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Hirsutism

Also listed as: Hair growth - excessive

• Signs and Symptoms
• Causes
• Risk Factors
• Diagnosis
• Preventive Care
• Treatment
• Other Considerations
• Supporting Research

Hirsutism is excessive growth of dark, coarse body and facial hair in women. The abnormal hair growth typically occurs in a pattern seen in adult males. While some body and facial hair growth is normal, 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 excessive and have no underlying cause, but some may indicate the presence of 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 signs and symptoms of hirsutism include:

• Hair growth on the abdomen, breasts, and upper lip (male-pattern hair growth in women)
• Irregular menstrual periods
• Acne
• Abnormally strong smelling perspiration
• Loss of feminine body shape
• Signs of masculinity -- deepening voice, frontal balding, enlarged clitoris, enlarged shoulder muscles
• Cushing's syndrome -- a condition marked by obesity (especially around the abdomen), high blood pressure, diabetes, and thinning of the skin

Causes

Identifiable causes of hirsutism are generally related to increased secretion of androgens from the ovaries or adrenal glands. This can result from a variety of conditions, including:

• Polycystic ovarian syndrome (PCOS) -- often associated with infertility
• Tumors on the adrenal glands or ovaries
• Cushing's syndrome
• Severe insulin resistance
• Obesity

Hirsutism may also be caused by:

• Medications that can cause hair growth -- phenytoin, minoxidil, diazoxide, cyclosporine, and hexachlorobenzene
• Anorexia nervosa
• Anabolic steroids
• Danazol -- a substance used to treat endometriosis
• Hormone replacement therapy (HRT) containing androgens
• Birth control pills containing high levels of androgen hormones

Risk Factors

The following factors may increase an individual's risk of hirsutism:

• Genetics -- hair patterns are inherited
• Anorexia nervosa
• Race and ethnicity -- the condition is more common in women predominantly of European ancestry than it is in those of Asian, Native American, or African ancestry. It is also more common in dark-skinned women.
• Menopause
• Obesity

Diagnosis

The first step is to conduct a physical examination. During the physical exam, the doctor will inspect the body for all sites of abnormal hair growth and ask questions about the onset and progression of the condition. A doctor may also perform a pelvic examination to determine whether tumors or cysts are present on the ovaries. After performing the physical examination, one of the following may be necessary to identify the cause of hirsutism:

• Laboratory tests -- may detect elevated androgen levels
• CT scan, MRI, pelvic ultrasound -- used to identify cysts or tumors on the ovaries or adrenal glands
• Laparoscopy -- an instrument is inserted into the abdominal wall to detect cysts or tumors on the ovaries.

Preventive Care

Even if an individual is at risk for hirsutism, there are steps she can take to prevent it. For example, studies suggest that obese women with PCOS may be less likely to develop hirsutism if they consume a low-calorie diet.

Treatment

The specific treatment for hirsutism depends on the extent of the problem, whether or not an underlying cause can be identified, and, if so, what the root of that cause is. For example, an individual with hirsutism will usually be advised to discontinue medications that may be contributing to the condition. If a tumor is located on the ovaries or adrenal glands, the doctor will likely recommend that it be surgically removed. Overweight individuals with hirsutism may be urged to participate in a weight loss program since calorie restriction may lower androgen production in the body. Although no medications for hirsutism have been approved by the U.S. Food and Drug Administration (FDA), some drugs may suppress androgen secretion and reduce hair growth. If no underlying cause that can be treated by conventional medication is identified, it may be possible to control the symptoms of hirsutism with acupuncture, and cosmetic therapies that conceal or remove excess hair (such as bleaching and waxing). Psychological support may also be helpful since hirsutism is often a frustrating and embarrassing condition.

Lifestyle

Eating a balanced diet and getting adequate exercise can help control weight, which may diminish or prevent hirsutism related to obesity.

