Hirsutism

Hirsutism is the medical term for the changes in a female caused by excess male hormones (androgens). Excess unwanted body hair is a frequent complaint of female patients seen in the dermatology clinic. Many women experience unwanted dark, thick hair growth on the upper lips, chin, neck, mid-chest and nipple region of the breasts. It is a more common complaint among blacks, Hispanic, Mediterranean and other dark-skinned races. In most people this unwanted hair is just a variant of or within normal limits. Rarely, it may be a sign of an underlying significant medical problem or hormonal/endocrine disorder.

Signs of an underlying significant medical problem include changes in:

• Menstrual cycles- especially cessation or prolonged bleeding, length, irregularity.
• Acne- late onset of severe acne resistant to medical treatment.
• Changes in muscle mass, voice energy and libido (sex drive).
• Significant thinning or loss of scalp hair.

Signs of an underlying significant medical problem include changes in:

• Breast atrophy (shrinkage), excess pubic hair or genital enlargement.
• If your doctor feels it is necessary/indicated he will order appropriate laboratory tests (DHEAS, testosterone, Androstenedione, FSH, LH) or consultations (Endocrinology, Ob-Gyn). Excess hormone production may result from functional or neoplastic disorders of the ovary, adrenals or pituitary.
• There are many simple treatments for simple unwanted or excess hair. These include:
• Bleaching with hydrogen peroxide

Signs of an underlying significant medical problem include changes in:

• Shaving (this does not make hairs thicker, darker or grow faster)
• Epilation (Mechanical plucking or warm wax, painful, not permanent)
• Electrolysis (slow, tedious, expensive, but effective in experienced hands)
• Laser hair removal (quick, can be uncomfortable, permanent, expensive)

Signs of an underlying significant medical problem include changes in:

• Topical medication (Vaniqa)
• Treatment of ovarian, adrenal or pituitary dysfunction will require expert medical help and evaluation. Treatments may include birth control pills (ovary), low dose prednisone (adrenal) or androgen blocking drugs like spironolactone. Occasionally surgery may be necessary. Very few patient who complain of excess hair need any of these systemic medications.