What is hirsutism?
Hirsutism is excess hair growth on the parts of the body that are dependent on the activity of male hormones (androgens). These areas include:
- Chin, sideburns
- Chest, areolas, abdomen
- Upper/Lower back
- Pubis, thighs
Both men and women make androgens, of which testosterone is only one. Androgens can be produced in the ovaries/testes as well as in the adrenal glands.
What causes hirsutism?
There are multiple possible causes:
- Genetics/ethnicity:
- If your hair patterns are similar to your parents’ hair patterns, this is probably a “normal” variant.
- Mediterranean, African, and Indian populations naturally produce more hair than Asian, Native American, and many White populations.
- Ovarian dysfunction:
- Ovarian tumors that make androgens
- Polycystic ovarian syndrome
- Adrenal dysfunction:
- Tumors that make androgens or cortisol
- Non-tumor causes of excess androgens (i.e., congenital adrenal hyperplasia)
- Pituitary gland tumors that signal excess androgen production
- Medications: certain contraceptive pills/IUDs, steroid hormones, seizure medications, supplements, etc.
How do we diagnose hirsutism?
Diagnosis involves several steps:
- Investigating puberty (early? late?) and periods (frequent? infrequent?)
- Running labs for excess androgens
- Possibly conducting an ultrasound of the pelvis
- Examining the history of plucking, shaving, waxing, and gauging hair growth using the Ferriman-Gallwey score:
- A score between 8-15 is MILD.
How can we treat hirsutism?
Treatment always focuses on addressing the underlying condition:
- Androgen-producing tumors are surgically removed.
- PCOS is treated with oral contraceptives that do NOT make androgens worse (e.g., Yasmin).
- Medications that worsen androgen production are removed if safe and appropriate.
If treating the underlying condition is not enough, or there IS no apparent underlying condition, we can add medications like spironolactone and tamsulosin to reduce hair growth. Additionally, various hair removal methods are available, though these are usually NOT covered by insurance:
- Lasers
- Electrolysis
- Shaving, plucking, waxing, threading