What Is Hormonal Hirsutism?

Hormonal Hirsutism is the term used to describe the coarse or colored hairs that develop on some women’s faces and bodies. Sometimes, a medical problem may be the cause. The hair on the body and face of most women is fine, pale, and barely perceptible, but it occasionally may be denser and more noticeable. Overproduction of androgens occurs in about 50% of hirsutism patients. These hormones typically spark male sexual and physical development. Women typically have low androgen concentrations; however, this can change for various reasons.

Hirsutism refers to excess facial or body hair growth in women driven by androgens like testosterone and DHT. Hair follicles over-respond to higher circulating androgens, becoming coarser and darker. It affects 5-10% of women, appearing at puberty or later from tumors, cysts, insulin resistance, or unknown causes.

The hair follicles may get overstimulated at higher doses, resulting in greater hair development than a woman should typically see. Hirsutism could affect anywhere from 5% to 10% of women, depending on geographical and cultural conceptions of “normal.” Age-related prevalence rises, particularly after menopause.

How Widespread Is Hormonal Hirsutism?

Although hirsutism affects 5–10% of women, the severity can vary greatly. Racial disparities in hair growth exist. Depending on one’s attitudes and society, there may be different thresholds for what constitutes excessive hair growth.

Estimates suggest hirsutism impacts around 10 million women in the U.S. Certain ethnicities see higher rates, like those of Middle Eastern or South Asian descent. Western societies tend to have lower thresholds for “abnormal” hair patterns warranting treatment.

Symptoms of Hormonal Hirsutism

In women with the mildest type of hirsutism, the top lip, chin, sideburn region, and areas around the lower belly or nipples may all experience noticeable hair growth. This hair would be fully grown or match the color of the scalp’s hair. It usually starts during adolescence and results in adult hair growing on the shoulders, upper back, chest, and upper abdomen.

A doctor should assess the symptoms if hirsutism appears before or following puberty, as the cause could be hormonal issues. In addition to excessive hair growth, hirsutism can cause the following symptoms in females:

• A receding hairline
• Greasy skin
• Acne
• Alopecia areata
• An enlarged clitoris
• A deeper voice

Visible signs include coarse dark hairs on the face, chest, areolas, abdomen, and back. Less common areas are the forearms, thighs, and pubis. Hair density, length, and rate of growth increase over time if untreated. Associated symptoms pointing to hormonal imbalances include greasy skin, acne flare-ups, hair loss, voice changes, etc.

Causes of Hormonal Hirsutism

Hormonal hirsutism can arise from elevated androgen levels or heightened sensitivity of hair follicles to androgens. While men naturally have more androgens, women also possess these hormones in smaller amounts. Male hormones like testosterone promote growth, increase body size, and enhance hair growth and pigmentation.

Common causes of hormonal hirsutism include polycystic ovarian syndrome (PCOS), non-cancerous adrenal or ovarian tumors, Cushing’s disease, pregnancy, and certain medications. Genetic predisposition can cause hair follicles to overreact even to normal androgen levels. Idiopathic hirsutism lacks identifiable hormonal or anatomical triggers.

Additional Factors Contributing to Hirsutism

High insulin levels, a hormone that enables cells to absorb energy from sugars, may also contribute to hirsutism. Insulin can stimulate ovarian cells to produce androgens, particularly in women with type 2 diabetes or insulin resistance. The insulin-like growth factor (IGF-1) receptors on these cells may also activate in response to high insulin levels.

Obesity, which can lead to type 2 diabetes, and high cholesterol are other risk factors. Certain drugs, such as androgen therapy with dehydroepiandrosterone (DHEA), testosterone, or the medication Danazol, may cause hormonal hirsutism. DHEA, naturally produced by the body, is sometimes supplemented to prevent age-related illnesses like osteoporosis, while Danazol, a synthetic steroid, is occasionally used to treat endometriosis. Both can increase testosterone levels.

Insulin further drives ovarian androgen synthesis directly and indirectly by enhancing IGF-1 and other growth signals. Obesity-related inflammation and impaired glucose metabolism worsen hyperinsulinemia. Steroids like prednisone, hormone-based birth control methods, and immunosuppressants frequently contribute to hirsutism as well.

Is Hormonal Hirsutism Inherited?

Yes, genetic factors play a major role. Those with family members who have hirsutism are more likely to experience it themselves. Certain ethnicities also see higher prevalence. Researchers identify gene variants regulating hair follicle sensitivity to androgens as culprits. The degree to which a person’s skin is responsive to sex hormones depends partly on genetic variables. 95% of occurrences of hirsutism are caused by polycystic ovarian syndrome and idiopathic hirsutism, and 50% of PCOS patients have a familial history.

