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Hirsutism

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(Excess Male-Pattern Hair Growth)

Definition

Hirsutism is excess male-pattern hair growth in women. The coarse, dark hair can occur in areas such as the face, chest, and back.

Causes

True hirsutism is often due to an increased level of a male sex hormone called androgen. The main circulating androgen is called testosterone. This hormone is normally found in both men and women. There are certain medical conditions or medications that may cause an elevation in the levels of this hormone in women.
The most common cause of hirsutism is polycystic ovary syndrome. Other less common include:
  • Congenital adrenal hyperplasia
  • Some forms of Cushing syndrome
  • Adrenal tumors
  • Ovarian tumors
  • Pituitary tumors
  • Certain drugs, including:
    • Minoxidil
    • Cyclosporine
    • Phenytoin
    • Anabolic steroids
    • Diazoxide
    • Progestin-containing medications (such as oral contraceptives)
Sometimes excess hair growth is due to the person's ethnic background or family tendencies. In some cases, the cause is not known.

Risk Factors

There are no known risk factors for hirsutism.

Symptoms

Symptoms and signs of some disorders associated with hirsutism may include:
  • Excess hair growth (on the face, arms, back, armpits, groin, or chest)
  • Abnormal or absent menstrual periods
  • Male-pattern baldness
  • Deepened voice
  • Increased size of clitoris
  • High blood pressure
  • Enlarged ovaries
  • Enlarged adrenal glands
  • Abnormal cholesterol levels and glucose intolerance
Adrenal Gland
Kidney and adrenal
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Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be done. Tests may include:
  • Blood tests—to measure the amounts of certain hormones
  • Stimulation or suppression tests—to measure how hormone levels in the blood respond to changes
  • Ultrasound—a test that uses sound waves to examine the inside of the body
  • CT scan—a type of x-ray that uses a computer to make pictures of the inside of the body
  • MRI scan—a test that uses magnetic waves to make pictures of the inside of the body

Treatment

Treatment is directed at the underlying cause of the hirsutism and may include:

Medications

Medications that may help include:
  • Spironolactone
  • Finasteride (Proscar, Propecia)
  • Flutamide
  • Oral contraceptives
  • Metformin (Glucophage)
  • Eflornithine (Vaniqa)

Hair Removal

Methods of removing hair include:
  • Shaving
  • Bleaching
  • Chemical treatment (depilatories)
  • Waxing
  • Electrolysis
  • Laser treatment
  • Intense pulsed light (IPL)—uses high-intensity pulses of light to remove hair; unlike laser treatment, IPL uses a range of wavelengths.

Treatment of Other Conditions

If you are diagnosed with a condition that may be causing hirsutism, proper treatment may resolve the hirsutism. Weight loss may also play a role in reducing underlying hormone imbalances.

Prevention

Hirsutism may be prevented by treating the underlying cause.

RESOURCES

American Osteopathic College of Dermatology http://www.aocd.org

Family Doctor.org http://www.familydoctor.org

CANADIAN RESOURCES

Canadian Dermatology Association http://www.dermatology.ca

Health Canada http://www.hc-sc.gc.ca

References

Azziz R. The evaluation and management of hirsutism. Obstet Gynecol. 2003;101:99-108.

DermNet NZ. Intense pulsed light therapy. DermNet NZ website. Available at: http://dermnetnz.org/procedures/ipl.html. Updated June 15, 2009. Accessed September 2, 2010.

Hirsutism. EBSCO DynaMed website. Available at: https://dynamed.ebscohost.com/about/about-us. Updated August 31, 2012. Accessed September 12, 2012.

Hirsutism. N Engl J Med. 2006;354:1532-1533.

Lustberg ME. American Osteopathic College of Dermatology website. Available at: http://www.aocd.org/skin/dermatologic%5Fdiseases/hirsutism.html. Accessed September 12, 2012.

11/1/2007 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Hamzavi I, Tan E, Shapiro J, Lui H. A randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women. J Am Acad Dermatol. 2007;57:54-59.

9/2/2010 DynaMed's Systematic Literature Surveillance https://dynamed.ebscohost.com/about/about-us: Haak CS, Nymann P, Pedersen AT, et al. Hair removal in hirsute women with normal testosterone levels: a randomized controlled trial of long-pulsed diode laser versus intense pulsed light. Br J Dermatol. 2010 Aug 20. [Epub ahead of print]

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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