Definition
Increased body and facial hair in women corresponding to the male hair type due to androgen-induced conversion of vellus hair to terminal hair.
Symptoms
- Excessive and altered hair growth (thick and pigmented) on the face, chest, abdomen, legs, buttocks, and back
- Acne
- Deeper voice
- Increased muscle mass
- Decrease in breast size
- Androgenetic alopecia
Views
Before puberty, all hairs are small and non-pigmented, they belonged to the type of vellus hairs. The sebaceous glands in the androgen-sensitive follicles are small. Due to the increased androgen levels during puberty, in certain body regions the vellus follicles develop into thick pigmented terminal hairs. In other body regions, the increased androgen levels cause the sebaceous glands to enlarge, yet the hairs remain vellus hairs.
Causes
Ovarian causes:
- Insulin resistance syndrome
- Androgen-producing tumors
- Pregnancy virilization
Adrenal causes:
- Androgenital snydrome
- Androgen-producing tumors
- Cushing’s syndrome
Combined ovarian and adrenal causes:
- Idiopathic (familial) hirsutism.
- Polycystic ovary syndrome (PCOS)
Exogenous androgens:
- Anabolic steroids
Complications
- Psychological stress
Risk factors
- Genetic predisposition
- Androgen-containing drugs
- Obesity
Differential diagnosis
- Hypertrichosis (increased androgen-independent hair growth).
- Polycystic ovary syndrome
- Androgenital syndrome
- Cushing’s syndrome
- Malnutrition
- Diabetes mellitus
- Galactorrhea
- Acromegaly
Non-drug therapy
Non-drug therapy can only reduce the increased hair, but not achieve permanent improvement: Cosmetic removal of hair by shaving, bleaching or the use of depilatories, electrolysis.
Drug therapy
The goal of drug therapy is to inhibit the action of androgens on the hair follicle: Oral contraceptives in combination with antiandrogens:
- Ethinylestradiol + cyproterone. The most useful hirsutism therapy for premenopausal women is to combine an oral contraceptive with an antiandrogen. The oral contraceptives are needed to suppress ovarian hyperandrogenemia. This is because the estrogen component is able to increase the concentration of SHBG (sex-hormone-binding-globulin) and thus the protein binding of androgens. The progestogens inhibit the secretion of LH, which promotes testosterone depletion. For therapy of hirsutism, oral contraceptives with progestins without androgenic activity should be prescribed preferentially. Oral contraceptives are an ideal therapeutic choice for patients with cycle abnormalities and acne. However, if they are used alone, they are not the most efficient method of therapy.
Antiandrogens:
- Cyproterone – considered standard therapy in postmenopausal women.
Ornithine decarboxylase inhibitors:
- Eflornithine, an irreversible inhibitor of the enzyme ornithine decarboxylase, is used in women with relatively mild hirsutism or as an adjunct to therapy with oral contraceptives or spironolactones.
5alpha-reductase inhibitors:
- Finasteride prevents the conversion of testosterone to active dihydrotestosterone by inhibiting 5α-reductase (problem: teratogenicity).
GnRH analogs:
- Leuprorelin, nafarelin. The gondaotropin-releasing hormone analogs suppress the secretion of LH and FSH, preventing the formation of the steroids in the ovaries.
Glucocorticoids:
- Dexamethasone, Prednisone. The use of glucocorticoids suppresses the stimulation of the adrenal cortex triggered by ACTH.
Antidiabetic drugs:
- Metformin, rosiglitazone, pioglitazone. The mechanism of action is postulated to be a reduction in the biosynthesis of androgens and an increase in sex-hormone-binding-globulin (SHBG).
Herbal therapy
- Evt.Teas with green mint
Advice
Facial hair is slower to respond to drug therapy than the rest of the body hair. The type of therapy depends on the cause of hirsutism, the location, and the extent of hair growth. It may take three to four months before there is a visible reduction in symptoms. To prevent a relapse, lifelong therapy is necessary.
Things to know
Approximately 5- 10% of women of reproductive age suffer from hirsutism, which is the clinical manifestation of elevated androgen levels along with acne and alopecia. Southern women are more likely to suffer from hirsutism. The most common cause of hirsutism is combined ovarian and adrenal causes (95%). Two different types of hair are distinguished: the fine, unpigmented vellus hair, which occurs all over the body and dominates during puberty, and the thicker, pigmented terminal hair. As androgen levels increase during puberty, the vellus hair is converted into the terminal hair. To activate the hair follicles, testosterone must be converted to dihydrotestosterone by 5α -reductase. Thus, in females, excessive androgen production and increased sensitivity of hair follicles lead to conversion of vellus hair to terminal hair.