Brief overview
- Treatment: Treatment of underlying diseases, replacement with other active ingredients, drug therapy (e.g. with antiandrogens), shaving, epilation, chemical hair removal, laser hair removal, cauterization of hair follicles
- When to see a doctor? If there is a sudden onset of excessive male body hair, especially if there are other symptoms such as a deeper voice or a greatly enlarged clitoris
- Causes: Impaired testosterone production in the ovaries or adrenal glands, ovarian or adrenal tumors, Cushing’s disease, porphyrias, certain medications (such as anabolic steroids, glucocorticoids), hereditary hypersensitivity of the hair follicles to testosterone
Hirsutism: Treatment
The treatment of hirsutism is individually adapted to each patient. It essentially depends on the cause of the disorder. In addition, the treatment of beards and the like depends on how pronounced the disturbing body hair is and where it occurs. Other important factors are the patient’s age, any previous illnesses and the desire to have children or use contraception.
There are therefore various treatment options for hirsutism, which are sometimes combined with each other. These include, for example
In the case of drug-induced hirsutism, doctors and patients try to discontinue or replace the medication causing the problem with a preparation that does not cause hirsutism. The increased hairiness then usually disappears by itself.
In addition, medication against hirsutism is often used, for example:
- Antiandrogens: Active substances such as cyproterone acetate reduce the effect of male sex hormones on the hair follicles and thus inhibit excessive hair growth. The doctor prescribes antiandrogens either as a single substance (monotherapy) or in combination with a hormonal contraceptive (ethinyl estradiol).
- GnRH analogs (gonadotropin-releasing hormone analogs) suppress the release of certain hormones so that fewer androgens are produced in the ovaries.
- Glucocorticoids (cortisone preparations) suppress the stimulation of the hormone-producing adrenal cortex.
What you can do yourself
Cosmetic treatment can help with mild hirsutism: hair on the back or face can be regularly shaved or epilated, for example. Chemical depilatories also help against hair growth. However, it is best to have the application explained to you by an expert before the first time in order to avoid side effects such as skin irritation.
Hirsutism can also be reduced by laser hair removal or by cauterizing the hair roots. Alternatively, the dark terminal hairs can be bleached with hydrogen peroxide.
It is essential that you leave such treatments to an expert (dermatologist or specialized beautician)!
Hirsutism: When to see a doctor?
The right first port of call for hirsutism is a dermatologist or gynecologist. If necessary, an endocrinologist – i.e. a hormone specialist – can help with further clarification of the hormonal causes. Specific questions regarding hair growth may be a case for the dermatologist.
Hirsutism: causes and risk factors
Hirsutism can have very different causes:
Idiopathic hirsutism
Around nine out of ten people affected suffer from idiopathic hirsutism. This means that hirsutism cannot be traced back to an underlying disease. Instead, the symptom is due to a genetic predisposition. Experts suspect that the hair follicles of those affected react hypersensitively to testosterone (with normal testosterone levels).
Causes in the area of the ovaries
Overproduction of testosterone in the ovaries occurs, for example, in polycystic ovary syndrome (PCOS). This complex ovarian dysfunction is associated with cycle disorders, obesity and hirsutism.
A very rare ovarian cause of hirsutism is an ovarian tumor that produces male sex hormones.
Causes in the area of the adrenal glands
Rarely, an androgen-producing tumor of the adrenal glands is behind hirsutism.
Medication-induced hirsutism
Sometimes hirsutism develops as a result of long-term or high-dose treatment with certain medications. These medications include, for example
- Androgens (male sex hormones)
- Anabolic steroids (muscle builders)
- Progestogens (female sex hormones)
- ACTH (adrenal cortex stimulating hormone)
- Glucocorticoids (“cortisone”)
- Minoxidil (antihypertensive and hair restorer)
- Ciclosporin (after transplants and for autoimmune diseases)
- Diazoxide (for hypoglycemia)
Other causes of hirsutism
- Acromegaly (rare hormonal disorder with an excess of growth hormone)
- Cushing’s disease (excessive production of the hormone ACTH, caused by a tumor of the pituitary gland)
- Porphyria (group of metabolic diseases)
- Neurological diseases
What is hirsutism?
There are many possible causes of this symptom. Some of them are associated with an increased testosterone level in the blood, others are not. Testosterone is the most important representative of male sex hormones (androgens). Hirsutism usually develops as a result of hormonal changes, particularly during puberty, pregnancy and the menopause. Darker skin and hair types appear to be more at risk than lighter ones.
Distinguishing between hirsutism and hypertrichosis
Virilization (masculinization)
Sometimes other typically male changes accompany hirsutism. In this case, the affected woman’s voice becomes deeper, while the hair on her head becomes thinner and even bald. Cycle disorders are also typical of virilization (masculinization). Some of the women affected also experience increased muscle development, while their breasts shrink and sag. The increased production of male sex hormones is always responsible for this masculinization.
Hirsutism: examinations and diagnosis
It is also advisable to inform the doctor about other signs of virilization, such as a deeper voice, a possible absence of menstruation or an unusually enlarged clitoris (clitoral hypertrophy). The doctor will also look for such changes and the pattern of increased body hair during the physical examination.
- If the testosterone, DHEAS and prolactin levels are normal, the hirsutism is idiopathic or due to polycystic ovary syndrome (PCOS).
- If, on the other hand, testosterone and DHEAS levels are normal but prolactin levels are elevated, this may indicate a benign tumor of the pituitary gland (pituitary adenoma). Certain medications can also increase the prolactin level.
Depending on the suspected cause, the doctor will carry out further examinations. For example, tumors of the ovaries or adrenal glands can be detected with a computer tomography (CT) scan or an ultrasound examination of the abdomen.
