Hirsutism

Introduction

Hirsutism is a condition where women have too much unwanted hair on their faces and bodies. The hair is dark and coarse and usually appears where men typically grow hair, on the chest, face, and back.

Some body and facial hair is normal, and how much hair 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 aren't caused by any underlying condition. However, sometimes there is a more serious underlying condition, such as Cushing's syndrome. About 8% of adult women in the United States have hirsutism. Sometimes there is no cause that can be found.

Signs and Symptoms

The main symptom of hirsutism is hair growing 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 caused by 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. Those high levels can be caused by:

  • Polycystic ovarian syndrome (PCOS), which may also cause infertility
  • Tumors on the adrenal glands or ovaries
  • Cushing syndrome
  • Medications that can cause hair growth, such as phenytoin (Dilantin), minoxidil (Rogaine), diazoxide (Proglycem), and cyclosporine
  • Anabolic steroids
  • Danazol (Danocrine), used to treat endometriosis

Sometimes, women with hirsutism may have normal levels of male hormones. If there is no underlying condition, then doctors don't know what causes hirsutism.

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 hair growth and also may do a pelvic examination to check for tumors or cysts on the ovaries. After doing the physical exam, 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. For women with polycystic ovary syndrome (PCOS), for example, controlling their weight through diet and exercise may help. 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 condition that is causing it. For example, if medications are making it worse, you can ask your doctor if you can switch medications. A tumor on the ovaries or adrenal glands can be removed surgically. Overweight women with hirsutism may want to lose weight so their bodies will make less testosterone.

If your doctor can't find a cause, you can try a combination of self-care and hair-removal techniques. 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 to treat hirsutism. However, some drugs may lower androgen production and reduce hair growth. It can take 6 months or longer for the medications to 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 lower the amount of androgens your body makes.
  • Spironolactone (Aldactone) -- blocks androgen from being used in the body
  • Eflorinithine (Vaniqa) is a prescription cream for 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

If a tumor on the ovaries or adrenal glands is causing hirsutism, you may need surgery to remove it.

Laser therapy can remove unwanted hair for some women. The laser destroys hair follicles and stop hair from growing. You'll need several sessions to reduce hair growth in specific areas, and you may need touch-ups afterward. Laser therapy works best on women with dark hair and light skin.

Nutrition and Dietary Supplements

Ask your health care provider how you can use complementary and alternative therapies in 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 stay at a good weight, which may help lower 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 fat, 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 may strengthen and tone the body's systems. As with any therapy, you should work with your health care provider before starting any treatment. You may use herbs as dried extracts (capsules, powders, and 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.

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, or other hormone-related conditions, should not take these supplements except under their doctor's supervision.

  • Saw palmetto (Serenoa repens) 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 thinners such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, ask your doctor before taking saw palmetto. Also ask your doctor before taking it if you take any hormone medication.
  • Chaste tree (Vitex agnus castus) standardized extract also has anti-androgenic effects. Chaste tree can interfere with some antipsychotic drugs as well as some Parkinson's medications.
  • Black cohosh (Actaea racemosa) 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 male hormone) in their blood. The researchers thought 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 hormone levels. Talk to your doctor if you are pregnant, breastfeeding, 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 improve your 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 techniques -- laser hair removal, waxing -- can reduce unwanted hair. Women who are embarrassed by their condition may be helped by seeing a trained counselor.

Supporting Research

Akdogan M, Tamer MN, Cure E, et al. Effect of spearmint (Mentha spicata Labiatae) teas on androgen levels in women with hirsutism. Phytother Res. 2007 May;21(5):444-7.

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.

Bode D, Seehusen DA, Baird D. Hirsutism in women. Am Fam Physician. 2012 Feb 15;85(4):373-80. Review.

Domino FJ, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins, Inc.; 2007.

Fauci AS, Braunwald E, Hauser SL, et al, eds. Harrison's Principles of Internal Medicine. 17th ed. New York, NY: McGraw-Hill; 2008.

Franks S. The investigation and management of hirsutism. J Fam Plann Reprod Health Care. 2012 Jul;38(3):182-6. doi: 10.1136/jfprhc-2011-100175.

Goldman L, Ausiello DA, et al, eds. Cecil Textbook of Medicine. 23rd ed. Philadelphia, Pa: W.B. Saunders; 2007.

Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010 Feb;24(2):186-8.

Larsen PR, Kronenberg HM, et al. Williams Textbook of Endocrinology. 11th ed. Philadelphia, Pa: W.B. Saunders; 2008.

Liepa GU, Sengupta A, Karsies D. Polycystic ovary syndrome (PCOS) and other androgen excess-related conditions: can changes in dietary intake make a difference? Nutr Clin Pract. 2008 Feb;23(1):63-71. Review.

Middlekauff HR, Yu JL, Kui K. Acupuncture effects on reflex responses to mental stress in humans. Am J Physiol Regulat Integrat Comp Physiol. 2001;280:R1462-R1468.

Wuttke W, Gorkow C, Seidlova-Wuttke D. Effects of black cohosh (Cimicifuga racemosa) on bone turnover, vaginal mucosa, and various blood parameters in postmenopausal women: a double-blind, placebo-controlled, and conjugated estrogens-controlled study. Menopause. 2006;13(2):185-96.

Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlove-Wuttke D. Chaste tree (Vitex agnus-castus )--pharmacology and clinical indications. Phytomedicine. 2003;10(4):348-57.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties.Yonsei Med J. 2005;46(5):585-96.

Alternative Names

Hair growth - excessive

Version Info

  • Last Reviewed on 12/28/2012
  • Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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This page was last updated: May 7, 2013

         
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