Information on hirsutism and excessive hair growth

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Hirsutism Information

Hirsutism is a hair growth disorder in women marked by excessive hair growth in a male-like pattern. The excessive hair growth generally occurs in body regions like the beard, mustache, neck, chest, or lower abdomen. Hirsutism is mediated by androgen hormones. Normally these hormones are only present at a low level in women, but if they increase in concentration, or androgen sensitivity increases, then some hair follicles can be stimulated into increased hair growth production with a male body hair distribution.

There are causes of excess hair growth which result in unwanted body hair which do not involve androgen hormone activity. These usually don't result in a male pattern of body hair growth. The conditions causing a non-male pattern body hair growth are grouped under the term "hypertrichosis". If you want to know more about hypertrichosis, see our sister web site

Hirsutism dot com has been written to provide you with information on hirsutism, what casues it, and how it is treated. Read on for a brief overview or click a link on the left to take you to more detailed information.

Introduction to hirsutism

Hirsutism is a cause of substantial psychological and social distress for many women worldwide. Studies suggest that 5% to 15% of women, and at least 5% of pre-menopausal women, suffer from this ailment. Hirsutism affects the normal cycle of human hair production and involves the transformation of small, fine vellus hair to large, pigmented terminal hair. This process starts when there is increased androgenic (testosterone and dihydrotestosterone) activity in the body. Once a female attains puberty, testosterone becomes more active in a woman's body and this continues through her reproductive life and only slows down with old age.

Human hair first forms in the fetal stages of development. This hair is known as lanugo hair. Lanugo hair is soft and silky and is lost in late gestation or early postpartum. Before puberty most hair on the body, except for the scalp, eyebrows and eyelashes, is vellus hair. Terminal hair is pigmented, dense, coarse and longer than vellus hair and constitutes the eyebrows, eyelashes, scalp hair, pubic hair, axillary hair, etc. Vellus hair is non-pigmented, soft and short and covers the apparently hairless body parts if you look closely. At and after puberty, androgens act on androgen responsive vellus hair follicles and stimulates them to grow into bigger terminal hair producing hair follicles in the groin and underarm areas and to a lesser extent on the lower arms and legs. Any abnormalities in this normal hair biology can be associated with hirsutism. If there is too much androgen activity, vellus hair follicles that are more mildly responsive to androgens in the beard, mustache, chest and back areas will start to grow into terminal hair folicles and make big pigmented hair fibers - unwatned excessive hair growth! For a correct diagnosis and treatment of hirsutism it is important to consult with a professional and follow a scientific evaluation process.

Diagnosis of hirsutism

The method introduced by Ferriman and Gallwey in 1961 is generally used for the evaluation of hirsutism. The Ferriman–Gallwey (F–G) scoring pattern was initially conducted on hair growth in 11 body parts of random cases, but later there were various modifications (a simpler and widely accepted scoring system takes hair growth on nine body areas into account). The score chart is from 0 (no terminal hairs) to 4 (extensive terminal hair growth) and the numbers are added up to a maximum count of 36. While most experts refer to a modified F–G count of 8 or more to diagnose hirsutism, some suggest a final tally of 6 or more is enough to indicate hirsutism. Based on this score pattern and other clinical tests, hirsutism can be evaluated as mild, moderate or severe. However, there are criticisms of the F-G scoring pattern's semi-quantitative approach.

Also, one must remember that since a number of ailments can cause hirsutism, they must also be simultaneously diagnosed (with an account of their medical history and a pathological examination) for a complete evaluation. Moreover, hirsutism must be distinguished from other similar hair growth stimulating ailments classified as hypertrichosis that also cause excess hair growth.

Causes of hirsutism

Before beginning any treatment of hirsutism, one must first know about its causes. Most cases of hirsutism are caused by endocrine malfunction resulting in excess androgen production. Since, androgens are the main hormones that regulate human hair development, any abnormality in their biosynthesis affects normal hair growth. Idiopathic hirsutism, where increased androgen production cannot be identified, is probably related to excess peripheral 5a-reductase activity, which is very difficult to measure. There are various other causes that are not directly related to androgen disorders as well, though they are rare. Here is an overview of each cause:

1. Endocrine organ or androgen production disorder

This is the most common cause of hirsutism affecting an estimated 75%–85% of all cases. It is triggered by a follicular or endocrine disorder that causes excess androgen production resulting in unwanted hair growth. The most common androgen-related disorder that is marked by hirsutism is polycystic ovary syndrome (PCOS). In fact, it accounts for most cases of hirsutism. Other androgen abnormality induced causes of hirsutism include hyperandrogenism, hypothyroidism, hyperandrogenic insulin-resistant acanthosis nigricans syndrome (HAIR-AN), 21-hydroxylase non-classic I adrenal hyperplasia (late-onset CAH), 21-hydroxylase-deficient congenital adrenal hyperplasia, hyperprolactinemia, androgenic tumors and Cushing’s syndrome.

2. Non-androgenic causes

These are rare causes including the excessive hair production of acromegalics, coarsening of the hairs caused by chronic skin problems, since a key function of hair is to protect the skin, and non-androgenic anabolic drug usage.

3. Idiopathic causes of hirsutism

This is the second most common diagnosis of hirsutism after PCOS. Studies in this field have suggested that this kind of hirsutism is probably caused by excessive peripheral 5a-reductase enzyme action in skin and hair follicles, other variations in androgen metabolism, or hypersensitivity of the androgen receptors in hair follicles. Menses (i.e. ovulation) and serum androgen levels remain unaffected in this kind of hirsutism. Another group of researchers came up with the fact that in the peripheral blood lymphocytes of some idiopathic hirsutism cases the longer of the two-androgen receptor gene alleles was “preferentially methylated” (and hence malfuntional). Thus, it has been concluded that probably genetic alterations of the androgen receptor activity and 5a-reductase activity could be associated with hirsutism. However, a lot more research remains to be done ito reveal the mechanisms behind what is currently termed idiopathic hirsutism.

Treatment of hirsutism

The treatment of hirsutism should involve a process that stops or at least slows down the conversion of vellus to terminal hair without harming the existing hair follicles.

These are some of the ways of achieving it:

  1. Androgen production regulation with the use of oral contraceptive pills (OCPs), gonadotrophin releasing hormone analogs, or insulin-sensitizing agents like metformin and pioglitazone.
  2. Blocking of peripheral androgens with anti-androgen drugs like spironolactone, cyproterone acetate, flutamide or a 5 a-reductase suppressant like finasteride.
  3. Epilation of the excess hairs with non-medicinal and cosmetic methods like bleaching or chemical depilation, plucking, waxing, shaving and more permanent methods like laser, electrolysis etc.
  4. Topical treatment with medications like Eflornithine 11.5%, Eflornithine Hydrochloride 13.9% cream etc.

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