It is normal for a woman to have fine, pale, faintly visible facial hair on the face, but some women have coarse or colored hair that grows on the face and body. This is called hirsutism, and it is sometimes linked to a medical condition.
About half of all cases are due to high levels of "male" androgen hormones. Women normally have low levels of androgens, but levels vary, and higher levels can over-stimulate the hair follicles, lead to excess hair growth.
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What are the symptoms of hirsutism?
High levels of testosterone mean that some women have more hair on the face and body.
A woman with the mildest form of hirsutism may notice significant growth of mature hair, or hair that is the same color as scalp hair on the upper lip, chin, sideburn area, and around the nipples or lower abdomen.
More advanced hirsutism will cause mature hair to grow on the upper back, shoulders, sternum, and upper abdomen. It usually begins during puberty. If hirsutism starts before or after puberty, the cause could be hormonal, and the woman should be evaluated by a doctor.
What causes hirsutism?
Hirsutism can be caused by either an increased level of androgens, or an oversensitivity of hair follicles to androgens. Although androgens are considered "male" hormones, women also have them, but in smaller quantities.
Male hormones such as testosterone stimulate hair growth, increase body size and intensify the growth and pigmentation of hair.
High circulating levels of insulin in women may also contribute to the development of hirsutism, because it can stimulate the ovarian cells to produce androgens. This can affect women with insulin resistance.
High levels of insulin may also activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.
Hirsutism can be an adverse effect of certain medications. Androgen therapy, for example, testosterone or dehydroepiandrosterone (DHEA), or the drug Danazol, may contribute to hirsutism.
DHEA is a hormone naturally produced by the human body, and it is sometimes taken as a supplement to combat age-related conditions such as osteoporosis. Danazol is a synthetic steroid that has been used to treat endometriosis. Both may raise testosterone as a side effect.
Excessive hair growth in women with normal androgen levels, regular menstrual periods, and no other underlying conditions is called idiopathic hirsutism. This means that there is no identifiable cause of the disorder. It occurs more frequently in certain ethnic populations.
Hirsutism does not always indicate a significant medical abnormality. However, if it starts before puberty, if it is accompanied by other male-related traits such as a deeper voice, or if it may be due to a tumor, the person should seek medical attention. Hirsutism that stems from a tumor is likely to be more severe and more sudden.
A physician will look at the patient's medical history, and especially the menstrual cycle. If the patient has a normal, cyclic pattern of menstrual periods, the hirsutism is most likely genetic, or inherited.
Irregular periods together with unusual body hair may indicate a more serious problem.
If menstruation is irregular, and if it has always been irregular, the cause could be polycystic ovary syndrome.
If the hirsutism and menstrual irregularity are new, and if the woman is missing her periods, tests may be carried out for a potentially more serious condition, such as a tumor of the ovary, adrenal glands, or pituitary gland.
In cases of mild hirsutism, and no other symptoms suggesting overproduction of androgen hormones, there may be no need for any additional testing.
If more testing is necessary, several blood tests are available.
By measuring levels of the hormones testosterone and DHEA, the tests can check for signs of polycystic ovary syndrome, ovary tumors, adrenal gland tumors, or tumors that can stimulate the adrenal glands.
They can also detect adrenal gland hormone deficiencies, which can cause overgrowth of the adrenal glands.
The hormone prolactin may be measured to check for signs of a tumor in the pituitary gland.
Blood sugar and cholesterol levels may be tested.
Depending on the results of these tests, there may be additional hormone tests to find out why androgen levels are high, by evaluating the function of your adrenal gland and pituitary gland.
Treatment options for hirsutism
If a specific cause of hirsutism becomes clear, the doctor may suggest appropriate treatment for that cause.
If insulin levels are high, lowering them may lead to a reduction in hirsutism.
For women who are overweight, losing weight may reduce androgen levels and decrease hirsutism.
Cosmetic approaches to hirsutism
Hirsutism can be distressing, but there are cosmetic and medical treatments that can help to decrease the levels of androgens or their impact on hair follicles.
Plucking, shaving, waxing, chemical hair softeners and depilatory creams are all effective treatments for mild hirsutism, but they can irritate the skin, and must be repeated for continued success. Waxing needs to be done every 4 to 6 weeks.
Laser hair-removal techniques use light to generate heat inside hair follicles, which destroys the ability of hair to grow from the follicle.
Laser treatment is more effective in some skin types than in others, and it does not prevent new hair follicles from forming. It is expensive and time-consuming, and it requires the services of a qualified professional such as a dermatologist or plastic surgeon. It lasts longer than creams, shaving, or waxing.
Electrolysis makes the follicles unable to grow hair by using electricity to generate heat within the follicles. Electrolysis has become less popular than laser treatment, because it is more likely to leave small areas of scarring.
Some medicines can change the impact of androgen hormones on the body and skin.
Combination birth control pills, which contain both estrogen and progesterone, can counter the masculine effects of androgen hormones and decrease the production of testosterone by the ovary. Hirsutism may improve after 6 to 12 months of consistent use of birth control pills. These must be taken daily as prescribed.
Anti-androgen medicines can work alone or together with birth control pills.
The most commonly used medicine is spironolactone, or Aldactone, but others are available. It is not safe to take anti-androgen medicines during pregnancy.
It is not always possible to control hirsutism, but a healthy diet and exercise can help to control weight and reduce the risk of high cholesterol and diabetes.
Avoiding unnecessary medicines known to cause hirsutism can also reduce the risk.