Causative & risk factors
Hirsutism can occur as a result of excess male sex hormones (androgens) or due to increased sensitivity of hair follicles to androgens. Sometimes it may also be idiopathic, where no appreciable cause can be detected.
All women produce androgens, but at a low level. Severe hirsutism is usually caused by high androgen level.
Conditions which can cause high androgen levels include PCOS, an androgen secreting tumour, Cushing’s syndrome, congenital adrenal hyperplasia and certain medications.
Clinical presentation
The woman develops thick & dark hair on the body, where women do not commonly have hair, such as the lips, face, chin, chest, abdomen and back. Signs of virilisation (resemblance to males) may be observed such as a deepened voice, acne and balding. The muscle mass increases, while the breast size decreases. The clitoris also appears enlarged.
Investigations
Following a medical history and physical exam, the physician will suggest investigations to assess the cause of hirsutism. These may include blood tests and imaging scans such as ultrasounds or MRI scans of the abdomen and pelvic areas.
Treatment
Treatment may be cosmetic or medical.
Home cosmetic measures may include bleaching the excessive hair growth or hair removal by shaving, plucking or waxing. The woman is advised to lose weight, which decreases the male hormone levels and reduces hair growth.
Hair removal can also be achieved by cosmetic procedures like electrolysis or laser therapy.
Medications can be prescribed depending upon the underlying cause. These may include oral contraceptives or anti-androgen drugs.