Medications

While there are currently no medications approved by the FDA specifically for the treatment of hirsutism, certain medications may be used to suppress the production and secretion of androgens in the body. Up to 70% of individuals with hirsutism may respond to these medications, but it can take 6 months or longer for the medications to effectively reduce hair growth and they must be taken indefinitely to keep the symptoms under control. These medications include:

• Glucocorticoids (such as Dexamethasone)
• Certain birth control pills with low levels of androgen hormones, such as desogestrel or norgestimate
• Spironolactone

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

Nutrition and Dietary Supplements

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

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• 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 margarine.
• Drink soy milk, for bone health and hormonal balance.
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, five days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins, and trace minerals such as magnesium, calcium, zinc and selenium.
• Calcium-D-Glucarate, 200 mg two times daily, may help the body detoxify hormones and decrease symptoms of hirsutism.
• Diindolylmethane, a natural supplement commonly sold under the trade name Indolplex, 120 mg daily, can help the body process hormones in the most beneficial way, creating helping balance the underlying hormonal balances which may be causing hirsutism.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 - 3 tablespoonfuls oil daily, to help decrease inflammation and help with immunity.
• Vitamin C, 500 - 1,000 mg, one to three times daily, as an antioxidant and for immune support.
• Probiotic supplement (containing Lactobacillus acidophilus ), 5 - 10 billion CFUs (colony forming units) a day, when needed for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Astaxanthin, 2 - 6 mg daily, for immune and antioxidant support.
• Alpha-lipoic acid, 25 - 50 mg twice daily, for antioxidant support.
• Ipriflavone (soy isoflavones) standardized extract, 200 mg three times a day, for breast cancer support.
• Coenzyme Q10, 100 - 200 mg at bedtime, for antioxidant and immune activity.
• Melatonin, 2 - 6 mg at bedtime as needed, for immune support and sleep. Consult your health care provider if you are taking prescription medications, as melatonin.

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.

• Green tea ( Camellia sinensis ) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer, and immune effects. Use caffeine-free products. You may also prepare teas from the leaf of this herb.
• Saw palmetto ( Serenoa repens ) standardized extract, 160 mg two times daily, for hormonal support.
• Chaste tree ( Vitex agnus castus ) standardized extract, 20 - 40 mg daily before breakfast, for hormonal balance.
• Black cohosh ( Actaea racemosa ) standardized extract, 20 - 40 mg two times a day, for hormonal balance.
• Milk thistle ( Silybum marianum ) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Rhodiola ( Rhodiola rosea ) standardized extract, 100 - 600 mg daily, for antioxidant and anti-stress activity.

Acupuncture

One small study of women with hirsutism found that acupuncture markedly reduced both hair density and hair length and significantly reduced their levels of the male sex hormone testosterone (a type of androgen). This study is promising, but further research will be required to determine whether greater numbers of women with hirsutism would benefit from acupuncture and what causes of hirsutism respond best to acupuncture.

Other Considerations

Pregnancy

• Medications that alter androgen levels should generally not be taken during pregnancy. A doctor can provide guidance and appropriate medical care.

• Hair growth may increase during the third trimester, especially on the face, extremities, and breasts. This hair growth 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 effectively controlled. Long-term medication, when appropriate, will slow hair growth, but it generally won't eliminate existing hair patterns on the face and body. There are some cosmetic therapies that can reduce the appearance of excessive hair growth. Counseling with a trained professional may also be helpful for women who experience psychological stress as a result of their hair growth.

Supporting Research

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Atmaca M, Kumru S, Tezcan E. Fluoxetine versus Vitex agnus castus extract in the treatment of premenstrual dysphoric disorder. Human Psychopharmacol . 2003;18(3):191-5.

Botwood N, Hamilton-Fairley D, Kiddy D, Robinson S, Franks S. Sex hormone-binding globulin and female reproductive function . J Steroid Biochem Mol Biol. 1995;53(1-6):529-531.

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea--a review. J Am Coll Nutr . 2006;25(2):79-99.

Crave JC, Fimbel S, LeJeune H, Cugnardey N, Dechaud H, Pugeat M. Effects of diet and metformin administration on sex hormone-binding globulin, androgens, and insulin in hirsute and obese women. J Clin Endocrinol Metab. 1995;80(7):2057-2062.

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El-Sheikh MM, Dakkak MR, Saddique A. The effect of Permixon on androgen receptors. Acta Obstet Gynecol Scand . 1988;67(5):397-399.

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• Review Date: 10/21/2006
• Reviewed By: Ernest B. Hawkins, MS, BSPharm, RPh, Health Education Resources; and Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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