Hirsutism is excessive growth of dark, coarse body and facial hair in women. The abnormal hair growth typically occurs in a pattern seen in adult males. While some body and facial hair growth is normal, women with hirsutism tend to produce elevated levels of male sex hormones called androgens from their ovaries and adrenal glands. Most cases of hirsutism are not excessive and have no underlying cause, but some may indicate the presence of a more serious underlying condition, such as Cushing's syndrome. An estimated 8% of adult women in the United States have hirsutism.
Signs and SymptomsThe primary signs and symptoms of hirsutism include:
- Hair growth on the abdomen, breasts, and upper lip (male-pattern hair growth in women)
- Irregular menstrual periods
- Abnormally malodorous perspiration
- Loss of feminine body shape
- Signs of masculinity – deepening voice, frontal balding, enlarged clitoris, enlarged shoulder muscles
- Cushing's syndrome – a condition marked by obesity (especially around the abdomen), high blood pressure, diabetes, and thinning of the skin
CausesIdentifiable causes of hirsutism are generally related to increased secretion of androgens from the ovaries or adrenal glands. This can result from a variety of conditions, including:
- Polycystic ovarian syndrome (PCOS) – often associated with infertility
- Tumors on the adrenal glands or ovaries
- Cushing's syndrome
- Severe insulin resistance
- Medications that can cause hair growth – phenytoin, minoxidil, diazoxide, cyclosporine, and hexachlorobenzene
- Anorexia nervosa
- Anabolic steroids
- Danazol – a substance used to treat endometriosis
- Hormone replacement therapy (HRT) containing androgens
- Birth control pills containing high levels of androgen hormones
Risk FactorsThe following factors may increase an individual's risk of hirsutism:
- Genetics – hair patterns are inherited
- Anorexia nervosa
- Race and ethnicity – the condition is more common in women predominantly of European ancestry than it is in those of Asian, native American or African ancestry; it is also more common in dark-skinned women
DiagnosisThe first step is to conduct a physical examination. During the physical exam, the physician will inspect the body for all sites of abnormal hair growth and will ask questions about the onset and progression of the condition. A physician may also perform a pelvic examination to determine whether tumors or cysts are present on the ovaries. After performing the physical examination, one of the following may be necessary to identify the cause of hirsutism:
- Laboratory tests – may detect elevated androgen levels
- CT scan, MRI, pelvic ultrasound – used to identify cysts or tumors on the ovaries or adrenal glands
- Laparoscopy –an instrument is inserted into the abdominal wall to detect cysts or tumors on the ovaries
Preventive CareEven if an individual is at risk for hirstutism, there are steps she can take to prevent it. For example, studies suggest that obese women with PCOS may be less likely to develop hirsutism if they consume a low-calorie diet.
Treatment ApproachThe specific treatment for hirsutism depends on the extent of the problem, whether or not an underlying cause can be identified, and if so, what the root of that cause is. For example, an individual with hirsutism will usually be advised to discontinue medications that may be contributing to the condition. If a tumor is located on the ovaries or adrenal glands, the physician will likely recommend that it be surgically removed. Overweight individuals with hirsutism may be urged to participate in a weight loss program since calorie restriction may lower androgen production in the body. Although no medications for hirsutism have been approved by the US Food and Drug Administration (FDA), some drugs may suppress androgen secretion and reduce hair growth. If no underlying cause that can be treated by conventional medication is identified, it may be possible to control the symptoms of hirsutism with acupuncture, and cosmetic therapies that conceal or remove excess hair (such as bleaching and waxing). Psychological support may also be helpful since hirsutism is often a frustrating and embarrassing condition.
LifestyleEating a balanced diet and getting adequate exercise can help control weight, which may diminish or prevent hirsutism related to obesity.
MedicationsWhile there are currently no medications approved by the FDA specifically for the treatment of hirsutism, certain medications may be used to suppress the production and secretion of androgens in the body. Up to 70% of individuals with hirsutism may respond to these medications, but it can take 6 months or longer for the medications to effectively reduce hair growth and they must be taken indefinitely to keep the symptoms under control. These medications include:
- Glucocorticoids (such as Dexamethasone)
- Certain birth control pills with low levels of androgen hormones, such as desogestrel or norgestimate
Surgery and Other ProceduresA physician may recommend the following surgical procedures in severe cases of hirsutism:
- Tumor removal – if a tumor on the ovaries or adrenal glands is the cause
- Ovary removal after childbearing years – if ovaries are producing elevated levels of androgens
Nutrition and Dietary SupplementsSome studies indicate that obese women with PCOS who lose weight by limiting their overall calorie intake may experience reduced symptoms of hirsutism. Interestingly however, restricting fat intake alone does not appear to have any added benefit for reducing symptoms of hirsutism.
Two laboratory studies have shown that an extract of saw palmetto (Serenoa repens) may inhibit androgen activity in human cells. More research is necessary, however, to determine whether these laboratory findings will have any practical applications in terms of treating hirsutism in humans.
Professional herbalists may also recommend the following herbs to relieve the symptoms associated with hirsutism:
- Black cohosh (Cimicifuga racemosa)
- Goats rue (Galegae officinalis herba)
- Fenugreek (Trigonella foenum-graecum)
- Chaste tree (Vitex agnus-castus)
One small study of women with hirsutism found that acupuncture markedly reduced both hair density and hair length and significantly reduced their levels of the male sex hormone testosterone (a type of androgen). This study is promising, but further research will be required to determine whether greater numbers of women with hirsutism would benefit from acupuncture and what causes of hirsutism respond best to acupuncture.
Warnings and PrecautionsCertain herbs and dietary supplements may boost androgen levels thereby promoting hirsutism. They should therefore be avoided by those with the condition. These include:
- Dehydroepiandrosterone (DHEA)
- Licorice root (Glycyrrhiza glabra)
- Medications that alter androgen levels should generally not be taken during pregnancy; a physician can provide guidance and appropriate medical care.
- Hair growth may increase during the third trimester, especially on the face, extremities, and breasts. This hair growth is considered normal and is not a sign of hirsutism.
Prognosis and ComplicationsIf the underlying cause of hirsutism can be identified and treated, the symptoms of hirsutism may be effectively controlled. Long-term medication, when appropriate, will slow hair growth, but it generally won't eliminate existing hair patterns on the face and body. There are some cosmetic therapies that can reduce the appearance of excessive hair growth. Counseling with a trained professional may also be helpful for women who experience psychological stress as a result of their hair growth.
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