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Hirsutism refers to the growth of coarse, dark hair in areas where women typically grow fine hair or no hair at all — above the lip and on the chin, chest, abdomen, and back. This excess hair growth is caused by an increased level of male hormones (androgens). Although all women produce androgens, increased levels of androgens can lead to hirsutism.
Androgens are present in all women, but those with hirsutism have either:
- an increased production of androgens, or
- an increased sensitivity to androgens
There are several different types of androgens. The most well known is testosterone. In men, testosterone is involved in making sperm and in the development of male sexual characteristics, such as the voice getting deeper. Testosterone is also found in small amounts in women, where it may:
increase your libido (sex drive)
affect your menstrual cycle (your periods)
affect your fertility
An increased level of androgens in women may be caused by:
- Polycystic ovary syndrome
- Congenital adrenal hyperplasia (CAH), which is due to a defect of the 21-hydroxylase enzyme
- Ovarian tumors
- Adrenal tumors
- ACTH secreting tumors
- Pregnancy luteomas, which are benign tumors of the ovary
Exposure to certain drugs, including:
- Oral contraceptives
- Progestin-containing medications
- Anabolic steroids
Hirsutism and Polycystic Ovary Syndrome (PCOS)
Hirsutism is a symptom of Polycystic ovary syndrome (PCOS), but just because someone has hirsutism it does not mean that they also have PCOS. Furthermore, there may be no obvious cause for hirsutism. In this case it is labelled idiopathic hirsutism.
The symptoms of hirsutism and PCOS are quite similar. They are both associated with excessive hair growth, acne, unusual periods, balding and so forth.
Figures vary as to how many women PCOS affects, but estimates suggest between 5-10% of women. There are three basic features of PCOS: cysts on the ovaries; failed ovulation (that is the release of eggs from the ovaries); and high levels of male hormones.
PCOS does not have a specific cure and so therapy tends to focus on controlling the symptoms. Patients may also be advised to concentrate on maintaining an ideal weight, as someone who is overweight is at a higher risk of developing the symptoms of PCOS.
The first step in assessing hirsutism is to have a complete history and physical examination performed by Dr. Greenberg. A careful history and physical examination can assess the degree of hirsutism, acne or hair loss, and other problems that are important in directing diagnostic testing and management. An equally important step is assessing the emotional impact of hirsutism on the individual so that a personalized management plan can be developed to target the physical, medical and psychological burdens of unwanted hair. Understanding how a woman feels about her body image and improving this perception are essential components of any management plan.
Blood tests may be recommended to determine whether the body is producing excess amounts of androgen. These blood tests can be combined with physical examination to determine whether a common condition known as polycystic ovary syndrome (PCOS) exists. At the same time, other causes for hirsutism, including hormone abnormalities of the pituitary, thyroid and adrenal as well as rare tumors, can be excluded.
Contact Dr. Greenberg for a consultation today! Diagnosis and treatment of your unique condition may be available.