Excessive Hair Growth (Hirsutism): What You Should Know

What Is Hirsutism?

Hirsutism is excessive hair growth that generally occurs in the midline of the body (upper lip, chin, chest, and abdomen). When this is associated with recession of hairline, deepening of the voice, loss of female body shape, and the development of male pattern pubic hair it is called virulism.

Many women have what they perceive to be excess hair growth. In reality, the pattern of hair growth may be normal. Ethnic variations due exist; African Americans are less susceptible to hirsutism because they have fewer hair follicles per surface area than Caucasians.

Normal Hair Pattern and Growth

There are 2 types of hair on the body: (1) vellus hairs which are short, fine and colorless and (2) terminal hairs which are long, coarse, colored and, in certain areas of the body, responsive to hormonal influence (androgens).

The adrenal gland and the ovary normally make androgens (male hormones). In normal amounts, androgens cause acne and the appearance of terminal hair on the extremities, armpits and pubic area at the time of puberty.

In women with excessive hair growth, the hair follicles are sensitive to androgens which may cause hairs to change from vellus to terminal hairs. Once a vellus hair becomes a terminal hair, it usually does not change back. If a woman’s androgen level is very high, she may experience male pattern balding, decreased breast size, and a deepening of her voice.

Causes of Hirsutism/ Virulism

Both hirsutism and virulism are caused by excess androgen secretion or increase sensitivity of the hair follicle to normal levels of androgens. Additionally, some medications that have similar characteristics as androgens may cause excessive hair growth. The following are the most common causes of hirsutism:

Causes of Hirsutism

Familial/Ethnic	Increased sensitivity of the hair follicle to androgens causes excessive hair growth. This can be hereditary.
Polycystic Ovarian Syndrome (PCO)	Excess androgen production from multiple cysts on the ovaries leads to excess hair production. PCO is also associated with abnormal menstrual cycles, insulin resistance and other metabolic abnormalities.
Menopause	Estrogen production is decreased but the continued androgen production leads to an increase in the number of terminal hairs.
Ovarian/Adrenal Tumors	These tumors produce androgens and can cause hirsutism. May also be associated with male pattern balding, deepening of the voice, and enlargement of the clitoris.
Late-Onset Adrenal Hyperplasia	May be associated with irregular periods, severe hirsutism, and defeminization.
Cushing Syndrome	Excess cortisol (an adrenal hormone) production can cause hirsutism, obesity, high blood pressure, easy bruising, and purple stretch marks.

Evaluation and Treatment

Initial evaluation consists of a complete history and physical exam. Often, this is enough to establish a diagnosis. The diagnosis is confirmed with further laboratory testing and possible radiological studies.

Treatment depends on the cause. If a tumor or metabolic disorder is found, these disease processes are treated. If these causes are ruled out, treatment depends on the patient’s desire. Options for treatment include medical therapy and cosmetic-based hair removal.

Medical therapy is successful in preventing new hair growth but does not affect existing hair. Existing hair must be managed by cosmetic therapy.

There are several medications used to treat hirsutism:

1. Birth control pills: the most commonly used medication in treatment for hirsutism. These pills prevent ovarian androgen production.

2. Spironolactone: blocks the effect of androgens on the hair follicle. Often used together with birth control pills.

3. Others: ketoconazole, flutamide, and steroids.

Cosmetic therapy is almost always combined with medical therapy and should be initiated six months after medical therapy is begun. Temporary techniques include shaving, waxing, and use of depilatory agents. Permanent techniques include electrolysis and shaving. Laser technology is a new approach to consider. A dermatologist experienced in treating black skin will be helpful in advising you.

Once a treatment has proven to be effective, it is continued indefinitely. Because it is usually not possible to cure the hormonal problem causing the excess hair growth, hirsutism will return if medical treatment is stopped.

Empowerment Points:

• Hirsutism is the excessive growth of long, coarse hair on the face, chest, lower abdomen, back, upper arms or upper legs of women.
• Hirsutism has a variety of causes, most of which relate to excess androgen (male hormone) production.
• This is a chronic condition, most commonly hereditary or familial.
• Hirsutism may rarely be caused by tumors producing excess androgens. A physician should investigate if excess hair growth develops over a short period of time.
• Treatment is available, you should not feel embarrassed, uncomfortable or self-conscious about your excessive hair growth.
• Treatment consists of medical as well as cosmetic therapies.