Hirsutism: Causes and Treatment

Hirsutism is a condition of increased hair growth in a woman associated with increased (or normal) levels of circulating androgens (sex hormones). Androgens are the steroids that help in development of masculine secondary sexual characteristics. Most important androgen is testosterone.

Hypertrichosis is another term that implies increased growth of non-sexual hair (eyebrows, eyelashes, hair on extremities).

Hirsutism involves male like growth pattern over midline portions of the body (face, chest, abdomen, inner thigh). There may be other signs such as decreased breast size, loss of vaginal lubrication, male-pattern balding, appearance of beard and moustaches, deepening of voice, irregular menstrual cycle, acne and clitoromegaly (enlargement of clitoris).

The onset of these symptoms is usually gradual. Sudden onset of Hirsutism is often seen in adrenal tumours.

Causes of hirsutism in women include polycystic ovarian disease (PCOD), cushing’s syndrome, adrenal cancer, certain medications, ovarian tumour, hypothyroidism or congenital adrenal hyperplasia.

In some females, menses are seen to be regular. In such cases, the causes include genetic influence, premature menarche (time of onset of menses), pregnancy and menopause. Some idiopathic cases are also known.

Treatment is slow and may be life long. It comprises of cosmetic and supportive therapy. Bleaching, shaving, waxing, plucking, electrolysis and laser are some cosmetic options. Shaving should however be prohibited or else it results in need for daily shaving. Bleaching is effective in mild cases. Electrolysis and laser are the main supportive measure but are expensive techniques.

Advise weight reduction in obese individuals and also encourage the patient to maintain the ideal weight. Along with these options, psychological support is also necessary. Supportive therapy includes oral contraceptive pills for almost 7-8 months.

A combination of hormonal suppression with supportive measures is the best line of treatment for hirsute patients. Hormonal treatment stops further growth of hair but does not reverse the present hair.