Hirsutism and Masculinization

Hirsutism (increased body hair) is the growth of colored (pigmented) thick hair in women. It is most noticeable when it is on the moustache or beard areas. The other common sites are the:

  • Chest.

  • Abdomen.

  • Thighs.

  • Back.

Pubic hair growth may run upward from the usual bikini line to the middle of the abdomen.

Virilism (masculinization) is more extensive than hirsutism. It has extra symptoms. There may be:

  • Acne.

  • Oily skin.

  • Baldness.

  • Enlargement of the clitoris.

  • Increased sex drive (libido).

  • Voice deepening.

  • Reduced breast size.

  • Irregular or absent periods.

  • Aggression.

The scalp hair growth may also bald in a typical male pattern.

CAUSES

This is caused by too much male sex hormone (androgen) in the body. It can be produced by the ovaries, adrenal glands, and within the skin. Hirsutism is most commonly related to polycystic ovarian syndrome (PCOS). The first signs of increased androgen levels are hirsutism and acne. How sensitive each person is to hormone levels varies greatly. Virilism may result from higher androgen levels. Some women with hirsutism have normal hormone levels. Eventually there may be male pattern balding. These problems are also connected to difficulty in having children (infertility). In addition, both malignant and benign tumors may cause hirsutism such as tumors of the adrenal gland (adenomas or adenocarcinomas) but this is a rare cause.

There is also evidence that insulin resistance may cause the androgenism. This problem is treated with some success with a medicine for diabetes (metformin).

Causes that come from outside the body (exogenous) may also lead to hirsutism such as intake of androgens by mouth.

Note: Women of Southwest Asian, Eastern European, and Southern European heritage commonly have facial, abdominal, and thigh hair that is normal for them.

TREATMENT

There are medical treatments that inhibit these conditions, such as:

  • Combined oral contraceptive pills, if you are not trying to become pregnant.

  • Medicines that stop the production of hormones (gonadotropins).

  • Steroids. This may be used if there is evidence of congenital (present since birth) adrenal hyperplasia (abnormal growth of cells).

  • Metformin for the treatment of virilization, if sensitive to insulin.

  • Suppression of ovarian hormone production with GnRH analogues (a hormone). They can only be used by themselves for short periods of time.

There are a variety of cosmetic treatments. These may be all that you need. They may be effective against occasional problems.

  • Shaving is the simplest and most effective in the short term. Bleaching is not usually suitable for severe hirsutism.

  • Plucking, waxing, sugaring (similar to waxing), and depilatory creams are effective. However, on occasion, they can result in skin irritation (inflammation) or infection.

  • Electrolysis is effective.

Your caregiver can help you decide what needs to be done and what course of treatment will be best for you. Your caregiver may refer you to an endocrinologist. This is a physician who is specialized in the treatment of glandular disorders.