Hirsutism

Hirsutism is excessive growth of facial or body hair in women. It is not a disease. The condition usually develops during puberty and becomes more pronounced as the years go by. However, an inherited tendency, over-production of male hormones (androgens), medication, or disease, can cause it to appear at any age.

Women who have hirsutism usually have irregular menstrual cycles. They sometimes have small breasts and deep voices, and their muscles and genitals may become larger than women without the condition.

In those cases in which the cause is not clear, hirsutism is probably hereditary, because there is often a family history of the disorder.

"Secondary" hirsutism is most often associated with polycystic ovary syndrome, an inherited hormonal disorder characterized by menstrual irregularities, biochemical abnormalities, and obesity. This type of hirsutism may also be caused by malfunctions of the pituitary or adrenal glands, use of male hormonesor minoxidil (Loniten), a drug used to widen blood vessels, or adrenal or ovarian tumors.

Hirsutism is rarely caused by a serious underlying disorder. Pregnancy occasionally stimulates its development. Hirsutism triggered by tumors is very unusual.

In hirsutism, hair follicles usually become enlarged and the hairs themselvesbecome larger and darker. A woman whose hirsutism is caused by an increase in male hormones has a pattern of hair growth similar to that of a man. Patients whose hirsutism is not hormone-related have long, fine hairs on their faces, arms, chests, and backs.

Diagnosis is based on a family history of hirsutism, a personal history of menstrual irregularities, and masculine traits. Laboratory tests are not neededto assess the status of patients whose menstrual cycles are normal and who have mild, gradually progressing hirsutism.

A family physician or endocrinologist may order blood tests to measure hormone levels in women with long-standing menstrual problems or more severe hirsutism. Computed tomography scans (CT scans) are sometimes performed to evaluatediseases of the adrenal glands. Additional diagnostic procedures may be usedto confirm or rule out underlying diseases or disorders.

Primary hirsutism can be treated mechanically, which involves bleaching or physically removing unwanted hair by cutting, electrolysis, shaving, tweezing,waxing, or using hair-removing creams (depilatories).

Low-dose dexamethasone (a synthetic adrenocortical steroid), birth-control pills, or medications that suppress male hormones (for example, spironolactone)may be prescribed for patients whose condition stems from high androgen levels.

Treatment of secondary hirsutism is determined by the underlying cause of thecondition.

Birth-control pills alone cause this condition to stabilize in one of every two patients and to improve in one of every 10.

When spironolactone (Aldactone) is prescribed to suppress hair growth, 70% ofpatients experience improvement within six months. When women also take birth-control pills, menstrual cycles become regular and hair growth is suppressed even more.

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