"The most effective treatments are those that combine estrogens and an anti-androgen".
DR. CAMILO SILVA FROJÁN
SPECIALIST. ENDOCRINOLOGY AND NUTRITION DEPARTMENT
Hirsutism is the excessive growth of hair in women, in areas where they do not usually have since they are androgen-dependent: upper lip, sideburns, chin, neck, breast areolas, chest, in the area immediately above or below the navel, as well as in English, thighs, back.
When the intensity of the disorder is greater, other systems are affected, such as the regulation of menstruation, producing menstrual alterations or even the absence of menstruation or amenorrhea and even infertility.
Hair loss or androgenic alopecia can also occur, which is also a sign of a marked hormonal alteration.
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What are the symptoms of hirsutism?
Since hirsutism is an androgenic manifestation, it can be accompanied by effects of the elevated action of these hormones on other tissues.
For example, acne and increased fat in the hair or seborrhea, are minor androgenic manifestations and are common in women with hirsutism.
Obesity promotes androgenic activity through various mechanisms, so it is more common in obese women than in thin women.
More rarely, it can produce an aggravation of voice tone, excessive muscle development or clitoral hypertrophy in the context of what is known as a virilization syndrome that usually translates into a deep hormonal disorder of androgenic secretion.
In addition, since androgens antagonize the effects of estrogens, defeminization with involution of breast development may occur.
In growing girls, excessive androgen concentration may initially accelerate growth rate but induce early epiphyseal closure, resulting in low final size.
The most common symptoms are:
- Excessive hair growth in women.
Do you have any of these symptoms?
You may suffer from hirsutism
What are the causes of hirsutism?
In general terms, it can be said that the increase of some of the androgenic steroids leads to an increase in the concentration of dihydrotestosterone. In this situation of hyperandrogenism, the fine hair and little pigmented, becomes thick and dark.
- The Polycystic Ovary Syndrome. It usually begins at puberty. Although the exact cause is unknown, the Luteinizing Hormone (LH) is increased in proportion to the Follicle Stimulating Hormone (FSH), causing lack of development of the ovarian follicles, leading to chronic anovulation with immature follicles, as well as high production of androgens. It causes hirsutism, acne, lack of menstruation or menstrual disorders and sterility.
- Ovarian hypertecosis. It is a disease of the ovaries in which there is proliferation of islands of teak cells. Unlike the Polycystic Ovary, it is a disease with normal LH and FSH values, but the androgen levels are higher.
- Idiopathic or familial hirsutism. It is due to an increased sensitivity of the skin to androgens, or increased activity at the skin level of an enzyme called 5-alpha-reductase, by family propensity to have a greater number of hair follicles per unit of skin area. It begins with puberty, with normal menstruation, circulating hormones and fertility.
- Congenital adrenal hyperplasia. It is caused by the lack of one of the enzymes necessary for the synthesis of Cortisol, which causes an increase in a pituitary hormone, ACTH, which stimulates the production of suprarenal androgens.
- Hypothyroidism. Decreases the levels of Testosterone transporting protein, leading to an increase in free Testosterone, which is the active fraction.
- Syndrome and Cushing's Disease. Due to an increase in the production of Cortisol
- Use of some medicines. Especially some oral contraceptives and steroids.
What is your prognosis?
During the first six months of treatment, no apparent beneficial effect is usually perceived; from the sixth month on, the hair becomes thinner and shorter, and the need for depilation is spaced out.
Sometimes a second cycle is required six months after completing the first treatment with a stronger anti-androgen, and some people even need a third cycle.
How is it different from excess hair?
Hirsutism refers to hair growth in androgen-dependent areas, which are those where hair growth is typical of males, such as the face, chest, abdomen, thighs and arms.
Hypertrichosis is the growth of hair in non-androgen-dependent areas such as the forearms, legs or back.
Hypertrichosis usually does not respond well to hormonal treatments for this reason.
How is hirsutism diagnosed?
Hirsutism is diagnosed by taking a medical history that allows us to know the date of the beginning of hair growth or acne or hair loss, as well as the subsequent evolution; date of the first menstruation and periodicity of the following ones.
It is necessary to perform a careful physical examination to quantify the intensity, length and thickness of the hair and hair, evaluating it by areas according to international criteria.
The determination of the hormones that may be involved is made between the second and ninth day of the menstrual cycle, according to the medical history and the examination.
In general terms, it is usually necessary to determine testosterone, dehydroepiandrosterone-sulfate, androstendione, 17-hydroxyprogesterone, sex hormone carrier protein, glucuronide, luteinizing hormone and follicle-stimulant.
In case of suspicion of late adrenal hyperplasia, it is advisable to perform a stimulation test with ACTH.
How is hirsutism treated?
Physical measures, including staining and hair removal, are effective and can be combined with drug treatment. As far as possible, treatment should be directed at the cause.
Reducing weight and excess body fat, if excessive, is a preferential therapeutic objective that requires hygienic dietary measures and healthy living.
If the objective is the symptomatic treatment of hirsutism, anti-androgenic drugs can be used, such as cyproterone acetate, which are usually combined with estrogenic preparations, which facilitate menstrual periodicity, although artificial, and increase the effectiveness of the treatment.
The treatment must be long-lasting, around at least one year, given the time it takes for the hair to grow and fall out. They have an anovulatory effect, so it is not possible to treat infertility with these drugs.
Only in cases where treatment with steroids is indicated, such as both classic and late-onset congenital adrenal hyperplasia, is it possible to treat both hirsutism and infertility at the same time. Androgen-producing tumors should be removed and hyperprolactinemia, Cushing's syndrome or acromegaly should receive specific treatment.
Where do we treat it?
IN NAVARRE AND MADRID
The Department of Endocrinology and Nutrition of the
of the Clínica Universidad de Navarra
The Department is organized into care units with specialists totally dedicated to the study, diagnosis and treatment of this type of disease.
We work with established protocols, which ensure that all diagnostic tests to be performed are done in the shortest time possible and that the most appropriate treatment is started as soon as possible in each case.
Organized in care units
- Obesity Area.
- Diabetes Unit.
- Thyroid and Parathyroid Disease Unit.
- Osteoporosis Unit
- Other diseases: e.g. Cushing's syndrome.
Why at the Clinica?
- European Center of Excellence in the diagnosis and treatment of Obesity.
- Team of specialized nurses at the Day Hospital of Endocrinology and Nutrition.
- We have a Metabolic Research Laboratory of international prestige.