Introduction:

Hirsutism is a condition that involves excessive growth of dark, coarse body and facial hair in women. The abnormal hair growth usually occurs on the body where men typically grow hair, on the chest, face, and back. Some body and facial hair growth is normal. But women with hirsutism tend to produce elevated levels of male sex hormones called androgens from their ovaries and adrenal glands. Most cases of hirsutism are not severe and have no underlying cause. However, sometimes there is a more serious underlying condition, such as Cushing's syndrome. An estimated 8% of adult women in the United States have hirsutism.

Signs and Symptoms:

The primary symptom of hirsutism is hair growth on the abdomen, breasts, and upper lip (male-pattern hair growth in women). If hirsutism is caused by high levels of male hormones, symptoms also can include:

• Irregular menstrual periods
• Acne
• Loss of feminine body shape
• Signs of masculinity -- deepening voice, frontal balding, enlarged clitoris, enlarged shoulder muscles

If hirsutism is due to Cushing syndrome, signs and symptoms can include:

• Obesity (especially around the abdomen)
• High blood pressure (hypertension)
• Diabetes
• Thinning of the skin

Causes:

About half of women with hirsutism have elevated levels of male sex hormones, called androgens. High levels of these hormones can be caused by:

• Polycystic ovarian syndrome (PCOS) -- often associated with infertility
• Tumors on the adrenal glands or ovaries
• Cushing syndrome
• Severe insulin resistance
• Medications that can cause hair growth -- phenytoin, minoxidil, diazoxide, cyclosporine, and hexachlorobenzene
• Anabolic steroids
• Danazol -- a substance used to treat endometriosis

In other cases, women with hirsutism may have normal levels of male hormones. If no underlying condition is found, the cause of hirsutism is unknown.

Risk Factors:

The following factors may increase your risk of hirsutism:

• Genetics -- some conditions that cause hirsutism may be inherited.
• Race and ethnicity -- women of European, Middle Eastern, and South Asian ancestry are more likely to develop the condition.
• Menopause

Diagnosis:

Your doctor will examine you and take a medical history. You may be asked about your menstrual cycles, what medications you take, and your family history. Your doctor will check you for excessive hair growth and also may perform a pelvic examination to determine whether tumors or cysts are present on the ovaries. After performing the physical examination, your doctor may order one of the following tests:

• Blood tests -- may show elevated androgen levels
• CT scan, MRI, pelvic ultrasound -- used to identify cysts or tumors on the ovaries or adrenal glands

Preventive Care:

Preventing hirsutism depends upon the underlying cause. Women with polycystic ovary syndrome (PCOS), for example, can benefit from controlling their weight through diet and exercise. Studies suggest that obese women with PCOS may be less likely to develop hirsutism if they eat a low-calorie diet.

Treatment:

The treatment for hirsutism depends how severe the problem is and whether there is an underlying cause. For example, a women with hirsutism may be advised to stop taking medications that could be contributing to the condition. If a tumor on the ovaries or adrenal glands is the cause, it may be removed surgically. Overweight women with hirsutism may be advised to lose weight to lower androgen production in the body.

If no underlying cause is found, a combination of self-care strategies and hair-removal techniques may be used. Psychological support may also be helpful since hirsutism is often a frustrating and embarrassing condition.

Lifestyle

Being overweight may contribute to hirsutism. Eating a balanced diet and getting adequate exercise can help control weight.

Medications

The U.S. Food and Drug Administration (FDA) has not approved any medications for the treatment of hirsutism. However, some drugs may lower androgen production and reduce hair growth. It can take 6 months or longer for the medications to effectively reduce hair growth. They must be taken indefinitely to keep symptoms under control. These medications include:

• Birth control pills -- Some birth control pills can reduce androgen production in the body.
• Spironolactone (Aldactone) -- blocks androgen receptors in the body
• Eflorinithine (Vaniqa) is a prescription cream that treats unwanted facial hair. It slows new hair growth but doesn't get rid of existing hair. Hair comes back if you stop using the cream.