Medical History and Initial Assessment of Hirsutism

A physician begins by reviewing the patient’s medical history, with special attention to the menstrual cycle. If the person has a consistent pattern of menstrual cycles, the hirsutism is likely hereditary or genetic. However, if the periods have consistently been irregular, polycystic ovarian syndrome (PCOS) may be the cause.

Doctors assess the severity of hirsutism using Ferriman-Gallwey scores, which evaluate hair growth in nine body areas. Blood tests check hormone levels, including androgens, 17-hydroxyprogesterone, and DHEA sulfate. Pelvic ultrasounds may also analyze reproductive anatomy to screen for PCOS, tumors, or other issues.

Further Testing and Diagnosis for Hirsutism

If the hirsutism and menstrual irregularity have recently started, and the woman is missing periods, the medical professional may test for more serious conditions like ovarian, adrenal, or pituitary tumors. Evaluating blood testosterone levels and DHEA can help detect indications of PCOS, adrenal gland tumors, ovarian tumors, or tumors that can stimulate the adrenal glands.

Additional examinations may not be necessary for mild forms of hirsutism without further symptoms indicating excess androgen hormone development. However, various blood tests are available to determine if further testing is required for adrenal gland hormone deficiency, which can cause adrenal gland overgrowth. The doctor may also measure prolactin levels to check for signs of a pituitary gland malignancy.

Which Technologies can contribute to diagnosis?

The following technologies may also be useful in locating tumors or physical anomalies that may have contributed to hirsutism:

• Brain MRI scanning.
• An adrenal glands-related CT scan.
• An ovulation ultrasound.

Once tumors and rarer causes are ruled out, cosmetic hair removal can proceed for symptom relief while monitoring for associated health issues over time. Those with irregular cycles, obesity, or strong family histories should receive screening tests for diabetes and heart problems.

Treatments for hormonal Hirsutism

The doctor may advise the best course of action when a specific origin of hirsutism is identified. If your insulin concentrations are high, lowering them could help you eliminate your hirsutism. A program for weight loss may help women with high body mass indices (BMI) by lowering testosterone levels, which in turn lessens hirsutism symptoms.

Beyond hair removal techniques, medications directly targeting hormonal drivers can be very effective, including birth control pills, spironolactone diuretics, metformin, finasteride, and even GnRH analogs like Lupron Depot. Laser hair removal provides longer-term reduction as well.

Cosmetic remedies

In addition to medical treatments, several cosmetic procedures can also help manage hirsutism. These procedures aim to reduce androgen concentrations or their effects on hair follicles. For mild cases of hirsutism, the following cosmetic remedies have been found to be effective:

• Depilatory creams: These are topical creams that chemically dissolve the hair at the skin’s surface. They offer a quick and painless way to remove unwanted hair.
• Shaving: Shaving is a common and effective method for removing hair. It can be done at home and provides immediate results, although the hair will grow back relatively quickly.
• Waxing: Waxing involves applying a layer of wax to the skin, allowing it to harden, and then pulling it off, along with the adhered hair. This method provides longer-lasting results than shaving, as it removes hair from the root.
• Plucking: Plucking involves using tweezers to remove individual hairs. While it can be time-consuming and potentially painful, it offers a more long-term solution as it pulls the hair out from the root.
• Chemical softeners for hair: Certain chemical products are designed to soften the hair, making it less noticeable or easier to remove using other methods.

People should get waxed every four to six weeks to prevent undesirable hair from returning. However, waxing has the potential to irritate the skin, so for the intended results, the patient must regularly repeat these treatments. In addition, it’s important to note that the effectiveness of these remedies can vary from person to person, and it’s advisable to consult with a healthcare professional before trying any new treatment

Conclusion

Endocrinology and dermatology experts sometimes find managing hirsutism, this excessive hair growth in women in typically male-pattern areas, challenging. However, adopting a healthy lifestyle can significantly reduce the risk and impact of this condition. By leading a balanced life, which includes a nutrient-rich diet and regular exercise, women can maintain a healthy weight and hormonal balance. Avoiding unnecessary medications known to induce or worsen hirsutism is also essential.

Making conscious dietary choices, such as consuming whole foods, fruits, vegetables, and lean proteins, can help manage hirsutism. Staying physically active through activities like cardiovascular exercises, strength training, and yoga further supports overall well-being. Additionally, prioritizing self-care and stress management, along with seeking support from healthcare professionals, can contribute to a holistic approach to managing hirsutism.