Hirsutism: Causes, Diagnosis and Treatment

Hirsutism is a condition of excessive hair growth in a woman mimicking the pattern seen in men. The underlying cause is androgen excess which may be due to various diseases. Approximately 5 to 10% of women in the reproductive age group are affected. This caused significant psychological distress to the woman.

Causes of Hirsutism

This occurs due to excess secretion of androgens (hormones predominantly responsible for male characteristics) such as testosterone, dehydroepiandrosterone sulfate (DHEAS), and androstenedione.

Conditions Associated with Hirsutism

• Polycystic Ovarian Syndrome (PCOS): This is the most common cause of hirsutism in young women. The ovaries have cysts with abnormal maturation of the eggs leading to difficulty in conceiving
• Idiopathic hirsutism: This is isolated hair growth without any underlying cause
• Tumors secreting androgens
• Cushing’s Syndrome: This occurs due to an excess level of steroids in the body from tumors
• Hyperprolactinemia: This is due to a tumor in the pituitary secreting prolactin. Excess prolactin leads to an imbalance in the sex hormones leading to hirsutism
• Insulin resistance: Elevated insulin can lead to increased secretion of androgens by affecting the ovaries
• Drugs: Steroid based medicines, androgen therapy

Clinical Features of Hirsutism

• This is marked by excessive thick, coarse, and dark hair growth. The hair growth is over the upper lip, chin, neck, chest, and abdomen in a pattern similar to that seen in men.
• Additional symptoms related to the underlying cause:
• Weight gain
• Irregular menstrual periods
• Facial acne
• Dark patches in underarms and back of the neck

Evaluation of Hirsutism

• History and Physical Exam: The pattern of hirsutism and associated symptoms in addition to the clinical exam provide hints to the diagnosis. Menstrual history and family history is also collected.
• Blood tests to measure the level of androgens
• Ultrasound of the abdomen and pelvis: this is used to evaluate for polycystic ovaries and tumors.

Treatment of Hirsutism

The underlying cause of hirsutism will determine definitive treatment. The excess hair growth can be treated through multiple ways

• Oral contraceptive pills: These contain combinations of estrogen and/or progesterone which help to stabilize hormones in the body
• Anti-androgens: These counteract the effects of excess androgens. These should not be taken if the woman is pregnant as it can cause harm to a developing fetus
• Cosmetic methods: Direct hair removal through laser can be attempted, however, re-growth occurs when there is excess levels of androgen

References:

• Escobar-Morreale HF, Carmina E, Dewailly D, Gambineri A, Kelestimur F, Moghetti P, et al. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. Hum Reprod Update. 2012 Apr;18(2):146–70.
• Hohl A, Ronsoni MF, Oliveira M de. Hirsutism: diagnosis and treatment. Arq Bras Endocrinol Metabol. 2014 Mar;58(2):97–107.