Hirsutism

According to Wikipedia, hirsutism (from Latin hirsutus = shaggy, hairy) is defined as excessive and increased hair growth in women in locations where the occurrence of terminal hair normally is minimal or absent. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a symptom rather than a disease and may be a sign of a more serious medical indication, especially if it develops well after puberty.

What is normal hair grow for women and what is hirsutism? What is considered normal for a woman and what is considered hirsute depends on factors such as culture and race. The extent of normal hair growth varies between individuals, families and races, being more extensive in the Mediterranean and some Asian subcontinent populations.

History knows several cases of excess hair grow in pretty famous women. Visiting art galleries you can see portraits of women from 15-18 centuries who were well known because of their hirsutism. For example, famous Spanish painter Jusepe de Ribera in 1631 AD introduced his painting “Magdalena Ventura with Her Husband and Son” which clearly demonstrated Magdalena’s excess hair grow (hirsutism) but fortunately her reproduction system was not damaged and she delivered a son and she was able to breastfeed her child.

In modern society, excess hair growth is considered abnormal and this can provoke stress and/or embarrassment. At least 25% of normal middle-aged women have unwanted facial hair. In many cases hirsutism is inherited and may be present in other female family members and/or relatives. Usually these women have normal amounts of male hormone (testosterone). The problem is that the hairs are more sensitive to small amounts of male hormones and so grow more quickly and thicker. In general the increased hair growth is usually first noted in late teenage years and tends to gradually get more severe as the
woman gets older.

The main causes of hirsutism are: increased sensitivity of the skin (hair follicles) to a group of “male” hormones called androgens (testosterone and androstenedione) and/or increased production of androgens. Androgen disorders (hyperandrogenism) affect 5% to 10% of all women. Often hyperandrogenism in women provoke irregular menstrual cycles and acne.

In general women body produces very low level of male hormones but in some conditions (diseases) the level of male hormones is increased:

	Polycystic Ovary Syndrome (PCOS),
	Congenital adrenal hyperplasia,
	Cushing’s disease,
	Tumors (ovarian or adrenal glands),
	Insulin resistance,
	Obesity,
	Genetics,
	Certain medications (Phenytoin, Epanutin, Cyclosporin, Anabolic Steroids, Minoxidil)
	Pregnancy,
	Aging.

Some girls and women are very sensitive to this issue. Sometimes they complain about excess hair grow without having any objective reasons (just trying to be super-perfect). The complaint of hirsutism is common and often accompanied by severe anxiety and social stress.  If you would like to check your body hair grow (normal or pathological), better use so called “hirsute score” which is very easy to use. Thanks to hirsute score classification you can discover three categories: normal constitutional hirsutism (usually genetic), border transmission hirsutism  (something between normal and pathological) hirsutism, hirsutism
pathological (usually a symptom of diseases) and severe hirsutism (mainly noticed during
tumors).

Extent and degree of hirsutism

All doctors can measure body and face hair grow by using special scoring system. It is objective evaluation and can be used for diagnosis as well as for monitoring of the success of hirsutism treatment. If hirsutism is just imagination of the client – some counseling is needed. If hirsutism needs treatment (cosmetic or medical) – proper management should be provided by service providers.

Menstrual cycle and hirsutism

Many clients with hirsutism are also suffering from menstrual disturbances (late rare periods). Hirsutism and rare periods related to PCOS usually begins around the time of the menarche and increases slowly and steadily in the teens and twenties. The greater the menstrual disruption - the more likely it is that there is a serious cause.

Weight control and hirsutism

Many clients with hirsutism are also suffering from overweight and/or obesity. This worsens the underlying androgen excess and insulin resistance and inhibits the response to treatment, and is an indication for appropriate advice on weight control, diet and exercises.

What should be done?

If you are experiencing difficulties in controlling body or facial hair by cosmetic methods, you
should visit your doctor for professional advice. Better to visit endocrinologist who knows
hormonal disturbances very well. The adequate treatment should be done and managed by
professionals.