Surgery and Other Procedures

A doctor may recommend the following surgical procedures in severe cases of hirsutism:

• Tumor removal -- if a tumor on the ovaries or adrenal glands is the cause
• Ovary removal after childbearing years -- if ovaries are producing elevated levels of androgens

Cosmetic hair removal techniques include laser therapy, which uses a laser to destroy hair follicles and stop hair from growing. Several sessions are needed to reduce hair growth in specific areas, and you may need touch-ups afterward. Laser therapy works best on women with light skin.

Nutrition and Dietary Supplements

A comprehensive treatment plan for hirsutism may include a range of complementary and alternative therapies. A few preliminary studies suggest that some nutritional supplements may reduce symptoms of some hirsutism. Ask your health care provider how to best incorporate complementary and alternative therapies into your overall treatment plan. Always tell your health care provider about the herbs and supplements you are using or considering using.

These nutritional tips are for general health:

• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes) and vegetables (such as squash and bell peppers).
• Avoid refined foods, such as white breads, pastas, and especially sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy, if no allergy), or beans for protein.
• Use healthy oils in foods, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and some margarines.
• Avoid alcohol and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

The following supplements may be suggested for hirsutism related to an excess of male hormones (androgens), although there is not a lot of evidence about whether they work. Always talk to your doctor before taking any supplement that can affect hormones. Do not take these supplements if you are pregnant or breast-feeding, or planning to become pregnant.

• Calcium-D-Glucarate, 200 mg two times daily, may help the body detoxify hormones and decrease symptoms of hirsutism.
• Diindolylmethane (DIM), a natural supplement derived from brassica vegetables (broccoli and cauliflower), 120 mg daily, has anti-androgenic effects. It may help the body with underlying hormonal balances which may be causing hirsutism.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted. Talk with your health care provider about which herb may be best for you.

These herbs are sometimes suggested to treat hirsutism, but scientific evidence is lacking. Always talk to your doctor before taking any herb that can affect hormones. Do not take these supplements if you are pregnant or breast-feeding, or planning to become pregnant.

• Saw palmetto (Serenoa repens) standardized extract, 160 mg two times daily, has anti-androgenic effects. It is sometimes suggested for treating polycystic ovary syndrome, although there is no scientific evidence whether it works or not.
• Chaste tree (Vitex agnus castus) standardized extract, 20 - 40 mg daily before breakfast, also has anti-androgenic effects.
• Black cohosh (Actaea racemosa) standardized extract, 20 - 40 mg two times a day, is another herb with anti-androgenic effects.
• Spearmint tea (Mentha spicata), 1 cup two times per day. A preliminary study found that women with hirsutism who drank spearmint tea had less free testosterone (a type of androgen or male sex hormone) in their blood. The researchers suggested that the tea might reduce symptoms of mild hirsutism.

Acupuncture

One small study of women with hirsutism found that acupuncture reduced both hair density and hair length. It also significantly reduced their levels of the male sex hormone testosterone. However, more research is needed to confirm the benefit and to see what causes of hirsutism respond best to acupuncture.

Other Considerations:

Pregnancy

• Generally, during pregnancy, do not take medications, herbs, or supplements that alter androgen levels. Talk to your doctor if you are pregnant, breast-feeding, or plan to become pregnant.

• Hair growth may increase during the third trimester, especially on the face, arms and legs, and breasts. This is considered normal and is not a sign of hirsutism.

Prognosis and Complications

If the underlying cause of hirsutism can be identified and treated, the symptoms of hirsutism may be reduced or eliminated. Long-term medication may slow hair growth, but it generally won't eliminate existing hair on the face and body. Some cosmetic therapies can reduce the appearance of excessive hair growth. Counseling with a trained professional may be helpful for women who experience psychological stress.

Alternative Names:

Hair growth - excessive