Hirsutism is a medical condition in which excessive hair growth occurs in females, particularly in areas where hair is usually minimal or absent, such as the face, chest, and back. The hair growth is usually dark and coarse, mimicking the appearance of male pattern hair growth. This condition can be distressing for women as it can impact their self-esteem and social life.
The definition of hirsutism is multi-faceted and includes a range of medical, biological, and cultural factors. In this article, we will discuss the main lists of definition for hirsutism and their implications.
- Medical Definition: Hirsutism is defined as the excessive growth of hair in women in areas where hair growth is typically minimal or absent. This definition is based on the observation of hair growth patterns in the population and is commonly used by healthcare providers to diagnose hirsutism.
- Biological Definition: Hirsutism is a condition in which there is an abnormal increase in androgens (male hormones) in the female body. These hormones are responsible for stimulating hair growth, particularly in male pattern hair growth areas. Women with hirsutism have higher levels of androgens, leading to excessive hair growth in areas such as the face, chest, and back.
- Cultural Definition: Hirsutism is also defined by cultural norms and expectations about hair growth patterns in women. In many cultures, hairless skin is considered attractive and femininity is associated with minimal hair growth. Women with hirsutism may experience social stigma and discrimination due to their hair growth, which can impact their self-esteem and quality of life.
The medical definition of hirsutism is based on the observation of hair growth patterns in the population and is commonly used by healthcare providers to diagnose hirsutism. This definition focuses on the physical manifestation of the condition and does not consider the underlying causes of excessive hair growth.
Causes
Normal hair growth is regulated by androgens, which are male hormones that are present in both men and women. Androgens stimulate hair growth in the beard, chest, and pubic areas, as well as on the scalp. In women, the ovaries and adrenal glands produce androgens, which are then converted into estrogens by the enzyme aromatase. Estrogens suppress hair growth, so a balance between androgens and estrogens is necessary for normal hair growth regulation.
There are several factors that can disrupt this balance and lead to hirsutism. Some of the most common causes of hirsutism include:
- Polycystic Ovary Syndrome (PCOS)
PCOS is a common endocrine disorder that affects approximately 10% of women of reproductive age. It is characterized by the presence of multiple cysts on the ovaries, and is associated with insulin resistance, obesity, and hyperandrogenism. Women with PCOS have elevated levels of androgens, which can lead to hirsutism, acne, and alopecia.
- Idiopathic Hirsutism
Idiopathic hirsutism is a diagnosis of exclusion, meaning that it is given when other causes of hirsutism have been ruled out. This type of hirsutism is believed to be due to an increased sensitivity of hair follicles to androgens. Women with idiopathic hirsutism typically have normal levels of androgens, but their hair follicles are more responsive to these hormones.
- Adrenal Disorders
The adrenal glands are located above the kidneys and are responsible for producing several hormones, including androgens. Adrenal disorders, such as adrenal hyperplasia and adrenal tumors, can lead to elevated levels of androgens and hirsutism.
- Cushing’s Syndrome
Cushing’s syndrome is a condition caused by excessive production of cortisol, a hormone produced by the adrenal glands. Cortisol can suppress the production of gonadotropins, which are hormones that stimulate the production of androgens. As a result, women with Cushing’s syndrome can develop hirsutism.
- Medications
Certain medications, such as glucocorticoids, testosterone, and danazol, can lead to hirsutism. Women who are taking these medications for other medical conditions should be monitored for the development of hirsutism.
- Androgen-secreting Tumors
Androgen-secreting tumors are rare, but they can lead to hirsutism. These tumors can occur in the ovaries, adrenal glands, or in other parts of the body. Women with androgen-secreting tumors will typically have elevated levels of androgens.
- Family History of Hirsutism
Hirsutism can also be inherited. Women who have a family history of hirsutism are more likely to develop the condition.
Symptoms
Hirsutism can be a result of hormonal imbalances, certain medical conditions, or the use of certain medications. It is estimated that up to 10% of women in the United States experience hirsutism.
The main symptoms of hirsutism include:
- Excessive hair growth in areas such as the face, chest, stomach, back, and thighs
This is the most common and noticeable symptom of hirsutism. Women with hirsutism may notice that they have thicker and darker hair growth in areas that are typically seen in males, such as the upper lip, chin, chest, back, stomach, and thighs. This hair growth is often coarser and more noticeable than the hair seen in these areas in women without hirsutism.
- Irregular menstrual cycles
Women with hirsutism may experience irregular menstrual cycles, which can include missed periods, lighter or heavier periods, or longer cycles. This can be a result of the hormonal imbalances that are causing the hirsutism.
- Acne
Women with hirsutism may also experience acne, particularly on their face, chest, and back. This is because the increased androgen levels in the body can lead to an increase in oil production in the skin, leading to the formation of acne.
- Deepening of the voice
In some cases, women with hirsutism may notice a deepening of their voice. This can be a result of the increased androgen levels in the body causing changes in the larynx, which is responsible for producing the voice.
- Changes in body shape
Women with hirsutism may also notice changes in their body shape, such as an increase in muscle mass and a decrease in body fat. This can be a result of the increased androgen levels in the body, which can affect metabolism and muscle mass.
