long-term use of certain medications, including the following steroid hormones: cyclosporin (Neoral, Sandimmune, SangCya), phenytoin (Dilantin), minoxidil (Rogaine), penicillamine (Cuprimine, Depen), as well as some dermatology medications that commonly are combined with ultraviolet light treatments.
A woman with the mildest form of hirsutism may notice significant growth of hair that is mature (the same color as scalp hair) on the upper lip, chin, sideburn area, around the nipples or lower abdomen. More advanced hirsutism will result in mature hair on the upper back, shoulders, sternum and upper abdomen. It most often begins during puberty.
Your doctor will begin the evaluation for hirsutism by hearing your medical history and performing a physical examination. His or her major goal will be to exclude more serious causes for hirsutism such as a tumor of the ovary, adrenal glands or pituitary gland. If you have mild hirsutism and no symptoms that suggest you are significantly overproducing androgen hormones, you may not require any additional testing.
Women with more problematic hirsutism and women with other symptoms that might suggest an underlying medical problem are likely to have several blood tests:
- The hormones testosterone and dehydroepiandrosterone may be measured to check for signs of polycystic ovarian syndrome, ovary tumors, adrenal gland tumors, adrenal gland hormone deficiencies (causing overgrowth, or hyperplasia, of the adrenal glands) or tumors that can stimulate the adrenal glands.
- The hormone prolactin may be measured to check for signs of a tumor in the pituitary gland.
- Blood sugar and cholesterol levels may be tested, because diabetes and high levels of cholesterol commonly are associated with some causes of hirsutism.
Depending upon the results of initial tests, additional hormone tests might be done after you are pretreated with dexamethasone, a medicine sold under several brand names. The additional tests can help clarify the reason you are producing too much androgen by evaluating your adrenal-gland and pituitary-gland function. In some cases, your doctor will want to see a picture of one or more organs. Commonly used tests are magnetic resonance imaging (MRI) of the brain, a computed tomography (CT) scan of the adrenal glands or an ultrasound of the ovaries.
Most causes of hirsutism create a tendency to have lifelong excessive hair growth. However, most women respond to medical treatment if they continue the treatment several months or longer. A few causes of hirsutism (such as tumors that produce androgen hormones or tumors in the pituitary gland) can be cured with surgical treatment, radiation or both.
Cosmetic treatments can remove unwanted hair temporarily, and may limit the amount of regrowth that occurs in treated areas.
Most causes of hirsutism are beyond a woman’s control. The most common medical cause of hirsutism, polycystic ovary syndrome, is less likely to occur in women who are able to maintain a normal body weight. You should avoid unnecessary use of medicines that are known to cause hirsutism.
If a specific cause of hirsutism is diagnosed, your doctor may suggest appropriate treatment for that cause. For women who are overweight, losing weight often helps to reduce androgen levels and improve hirsutism. For all women with hirsutism, cosmetic treatments and medical treatments that decrease the levels of androgens or their impact on hair follicles can be helpful:
- Plucking, shaving, waxing, chemical hair softeners (depilatory creams) — While these are all effective treatments for mild hirsutism, they can irritate the skin, and must be repeated for continued success. Waxing need be done every four to six weeks; the other treatments more frequently.
- Laser hair-removal techniques — This uses light to generate heat inside hair follicles, which destroys the ability of hair to regrow from the follicle. Laser treatment is more effective in some skin types than in others, and it does not prevent new hair follicles from forming. It is expensive, time-consuming and requires the professional services of a dermatologist, plastic surgeon or private spa. However, it lasts longer than the techniques described above.
- Electrolysis — This also destroys hair-follicle function, but uses electricity to generate heat within the hair follicles. Electrolysis has become less popular than laser treatment because it is more likely to leave small areas of scarring.
- Medicines — Several medicines can alter the impact of androgen hormones on the body and skin. Combination birth-control pills (containing both estrogen and progesterone) can counterbalance the masculine effects of androgen hormones and decrease production of testosterone by the ovary. Hirsutism may improve after six to 12 months of consistent use of birth-control pills.
- Anti-androgen medicines — These can work alone or in combination with birth-control pills. The most commonly used medicine is spironolactone (Aldactone), although others are available. It is unsafe to take anti-androgen medicines during pregnancy.
When To Call A Professional
If you have excessive, male-pattern hair growth or unusually rapid growth of male-pattern hair in a short period of time, you should undergo a medical evaluation. Also discuss hirsutism with a doctor if you have any symptoms of overproduction of androgens:
- Menstrual periods that are infrequent, irregular or absent
- Acne that is difficult to manage
- Deepening of the voice
- A receding scalp line or thinning hair in your head’s crown area
- Decreased breast size or enlargement of your genitals, especially the clitoris
Discuss hirsutism with your doctor if you have other symptoms that may suggest an underlying problem in the ovaries, adrenal glands or pituitary gland, including:
- Obesity (commonly seen in the most common cause of androgen excess, polycystic ovarian syndrome)
- Darkened, thickened skin (“velvetlike”) in your armpits, groin or neck area
- Easy bruising, weight gain in your midsection or muscle weakness
- Leakage of milk or other fluid from your nipples when you are not breast-feeding
- High blood pressure, high blood sugar or a cholesterol problem
- Hirsutism prior to puberty or hirsutism that occurs suddenly
Because some medical problems resulting in hirsutism run in families, talk to your doctor if you have these symptoms, even if your hirsutism is typical for your female relatives.
Most cases of hirsutism can be successfully treated with medication and cosmetic attention. It may require time and persistent use of these therapies, but most cases will eventually respond to a combined approach.
Diseases and Conditions Center
All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.