Hirsutism

Overview

Hirsutism (HUR-soot-iz-um) is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern — face, chest and back.

With hirsutism, extra hair growth often arises from excess male hormones (androgens), primarily testosterone.

Self-care methods and effective treatment options are available for women who wish to treat hirsutism.

Symptoms

Hirsutism is stiff or dark body hair, appearing on the body where women don't commonly have hair — primarily the face, chest, lower abdomen, inner thighs and back. People have widely varying opinions on what's considered excessive.

When high androgen levels cause hirsutism, other signs might develop over time, a process called virilization. Signs of virilization might include:

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

When to see a doctor

If you think you have too much coarse hair on your face or body, talk with your doctor about treatment options.

Excess facial or body hair is often a symptom of an underlying medical problem. See your doctor for assessment if over a few months you experience severe or rapid hair growth on your face or body or signs of virilization. You may be referred to a doctor who specializes in hormone disorders (endocrinologist) or skin problems (dermatologist).

Causes

Hirsutism may be caused by:

• Polycystic ovary syndrome (PCOS). This condition, which often begins with puberty, causes an imbalance of sex hormones. Over years, PCOS may slowly result in excess hair growth, irregular periods, obesity, infertility and sometimes multiple cysts on the ovaries.
• Cushing syndrome. This occurs when your body is exposed to high levels of the hormone cortisol. It can develop from your adrenal glands making too much cortisol or from taking medications such as prednisone over a long period.
• Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.
• Tumors. Rarely, an androgen-secreting tumor in the ovaries or adrenal glands can cause hirsutism.
• Medications. Some medications can cause hirsutism. These include minoxidil (Minoxidil, Rogaine); danazol, which is used to treat women with endometriosis; testosterone (Androgel, Testim); and dehydroepiandrosterone (DHEA). If your partner uses topical products containing androgens, you can be affected as well, through skin-to-skin contact.

Often hirsutism occurs with no identifiable cause.

Risk factors

Several factors can influence your likelihood of developing hirsutism, including:

• Family history. Several conditions that cause hirsutism, including congenital adrenal hyperplasia and polycystic ovary syndrome, run in families.
• Ancestry. Women of Mediterranean, Middle Eastern and South Asian ancestry are more likely to have more body hair with no identifiable cause than are other women.
• Obesity. Being obese causes increased androgen production, which can worsen hirsutism.

Complications

Hirsutism can be emotionally distressing. Some women feel self-conscious about having unwanted hair. Some develop depression. Also, although hirsutism doesn't cause physical complications, the underlying cause of a hormonal imbalance can.

If you have hirsutism and irregular periods, you might have polycystic ovary syndrome, which can inhibit fertility. Women who take certain medications to treat hirsutism should avoid pregnancy because of the risk of birth defects.

Prevention

Hirsutism generally isn't preventable. But losing weight if you're overweight might help reduce hirsutism, particularly if you have polycystic ovary syndrome.