Hirsutism

Causes of Hirsutism

Diagnostics

Treatment of hirsutism

Forecast

Hirsutism – excessive male hairiness in women, manifested by the appearance of whiskers and beards, excessive hair growth on the body and limbs, mainly associated with an increase in the concentration of androgens (male hormones) in the blood.

Hirsutism is often combined with menstrual disorders and infertility. In the future, there may be an increase in muscle mass, an increase in the clitoris, alopecia at the temples, coarsening of the voice and increased sexual desire. In addition, signs of de-feminization may appear (for example, a decrease in the size of the mammary glands and the cessation of the formation of vaginal lubrication).

Causes of Hirsutism

  • Premature puberty, menopause
  • Idiopathic hirsutism (idiopathic androgen excess syndrome) is a poorly understood, but often observable condition characterized by minor hirsutism, acne, and irregular menses without significant hormone abnormalities.
  • Medication (phenytoin, hexachlorobenzene, glucocorticoids, progestins, anabolic drugs, androgens).
  • Disorders of adrenal origin (congenital or acquired hyperplasia of the adrenal cortex, adrenal tumors)
  • Disorders of ovarian origin (polycystic ovarian disease, androblastoma, granulosa cell disease, pregnant luteoma, hypertecosis, chronic anovulation, amenorrhea)
  • Disorders of pituitary origin (Itsenko – Cushing syndrome, acromegaly)
  • Genetic and chromosomal abnormalities

Diagnostics

Diagnosis of hirsutism is carried out by an endocrinologist using special research methods:

  • Serum testosterone. The total testosterone content of less than 200 ng / ml (decreases when taking oral contraceptives or prednisone) is usually due to polycystic ovaries. A total testosterone concentration of more than 200 ng / ml suggests the presence of a tumor.
  • Serum dehydroepiandrosterone sulfate (DHEAS) is an indicator of the secretory activity of the adrenal glands. Concentration above 700 ng / ml, decreasing when taking dexamethasone, indicates hyperplasia of the adrenal cortex. The increased content of DHEAS, which does not decrease when taking dexamethasone, suggests a tumor of the adrenal glands.
  • Androstenedione serum: an increase in the content of androstenedione indicates ovarian disease
  • 17-Hydroxyprogesterone serum increases with the failure of various enzymes (for example, 21-hydroxylase, observed with congenital adrenal hyperplasia
  • Cortisol: an increase in serum cortisol concentration occurs with Itsenko-Cushing’s syndrome
  • Gonadotropins: a relative increase in the luteinizing hormone (LH) / follicle-stimulating hormone (FSH) ratio indicates polycystic ovary.

Treatment of hirsutism

  • Removal of ovarian or adrenal tumors
  • Discontinuation of medications that promote hair growth
  • Suppression of the formation of androgens in the adrenal glands by prednisone or dexamethasone
  • Treatment of Itsenko-Cushing’s syndrome, hypothyroidism or acromegaly
  • Drug therapy for hirsutism is carried out after the exclusion of tumors secreting androgens
  • Oral contraceptives with antiandrogenic properties (for example, Diane-35, Janine) are the drugs of choice for idiopathic or ovarian-related hirsutism. The concentration of testosterone in the blood decreases within 1-3 months, which is accompanied by an improvement. For contraindications to oral contraceptives, medroxyprogesterone is administered at a dose of 150 mg intramuscularly every 3 months. Contraindications for all drugs – pregnancy.
  • Antiandrogenic agents (prescribed for the ineffectiveness of oral contraceptives) are less effective and cause more side effects. Spironolactone (100-200 mg / day): the therapeutic effect develops slowly, side effects – increased urination, lowering blood pressure, uterine bleeding; contraindicated in pregnancy.Tsiproteron (50 mg 2 p / day): usually the drug is taken along with estrogen; during treatment, breakthrough bleeding, decreased sexual desire and depression occur; contraindicated in pregnancy.
  • Ketoconazole at a dose of 400 mg / day; contraindicated during pregnancy

Forecast

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It may take 6–12 months of treatment to noticeably reduce excessive hair growth. With long-term treatment of hirsutism, the prognosis for stopping the growth of new hair is good, and for the elimination of already existing hairs, it is doubtful. The goal of hirsutism treatment is to stop the process of new hair growth, not to remove old ones. After the appearance of coarse dark hair, a decrease in the content of androgens will not affect the character of hair distribution. Treatment of hirsutism does not completely eliminate the excessive growth of hair, although it will slow down their growth rate.

Shaving hair is undesirable because this will lead to the need for daily shaving. Chemicals for hair removal often cause skin irritation, and their daily use may also be needed in the future. Epilation using wax provides a longer lasting effect compared to shaving and chemical means. With moderately pronounced hirsutism, hair bleaching is effective. It is undesirable to pluck long hair, as this often leads to scarring.

A radical additional measure is electrolysis, which causes the destruction of the hair follicles (the disadvantages are high cost, pain and a long procedure).

The best long-term results are given by a combination of hormonal and complementary treatments for hirsutism.

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