Chapter 17

Hirsutism - Excess Facial and Body Hair

Hirsutism is the growth of long, coarse hair on the face and body of women in a pattern similar to that found in men. Besides being cosmetically distressing, hirsutism may also signal the presence of a hormone imbalance or a hormone-producing tumor.

Normal hair growth

Each hair grows from a follicle deep in the skin. As long as these follicles are not completely destroyed, hair will continue to grow even if the shaft, which is the part of the hair that appears above the skin, is plucked or removed.

Adults have two types of hair, vellus and terminal. Vellus hair is soft, fine, colonless, and usually short. In most women, vellus hairs grow on the face, chest, and back and give the impression of "hairless" skin. Terminal hairs are the longer, coarser, darker, and sometimes curly hairs that grows on the scalp, pubic, and armpit areas in both adult men and women. The facial and body hair in men is mostly of the terminal type.

What causes hirsutism?

Most often, excess facial and body hair is the result of abnormally high levels of androgens or male hormones in the blood. Androgens are present in both men and women, but men have much higher levels. These hormones cause hairs to change from vellus to terminal. Once a vellus hair has been transformed to the coarser terminal hair, it usually does not change back. Androgens also cause terminal hairs to grow faster and thicker. Both the ovaries and the adrenals produce androgens. To some degree, the female hormones, estrogen and progesterone, counteract these effects of androgens.

The circumstances described below can lead to high androgen levels, which, in turn, can cause hirsutism.

Genetics

There are strong family and racial influences in patients with hirsutism. In some women, the skin is very sensitive to even low levels of androgens and their follicles produce primarily terminal (coarse and dark) hairs. If your mother, grandmother or sister experienced the disorder, then you are at a greater risk of developing it.

Polycystic Ovarian Syndrome

This is the commonest reason for hirsutism in infertile women. Polycystic ovarian syndrome causes the ovaries to develop many small cysts and to overproduce male hormones. The disorder is often associated with hirsutism, irregular ovulation, menstrual disturbances and obesity.

Ovarian Tumors

On rare occasions, androgen-producing ovarian tumors cause hirsutism. When this is the case, hirsutism progresses rapidly and may even cause virilisation, in which the woman starts developing masculine characteristics, such as a deep voice and an enlarged clitoris. An ovarian mass may be detected during a pelvic examination. Though tumours are a very rare cause of hirsutism if male hormone levels are very high, the doctor may need to do specialised tests to rule out the possibility of a tumour being the cause.

Adrenal disorders

The adrenal glands, which are located just above each kidney, also produce androgens. The most common disease of the adrenal gland that can result in hirsutism is an inherited disorder called late onset adrenal hyperplasia. Adrenal tumours and other adrenal diseases, such as Cushing's disease, can also rarely cause overproduction of androgens.

Credits: How to Have a Baby: Overcoming Infertility