Introduction
Normally, women have less body hair than men due to hormones. Sometimes, however, women also have a hair pattern that is more similar to that of men. This means that those parts of the body are more hairy than usual, whose hairiness is under the influence of sex hormones. These include the face (i.e. the beard, especially on the upper lip and the lateral cheeks), the armpits, the breasts, the belly and the genital region including the transition to the thigh. If such an image is present without further characteristics of masculinization such as a male physique, acne and/or hair loss, the physician speaks of hirsutism.
Hirsutism
The more conspicuous hirsutism is, the more people affected usually suffer from it and for many of them this condition results in a very high level of suffering. For this reason, a therapy is usually started, even in cases where the increased hair growth is not really a medical problem. This clinical picture is not uncommon: Since the transition between normal and male hair is fluid and depends, among other things, on the ethnicity of the woman, exact frequencies are difficult to determine.
However, it is assumed that between 5 and 10% of all women suffer from more or less severe hirsutism. There are various causes that can lead to male hair growth in women, most of which can be easily controlled with appropriate treatment. Female moustache is the term used to describe excessive facial hair in women on the chin, upper lip and cheeks.
A stronger hairiness (not only in the face but also on the whole body) in women should be clarified by the doctor, because among other things also pathological processes in the body can be to blame for the increased hair growth. In most cases, however, a genetic predisposition with an overproduction of male hormones such as androgen is responsible for the female moustache. It is not uncommon that no reason at all can be found for excessive hair growth in women.
This is then also called the “idiopathic form” of hirsutism. In contrast to the other types, the hormone levels of the sex hormones in these women are in the normal range. Here the tendency for a male pattern of hair growth is often simply in the family, often women from the Orient or the Mediterranean area are affected.
Also women who are already in menopause (i.e. after the last period) are more likely to suffer from hirsutism. Most often, however, “male hair growth” in women is caused by a disturbance in the hormonal balance, which results from the male sex hormone testosterone being present in the blood in too high a concentration. Such a disorder can also have a variety of causes: To differentiate between adrenal (caused by the adrenal glands) and ovarian (caused by the ovaries) hirsutism, the hormone dehydroepiandrosterone (DHEA), which is a steroid hormone that is further metabolized to testosterone, can be determined.
If this hormone is also elevated, an excess of testosterone indicates a problem in the adrenal cortex. Other diseases can also lead to secondary hirsutism, as they affect the hormone balance of the body. These include diabetes mellitus type II, obesity or acromegaly.
Apart from these diseases, the use of certain drugs can also be associated with increased hair growth. These include glucocorticoids (e.g. cortisol), anabolic steroids (e.g. testosterone), ACTH, derivatives of the female sex hormone progesterone, spironolactone (a dehydrating agent, diuretic), ciclosporin (an immunosuppressive agent), phenytoin (a drug against epilepsy) or minoxidil (a drug against high blood pressure).
- Often the problem lies in the area of the ovaries (ovaries). Here, for example, polycystic ovarian syndrome (PCO) comes into question. In this disease, there is a disturbance in the control circuit of the hypothalamus, pituitary gland and ovary, but it is still unclear at which exact point the circulation is defective.
In the end, however, the ovaries are permanently stimulated with the hormone LH, which causes an increased production of male sex hormones. This also leads to the formation of many small cysts and a thickening of certain areas of the ovaries.
- A similar, but altogether weaker clinical picture is offered by hyperthecosis (hyperthecosis ovarii), in which there is also a structural change in the ovaries.
- Tumors in the ovaries can also be associated with an increased synthesis of testosterone. However, the reproductive organs are not the only place where sex hormones are produced.
- To a lesser extent, sex hormones are also produced in the adrenal cortices.
As a result, diseases affecting the adrenal cortex can also manifest themselves through increased hair growth in women. These include the Adrenogenital Syndrome (in this syndrome, the synthesis of steroid hormones also produced in the adrenal cortex is disturbed, which stimulates the production of sex hormones) and the Cushing’s Syndrome, in which for various reasons there is too much cortisol in the body, which in high concentrations can also have a testosterone-like effect.
- A tumor of the adrenal cortex can also induce testosterone production.
First of all, the cause of the strong hair growth must be clarified in order to exclude serious causes. The therapy for strong hair growth depends mainly on its cause.
Depending on the cause and the patient’s level of suffering, there are various options for treating increased hair growth. Often a treatment can be limited to purely cosmetic aspects, for example the removal of a lady’s beard. In other cases a treatment with hormones is useful.
For this purpose, so-called anti-androgens are normally used, i.e. drugs which counteract the quantity or function of the male sex hormones in various ways. These include cyproterone acetate (it blocks the receptor for androgens), finasteride (inhibits the conversion of testosterone into the even more potent dihydrotestosterone), flutamide (switches off the effect of the androgens on the cell nuclei). Important side effects of all these drugs are potential damage to an unborn child in pregnant women and damage to the liver.
Ovulation inhibitors (i.e. preparations based on the effect of estrogen) are also a possibility, especially in the ovarian forms. If there is a tumor of the adrenal gland, the ovary or even the pituitary gland, an oncologist must be involved in the treatment. The oncologist can then decide whether the tumor should be surgically removed or irradiated, whether it is advisable to take chemotherapeutic drugs or whether hormonal preparations are best used here as well. If another disease is responsible for hirsutism, it is important to treat it appropriately. In addition, any risk factors (such as taking the above-mentioned drugs or excessive body weight) should be eliminated as far as possible.
