Introduction:

Hirsutism is a condition where women have excess facial and body hair that is dark and coarse. The abnormal hair growth usually happens on the body where men typically grow hair, on the chest, face, and back.

Some body and facial hair is normal, and the amount varies among women. But about half of women with hirsutism may have high levels of male sex hormones called androgens. 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. Sometimes there is no cause that can be identified.

Signs and Symptoms:

The top 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, male pattern baldness, enlarged clitoris, enlarged shoulder muscles

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

• Obesity, especially around the middle section
• High blood pressure (hypertension)
• Diabetes
• Thinning skin

Causes:

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

• Polycystic ovarian syndrome (PCOS) -- may also cause infertility
• Tumors on the adrenal glands or ovaries
• Cushing syndrome
• Medications that can cause hair growth -- phenytoin, minoxidil, diazoxide, cyclosporine, and hexachlorobenzene
• Anabolic steroids
• Danazol -- 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

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 do a pelvic examination to check for tumors or cysts on the ovaries. After doing the physical examination, your doctor may order one of the following tests:

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

Preventive Care:

Preventing hirsutism depends on what may be causing it. Women with polycystic ovary syndrome (PCOS), for example, may help by 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, if medication are making the condition worse, you may want to ask your doctor if you can take other medications or stop taking them. If a tumor on the ovaries or adrenal glands is the cause, it may be removed surgically. Overweight women with hirsutism may want to lose weight so their bodies will produce less testosterone.

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

Lifestyle

Being overweight may contribute to hirsutism. Eating a balanced diet and getting enough 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 long-term 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 tumor removal, if a tumor on the ovaries or adrenal glands is the cause of hirsutism.

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

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 may help women maintain a proper weight, which may help lower levels of androgens in the body:

• 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.

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 most haven' t been studied by scientists. 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. Women who have a history of breast, uterine, or ovarian cancer should not take these supplements except under their doctor's supervision.

• Saw palmetto (Serenoa repens) standardized extract, 160 mg two times daily, has anti-androgenic effects, meaning it lowers levels of male hormones in the body. It is sometimes suggested for treating polycystic ovary syndrome, although there is no scientific evidence whether it works or not. Saw palmetto may increase the risk of bleeding. If you take blood-thinning medications such as warfarin (Coumadin), ask your doctor before taking saw palmetto.
• Chaste tree (Vitex agnus castus) standardized extract, 20 - 40 mg daily before breakfast, also has anti-androgenic effects. Chaste tree can interfere with some antipsychotic drugs as well as some Parkinson' s medications.
• Black cohosh (Actaea racemosa) standardized extract, 20 - 40 mg two times a day, is another herb with anti-androgenic effects. Do not take black cohosh if you have liver disease. Black cohosh may increase the risk of blood clots, so do not take it if you have a clotting disorder.
• 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 hormone) in their blood. The researchers suggested that the tea might reduce symptoms of mild hirsutism. Another study found that spearmint tea lowered androgen levels in women who had PCOS.

Acupuncture

One small study of women with hirsutism found that acupuncture reduced both hair density and hair length. It also reduced their levels of the male hormone testosterone. However, more research is needed to make sure acupuncture works for hirsutism.

Other Considerations:

Pregnancy

If you are pregnant, you should not take medications, herbs, or supplements that change androgen levels. Talk to your doctor if you are pregnant, breast-feeding, or plan to become pregnant.

Pregnant women may notice more hair growth during the third trimester, especially on the face, arms and legs, and breasts. This is normal and is not a sign of hirsutism.

Prognosis and Complications

Treating the underlying cause of hirsutism can reduce the symptoms. Long-term medication may slow hair growth, but it usually won't get rid of existing hair on the face and body. Some cosmetic therapies -- laser hair removal, waxing -- can reduce the appearance of hair growth. Counseling with a trained professional may be help women who are embarrassed or have poor self-esteem.

Alternative Names:

Hair growth - excessive