Hirsutism and the best ways to treat it!

Hirsutism is a condition in women that results in excessive growth of coarse hair in a male-like pattern, in areas where women don’t commonly have hair. Excessive hair growth might be seen on the face, back, and chest.

What are possible causes of hirsutism in women?

In women, excessive hair growth is often due to excess male hormones (androgens), primarily testosterone. There often is no identifiable cause but possible causes include:

Polycystic ovary syndrome (PCOS). PCOS is a condition, which often begins with puberty. There is an imbalance of sex hormones. Over time, PCOS may result in obesity, excess hair growth, irregular periods, infertility and sometimes multiple cysts on the ovaries.

Cushing syndrome. This syndrome occurs due to high levels of a hormone called cortisol. This can happen when your adrenal glands make too much cortisol or from taking medications such as prednisone (a steroid) over a long period.

Congenital adrenal hyperplasia. CAH is an inherited condition in which the adrenal glands produce an abnormal amount of steroid hormones, including cortisol and androgen.

Tumors. Androgen-secreting tumor in the ovaries or adrenal glands can cause hirsutism but this is rare.

Medications. There are medications that can cause hirsutism. These include:

Danazol-a medication used to treat women with endometriosis

Minoxidil (Minoxidil, Rogaine);

Testosterone (Androgel, Testim)

Dehydroepiandrosterone (DHEA). Please keep in mind that if your partner uses topical products containing androgens, you can be affected through skin-to-skin contact.

What are possible symptoms of high androgen levels?

When high androgen levels cause hirsutism, some women might experience a process called virilization. Signs of virilization might include:

• Acne
• Decreased breast size
• Deepening voice
• Increase in muscle mass
• Balding
• Enlargement of the clitoris

What should you do if you have any of the symptoms described above?

Please see your doctor for possible tests and treatment options. Your doctor may refer you to other doctors that specialize in skin problems (dermatologist) and hormone disorders (endocrinologist).

Mental health impact of hirsutism:

Hirsutism can be emotionally distressing. Some women become self-conscious which can lead to low self-esteem. Some women develop anxiety and depression.

What tests are used for diagnosis?

Your doctor might check tests that measure the amount of certain hormones in your blood, including testosterone or testosterone-like hormones. This will help your doctor to determine whether elevated androgen levels are causing your hirsutism. Your doctor might also examine your abdomen and do a pelvic exam to look for masses that could indicate a tumor.

Treatment of hirsutism with no sign of endocrine disorder is not necessary. For women who do need or seek treatment, it may involve treating any underlying disorder, developing a self-care routine for unwanted hair, and trying various therapies and medications.

Medications

If cosmetic or self-care methods of hair removal haven’t worked for you, talk with your doctor about drugs that treat hirsutism. With these medications it usually takes up to six months, the average life cycle of a hair follicle, before you see a significant difference in hair growth. Options include:

• Oral contraceptives- Birth control pills or other hormonal contraceptives, which contain estrogen and progestin, treat hirsutism caused by androgen production. Oral contraceptives are a common treatment for hirsutism in women who don’t want to become pregnant. Possible side effects include nausea and headache.
• Anti-androgens.These types of drugs block androgens from attaching to their receptors in your body. They’re sometimes prescribed after six months on oral contraceptives if the oral contraceptives aren’t effective enough.

The most commonly used anti-androgen for treating hirsutism is spironolactone (Aldactone, CaroSpir). The results  take at least six months to be noticeable. Possible side effects include menstrual irregularity. Because these drugs can cause birth defects, it’s important to use contraception while taking them.

• Topical cream.Eflornithine (Vaniqa) is a prescription cream specifically for excessive facial hair in women. It’s applied directly to the affected area of your face twice a day. It helps slow new hair growth but doesn’t get rid of existing hair. It can be used with laser therapy to enhance the response.

Procedures

Hair removal methods whose results may last longer than self-care methods — and which may be combined with medical therapy — include:

• Laser therapy.A beam of highly concentrated light (laser) is passed over your skin to damage hair follicles and prevent hair from growing (photoepilation). You might need multiple treatments. For people whose unwanted hair is black, brown or auburn, photoepilation is usually a better option than electrolysis.

Talk with your doctor about the risks and benefits of the various lasers used for this hair removal method. People with tanned or darkly pigmented skin are at increased risk of side effects from certain lasers, including a darkening or lightening of their usual skin tones, blistering, and inflammation.

• This treatment involves inserting a tiny needle into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments. For people with naturally blond or white hair, electrolysis is a better option than laser therapy.

Electrolysis is effective but can be painful.

Treatment for hirsutism:

1. Hirsutism is not preventable but it is treatable.
2. Losing weight might help reduce hirsutism, particularly if you have polycystic ovary syndrome.
3. If cosmetic or self-care methods of hair removal does not work, talk to your doctor about what your options are.
4. Medications can be used to treat hirsutism but it will likely take up to 6 months before you see any significant difference in hair growth. Medications that are used to treat hirsutism include: oral contraceptives, anti-androgens, and topical cream (such as Vaniqa).

Other options for treatment are Natural remedies:

1. Spearmint tea- some reports suggest that women who drink spearmint tea twice a day for five days can reduce levels of androgens that can cause hirsutism. Spearmint tea is said to reduce androgen hormone levels. Prior research suggests that the changes noted from spearmint tea is not substantial and individuals suffering from hirsutism will likely require additional treatment.
2. Saw palmetto

How does Saw Palmetto Work to Reduce Hirsutism?

• Increases DHT breakdown
• Inhibits DHT production
• Reduces 5 alpha-reductase activity
• Inhibits DHT binding to androgen receptor sites

Saw palmetto may help with thinning head hair, PCOS, and possibly lower the incidence of acne.

Saw Palmetto takes time to be effective.

Caution:

Please keep in mind that this plant has anti-androgenic effect, and it does manipulate some hormone levels in the body, it is not suggested for combination with any type of medications for fertility that also affect hormone levels.

Always speak with your doctor prior to using Saw Palmetto.

Do not use Saw Palmetto during pregnancy or breastfeeding.

Do not use Saw Palmetto prior to getting hormone testing for any fertility issue. Saw Palmetto may affect the test results.

• Nutrition Strategy and Life Style in Polycystic Ovary Syndrome-Narrative Review.

Szczuko M, Kikut J, Szczuko U, Szydłowska I, Nawrocka-Rutkowska J, Ziętek M, Verbanac D, Saso L.Nutrients. 2021 Jul 18;13(7):2452. doi: 10.3390/nu13072452.PMID: 34371961 Free PMC article. Review.

• Chinese herbal medicine for subfertile women with polycystic ovarian syndrome.

Zhou K, Zhang J, Xu L, Lim CED.Cochrane Database Syst Rev. 2021 Jun 4;6(6):CD007535. doi: 10.1002/14651858.CD007535.pub4.PMID: 34085287 Free PMC article.

• The Effects of Traditional Chinese Medicine-Associated Complementary and Alternative Medicine on Women with Polycystic Ovary Syndrome.

Shen W, Jin B, Pan Y, Han Y, You T, Zhang Z, Qu Y, Liu S, Zhang Y.Evid Based Complement Alternat Med. 2021 Feb 26;2021:6619597. doi: 10.1155/2021/6619597. eCollection 2021.PMID: 33727940 Free PMC article. Review.

• Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Research. 2010 Feb;24(2):186-8.