Affiliated Physicians: Fertility Doctors
Hirsutism in Women
Hirsutism in women is defined as excessive coarse hair appearing in a male-type pattern. It represents exposure of hair follicles to high levels of the male hormone androgen in the blood and/or the hair follicle itself. Consequently, one-half of women with mild hirsutism have elevated levels of circulating androgens, as do most women with more severe hirsutism, although the severity of hirsutism is not necessarily proportion to the circulating androgen level.
It is important to recognize that hirsutism can be an emotional burden that can harm one’s self-esteem and body image. Many women with hirsutism report feeling unfeminine and embarrassed due to unwanted hair. Many of these women also hide their hair growth and avoid physical closeness with others to conceal it. Because hair removal can be time-consuming, expensive, and frustrating, many hirsute women feel unable to manage their hair removal effectively, and some experience depression. Nevertheless, significant variability exists in how women view their hirsutism, ranging from not bothersome to humiliating.
The first step in assessing hirsutism is to have a complete history and physical examination performed by a trained health care provider. A careful history and physical examination can assess the degree of hirsutism, acne or hair loss, and other problems that are important in directing diagnostic testing and management. An equally important step is assessing the emotional impact of hirsutism on the individual so that a personalized management plan can be developed to target the physical, medical and psychological burdens of unwanted hair. Understanding how a woman feels about her body image and improving this perception are essential components of any management plan.
Blood tests may be recommended to determine whether the body is producing excess amounts of androgen. These blood tests can be combined with physical examination to determine whether a common condition known as polycystic ovary syndrome (PCOS) exists. At the same time, other causes for hirsutism, including hormone abnormalities of the pituitary, thyroid and adrenal as well as rare tumors, can be excluded.
Hirsutism is often treated with a combination of approaches, including oral contraceptives with or without an antiandrogen, such as spironolactone, to lower levels or block actions of androgen on hair follicles. Oral contraceptives are often combined with antiandrogens to improve their clinical effect and to prevent pregnancy, since accidental exposure of the male fetus to antiantrogens can harm fetal development. A topical cream (eflornithine hydrochloride) also can be applied to treat facial hirsutism.
Medical therapy inhibits hair growth without eliminating hair already present. Therefore, medical therapy usually is combined with mechanical methods of hair removal, such as electrolysis or lasers. Electrolysis refers to the insertion of an electrode to destroy individual hair follicles. It is ideal for removing small areas of sparse hair of any color. Laser hair removal is a common, safe and effective cosmetic procedure that also is performed for removal of unwanted facial and body hair. Laser therapy is more expensive than electrolysis but is faster, less painful, and requires fewer sessions. Laser therapy destroys hair by targeting the pigment (melanin) in the hair follicle and is ideally suited for dark-haired, light-skinned individuals. Longer-wavelength lasers with cooling devices can be used for individuals who have red, true blond, or white hair and for dark-skinned people. With appropriate therapy, there is up to a 70% reduction in hair density in treated areas, with remaining hairs becoming thinner in diameter within 3-6 months of treatment. Most patients then require some degree of maintenance treatment, usually every 6-12 months.
Acne is usually treated with oral contraceptives and topical or antibiotic therapies. Hair loss may require androgen suppression combined with antiandrogen therapy and topical means of stimulating hair regrowth.
Management of Hirsutism
A successful management plan for unwanted hair addresses a woman’s own concerns and allows for an individualized strategy that balances time spent on mechanical hair removal with prevention of further hair growth through medical therapy. Follow-up visits are often necessary to review progress, assess side effects, and advise further management as necessary, thereby increasing long-term satisfaction. The best management of unwanted hair growth often requires a multidisciplinary approach provided by qualified physicians, aestheticians, laser therapists, and electrologists and that 3 to 6 months of treatment is commonly required before improvement of hirsutism is observed.