Hirsutism

Hirsutism, excess body hair in women, typically refers to pigmented coarse and dark hairs in a male pattern distribution. The common sites affected are the face, chest and abdomen. Other areas such as the back, arms and legs may be involved in more severe cases. Hair follicles at these sites are sensitive to male hormones (androgens).

Excess hair can result from an increased sensitivity of hair follicles to normal amounts of male hormones, the presence of higher than normal amounts of male hormones such as in polycystic ovary syndrome, adrenal disorders, or androgen-secreting tumors. Women taking hormones such as testosterone or anabolic steroids, and medications such as minoxidil also can have similar symptoms.

Women from certain ethnic backgrounds such as those of Mediterranean, Middle-Eastern or Hispanic ancestry, have more sensitive hair follicles, or idiopathic hirsutism. Significant weight gain is sometimes associated with excess body hair due to increased amounts of the male hormones that are not bound to proteins.  Weight loss in this situation can improve this symptom. Diabetes and high insulin levels can worsen hirsutism or produce a brown discoloration of the skin, known as acanthosis nigricans, around the neck, under the arms, and along the folds of the upper thighs.

Evaluation involves tests to assess male hormone levels in the blood. Additional tests may be necessary to determine the site of production of excess hormones and exclude other more serious medical conditions. Before considering appropriate treatment options, it is important that an accurate diagnosis is made.

There are medical and non-medical methods to treat excess body hair. Medical treatment includes the use of birth control pills or anti-androgens that reduce and block the action of androgens. These agents only prevent the formation of new hairs and progression of existing hirsutism; they do not eradicate already existing hair. Pregnant women or those who are trying to become pregnant should not take these medications. Existing hair can be addressed by non-medical or cosmetic methods such as shaving, depilators, bleaching, plucking, waxing, electrolysis and laser hair removal - the last two being the most effective techniques.

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