From the Guidelines
Hirsutism is a condition characterized by excessive hair growth in women, typically in areas where men usually have hair, such as the face, chest, lower abdomen, inner thighs, and back, often caused by higher-than-normal levels of androgens or increased hair follicle sensitivity to normal androgen levels. This condition can result from various factors, including polycystic ovary syndrome (PCOS), Cushing's syndrome, congenital adrenal hyperplasia, certain medications, or tumors that produce androgens 1. The primary treatment for hirsutism in PCOS has not been established, and treatment is often palliative rather than curative, with agents such as oral contraceptives, antiandrogen drugs (spironolactone; flutamide; finasteride), insulin-sensitizing agents, and eflornithine being used 1.
Treatment Options
- Mechanical removal of hair (e.g., plucking, shaving, waxing)
- Electrolysis
- Laser vaporization
- Medical management directed at reducing androgen levels, which usually involves a combination of an antiandrogen and an ovarian suppression agent, such as oral contraceptives 1
- Addressing the underlying cause of hirsutism, if possible
Importance of Treatment
While hirsutism itself is not medically dangerous, it can cause significant psychological distress and may signal underlying hormonal imbalances that require medical attention. Therefore, treatment should be tailored to the individual's specific situation and the underlying cause, with a focus on reducing androgen levels and managing excessive hair growth. In some cases, combined medical interventions may be the most effective treatment approach to hirsutism 1.
From the Research
Definition of Hirsutism
- Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women, which grows in a typical male distribution pattern 2.
- It is a common clinical problem in women, and the treatment depends on the cause 2.
Causes of Hirsutism
- Polycystic ovary syndrome and idiopathic hirsutism are the most common causes of the condition 2.
- Hirsutism can be caused by either androgen excess or increased sensitivity of the hair follicles to normal levels of androgens 3.
Diagnosis of Hirsutism
- A woman's history and physical examination are particularly important in evaluating excess hair growth 2.
- The diagnosis is often made by exclusion, and serum testosterone level >200 ng/dL is highly suggestive of adrenal or ovarian tumor 2.
Treatment of Hirsutism
- Treatment includes lifestyle therapies, androgen suppression, peripheral androgen blockage, and cosmetic treatments 2.
- Anti-androgen drugs, such as cyproterone acetate, spironolactone, and flutamide, play a key role in the treatment of hirsutism 4, 3, 5.
- Combination therapies, such as cyproterone acetate plus ethinyl estradiol and spironolactone, have been used successfully in decreasing the hirsutism score 3.
- Insulin sensitizers have also been shown to be effective in the treatment of hirsutism, particularly in patients with polycystic ovarian syndrome 3.