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Women's Health
Is excess body hair merely a cosmetic inconvenience or a sign of a serious underlying illness? Usually, hirsutism is an embarrassing physical problem, for which many treatments are available.
InteliHealth Content

InteliHealth Content

In This Article:
Getting To The Root
  Of The Problem

Timing Is Everything

"At least it's not cancer. That was my first reaction when I learned what was causing the alarming growth of hair on my face and body," says Susan, 25, who works for a marketing and media firm in the Midwest.

"Yes, I always had more than the average amount of hair on my legs and arms and even secretly shaved my upper lip every couple of weeks while I was still in high school. But, hey, I come from a long line of Italian women who have mustaches and beards, so at first I didn't give it much thought. But then when I was about 21, I noticed lots more hair than ever before. It began showing up on my breasts and stomach as well as my face. It's not exactly cool if you have to pluck your breasts before going to a hip party," she says.

"The strange thing was that at the same time I was developing all this body hair, the hair on my head started to become noticeably thinner. I also started to get acne again, and within a two-month period gained a horrifying 60 pounds. It took a while, but I finally found a doctor who told me what was wrong — I had a genetic overproduction of androgens, the male hormones."

At first, Susan (who declined to be identified by her full name) thought her condition was rare. Not so. The problem of excessive hair is more common than you might imagine. In fact, up to 10 percent of the female population may be hirsute, according to the American Osteopathic College of Dermatology.

Not all excessive body hair is due to a medical condition, but excess hairiness sometimes can be a warning sign of a serious problem. Excess hairiness in women that is limited to the arms and legs is usually just an inherited trait. But excess hair on the face, chest, breasts or down the middle of the abdomen to the pubic area may suggest a more serious condition, especially if coupled with other symptoms, such as menstrual irregularity, acne and obesity. In these cases, it's important that the underlying cause be identified and treated.

Getting To The Root Of The Problem

Hirsutism isn't actually a disease; it's a symptom of increased hair growth on certain parts of the body. Hirsutism is caused by either an excess production of androgens (male hormones such as testosterone and androstenedione) or an increased genetic sensitivity of the hair follicles to normal levels of androgens. It's normal for women to produce some male hormones, just not as much as men do. When women produce too much, it causes male-type physical changes like Susan's — excessive body hair and thinning head hair.

Overproduction of male hormones can be due to a number of causes. One of the most common causes is polycystic ovary syndrome (PCOS), also known as Stein-Leventhal syndrome. With PCOS, the ovaries accumulate loads of incompletely developed follicles or small cysts. A woman with this condition is likely to experience very irregular periods with scanty bleeding, obesity and infertility, along with hirsutism.

"Another cause of hirsutism may be a hereditary problem with the hair follicles themselves. Although the levels of male hormones in the bloodstream may be normal, the hair follicles can be especially sensitive to these male hormones. In these cases, menstrual irregularities do not usually accompany hirsutism.

Hirsutism also can be a symptom of some far less-common conditions including Cushing's syndrome (a disorder of the adrenal glands), congenital adrenal hyperplasia (an inherited disease) and adrenal or ovarian tumors.

Timing Is Everything

Once your doctor suspects an underlying cause for hirsutism, the detective work begins. The doctor will ask about your medical history and give you a physical exam. Your answers to questions such as "Did you always have menstrual irregularities?" and "When did the hirsutism start?" can help the doctor identify a cause.

For example, if your hirsutism started around puberty, the cause may be PCOS or adrenal hyperplasia. If your hirsutism started suddently at age 30, the cause may be something more serious, such as Cushing's syndrome or a tumor. An early diagnosis can lead to early identification and treatment of an underlying disorder, so it is important to visit your doctor if you are affected by hirsutism.

Older, postmenopausal women who develop hirsutism need to get it checked out, too. In this instance, it could also be a sign of an androgen-secreting tumor.

Blood tests can help determine the origin of the excess production of male hormones. There are three potential sources — the ovaries, the adrenal glands or local hair follicles. Excessive androgen production by the ovaries indicates that PCOS is the cause. Excessive production by the adrenal glands suggests Cushing's syndrome or adrenal hyperplasia. If hair-follicle sensitivity to androgens is suspected, another test is needed to measure the enzyme responsible for converting testosterone to a form that turns on hair follicle growth.

Treatment Depends On Diagnosis

Whether your hirsutism is simply a family trait or it's caused by a medical condition, the right treatment can help you reduce the amount of hair that's developed.

If being on the hairy side simply runs in your family, and you have no underlying medical problem, then you might try hair-removal methods such as depilatories, electrolysis or lasers. They each have their pros and cons. Depilatories — creams that remove hair — leave no stubble, but they may irritate your skin. It's a good idea to test a bit of the product on the inside of your wrist, and then wait a day or so. If you have no reaction it's probably OK to use the product on other parts of your body. Electrolysis gets rid of hair by delivering a small electrical current through a needle placed in the hair follicle. The process can be expensive and time consuming. Laser treatments, also costly, work by using light to generate heat, which destroys hair follicles. It can require several treatments, and may leave permanent blotching, particularly in women who are dark skinned. There is also a medication called eflornithine (brand name Vaniqa) available to treat facial hair. This topical cream — applied twice daily — works by blocking an enzyme that stimulates hair growth. Eflornithine is effective in about 40 percent of patients, but this drug is not a permanent fix. The hair will come back if the patient stops using it.

When excessive hair is caused by an overproduction of androgens — whether it's genetic or from a condition such as PCOS — then medications can be very beneficial, especially if used in combination. Metformin (Glucophage) is commonly prescribed to help correct the underlying reason for the androgen overproduction. Metformin lowers the body's insulin levels. It also reduces ovarian androgen production. This treatment may be particularly helpful for women who are overweight and insulin-resistant, meaning their bodies need to make more insulin to keep blood sugars from rising. Insulin not only has an effect on blood sugar, but may stimulate production of male hormones as well.

Another approach is to take an oral contraceptive to regulate menstruation, help reduce acne and also suppress circulating testosterone levels.

Doctors sometimes prescribe spironolactone (brand name Aldactone), a pill usually used to treat water retention (a diuretic). Spironolactone inhibits ovarian and adrenal production of androgens and consequently reduces hirsutism. Changes will not be noticeable for several months. That's because Aldactone doesn't take away any existing hair; it keeps the next hair follicle from coming in — the natural turnover of hair follicles occurs about twice a year.

Other treatments are available. It's possible you'll need to try several before you get the desired results. The bottom line is that excessive body hair can usually be treated successfully. But you owe it to yourself to find out the root of your problem and rule out any potentially serious conditions.



hirsutism,hormones,adrenal,follicles,androgens,acne,cushing's syndrome,dermatology,hair follicle,insulin,ovarian,ovaries,androgen,electrolysis,facial,metformin,obesity,spironolactone,stein-leventhal syndrome,tumor,women's health
Last updated April 08, 2008

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