- Infertility
In some cases, women with hirsutism may experience infertility. This can be a result of hormonal imbalances that are causing the hirsutism, which can affect ovulation and the ability to conceive.
- Increased levels of testosterone
Women with hirsutism often have elevated levels of testosterone, which is a male hormone. This can be measured through a blood test and is used to diagnose hirsutism.
- Other hormonal imbalances
Women with hirsutism may also experience other hormonal imbalances, such as elevated levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which play a role in regulating ovulation and menstrual cycles.
It is important to note that not all women with hirsutism will experience all of these symptoms. The symptoms of hirsutism can vary from person to person and can also depend on the underlying cause of the condition.
Diagnosis
The condition is often caused by an increase in androgens, male hormones, which can result from a variety of causes, including Polycystic Ovary Syndrome (PCOS), adrenal gland tumors, and certain medications. The following is a list of the main diagnostic tests for hirsutism:
- Medical History and Physical Examination: The first step in diagnosing hirsutism is to take a complete medical history and perform a physical examination. The doctor will ask questions about the patient’s menstrual cycle, weight changes, and any medications being taken. A physical examination will be performed to assess the extent of hair growth and to determine if there are any other signs of androgen excess, such as acne or deepening of the voice.
- Blood Tests: Blood tests are used to measure the levels of androgens and other hormones in the body. These tests can help determine if hirsutism is caused by an increase in androgens or by a hormonal imbalance. The most commonly used tests include testosterone, dehydroepiandrosterone sulfate (DHEAS), and luteinizing hormone (LH).
- Ultrasound: An ultrasound is a diagnostic tool that uses high-frequency sound waves to produce images of internal organs. An ultrasound can be used to assess the size and appearance of the ovaries and to determine if there are any cysts present, which can be a sign of PCOS.
- Magnetic Resonance Imaging (MRI): An MRI is a diagnostic tool that uses a magnetic field and radio waves to produce detailed images of internal organs. An MRI can be used to evaluate the size and appearance of the adrenal glands and to determine if there are any tumors present.
- Hormonal Suppression Tests: Hormonal suppression tests are used to determine if hirsutism is caused by an increase in androgens or by a hormonal imbalance. These tests involve administering a drug that temporarily suppresses the production of androgens. If the hair growth decreases, it is an indication that hirsutism is caused by an increase in androgens.
- Biopsy: A biopsy is a procedure that involves removing a small sample of tissue for examination under a microscope. A biopsy may be performed if a tumor is suspected, to determine if it is benign or malignant.
- Ferriman-Gallwey Score: The Ferriman-Gallwey Score is a simple, non-invasive method for assessing the extent of hair growth in women with hirsutism. The score is based on the amount of hair growth in 9 specific areas of the body and ranges from 0 to 36. A score of 8 or higher is considered abnormal.
Treatment
There are various treatment options available for hirsutism, ranging from lifestyle changes to medical interventions. Here are the main lists of treatments for hirsutism:
- Lifestyle Changes
Lifestyle changes can be effective in reducing symptoms of hirsutism and include:
a. Diet: A diet low in androgens (male hormones) and high in fiber can help reduce hirsutism. Women with hirsutism should avoid foods that contain high levels of androgens, such as dairy products, red meat, and sugar.
b. Exercise: Regular physical activity can help regulate hormone levels and reduce symptoms of hirsutism.
c. Stress management: Stress can contribute to hirsutism, so it is important to manage stress levels through activities such as yoga, meditation, or exercise.
- Hair Removal Methods
There are several hair removal methods that can be used to reduce the appearance of hirsutism:
a. Shaving: This is an effective and simple method of removing hair, but it needs to be done regularly to keep hair at bay.
b. Waxing: Waxing removes hair at the root and can last for several weeks.
c. Electrolysis: This method uses an electric current to destroy hair follicles, resulting in permanent hair removal.
d. Laser hair removal: This method uses lasers to destroy hair follicles and is a more permanent solution than electrolysis.
- Medications
Medications can be used to treat the underlying causes of hirsutism and include:
a. Birth control pills: Birth control pills contain hormones that regulate ovulation and reduce the production of androgens.
b. Anti-androgens: Anti-androgens are medications that block the effects of androgens and reduce hirsutism.
c. Metformin: Metformin is a medication used to treat diabetes, but it can also help reduce symptoms of hirsutism in women with polycystic ovary syndrome (PCOS).
d. Spironolactone: This medication is used to treat high blood pressure, but it can also help reduce symptoms of hirsutism.
- Surgery
In severe cases of hirsutism, surgery may be necessary to remove the source of excess androgens. Surgical options include:
a. Ovarian drilling: This procedure involves making small incisions in the ovaries to reduce the production of androgens.
b. Adrenalectomy: This procedure involves removing the adrenal glands, which produce androgens.
It is important to note that surgery is only recommended in severe cases of hirsutism and should only be considered after other treatments have failed.
In conclusion, hirsutism is a common condition that affects women and can be treated with lifestyle changes, hair removal methods, medications, or surgery. The best course of treatment will depend on the underlying cause of hirsutism and the severity of symptoms. Women with hirsutism should talk to their doctor to determine the best treatment plan for their individual needs.
