Hypertrichosis and Hirsutism

HYPERTRICHOSIS, Hirsutism and hairiness are an issues for many women very often determined by genetic basis. In other cases, they are derived from hormones, in particular ovarian hormones. In every case, these conditions represent such a real cosmetic issue to affect not only relationships.

There are a lot of strategies to fight this blemish, but the right therapeutic choices  always lay their foundations on a correct diagnosis. Before facing this multidisciplinary issue, I would like to explain the “hair”.

DIFFERENCES BETWEEN HAIRS

A normal hair on adult and wealthy women is formed by a not pigmented 2-3 mm long body hair distributed over the entire body. These body hair are called “Vellus Hair” and they already are present during childhood. They are normal on males and tends to disappear in later life. By “Vellus Hair”, we can find, almost invisible, some longer and pigmented hair, with a harder consistence. Typical of underarm regions, these androgen-depending hair are called “Sexual Hair” and typically arise during puberty.

Physical Condition connected to a light or moderate hairiness:

  • Pregnancy
  • Ageing

The “Sexual Hair” are also present on the middle of lower abdomen (called “Linea Alba”), face, shoulder, back and on limbs. These hair are normal on males and usually they are lower or absent on women, but as the years pass they become more marked because of a progressive androgenization of the endocrine structure in the post-menopausal years.

DEBATING THE HAIR PROBLEM WITH YOUR FAMILY AND WITH ESTHETICIANS: TOO MANY OR NO

hirsutism classification

The Ferrimans and Gallwey classification of the Hirsutism.

TOO MANY….

How can we rationally distinguish those somatic hair growth typical of a ethnic group (hair growth on a woman from Southern Italy are not the same on a finnish woman) from  those included in Hypertrichosis and Hirsutism cases?

In fact, an opinion made on visual subjective assessment and in particular on the light form of the disease might actually be controversial.

Hypertrichosis is an increase of hairiness in regions of the female body where hair are usually present but not visible. Hair become more numerous, thick, dark and so easily visible.

Hirsutism cause a male pattern of body hair like chin, cheeks, chest, abdomen, shoulder and back.

MORE THAN A REASON, UNFORTUNATELY

Not always it is only a blemish. Indeed, in some cases excessive hairiness might be pathological endocrine, a drug or a chemical substance effect.

Hirsutism Pharmacological causes:

  • Testosterone
  • Danazol
  • Anabolic Steroids
  • Some Progestogen with a marked androgenic capacity (19-nortestosterone derivative)
  • Minoxidil (anti-hypertension medicine)

A word of advice: spend a moment by your General Practitioner before consulting a beauty center.

hirsutism distribution

Typical distribution of Hirsutism.

Woman may experience an increased sensitivity of the follicles receptors at normal levels of androgens in blood but sometimes these last are increased and the cause is usually ovary and / or adrenal: One of the most common causes is the Polycystic Ovary Sindrome but less frequently there may be an enzyme deficiency in the Adrenal gland or pathologies that also involve the Pituary gland.

A GOOD STARTING POINT in an analysis of a case of Hypertrichosis or Hirsutism is the assessment of androgen hormones but instrumental investigations will be oriented mainly by suspected diagnosis and so the role of the gynecologist and endocrinologist has become more important.

About the Polycystic and Micropolycystic Ovary Sindrome you will find a very wide explanation in other pages of this site.

THERE IS NOT ONLY A PHARMACOLOGICAL SOLUTION

The psychological impact of a hypertrichosis and hirsutism condition is significant at any age. Fortunately, there are a lot of solutions. The problem must be always faced by several different medical and non-qualified medical professional in a collaborative and integrated way.

It is clear that promptly aesthetic actions ranging discoloration, depilatory wax and laser (we explain them in other sections of this website) must be follow an pharmacological interventions when indicated.

Pharmacological therapy should be modulated on the seriousness of the problem, on the quantity of androgens and on possible problems concerning internal medicine and endocrine systems.

Medicines used against Hirsutism are numerous and some of them have a decent effects but unfortunately have also possible side effects, reason why prescription is always made by endocrinology and metabolism specialists.

Some of these medications are intended to reduce the ovarian production and increase the plasma levels of androgen binding proteins, others operate at the receptor level (androgen fails to bind to the target cell), others act at post-receptoral level reducing enzymatic transformations into active metabolites. We deliberately do not make a list to discourage attempts to misuse.

NEVER FORGET METABOLISM AND CARDIOVASCULAR SYSTEM

Sometimes changes in lifestyle and a different diet could help the patient: for example, it is important to correct a condition of overweight or obesity because hyperinsulinemia associated to these conditions stimulates the ovarian production of androgens.

hirsute woman

Hirsute woman with moderate abdominal obesity.

It is also important treat metabolic and cardiovascular damages caused by an excessive increase of androgens. Indeed, an excessive increase of androgens or a high use of androgens drugs may negatively impact on glucose and lipid metabolism speeding up the process of arteries atherosclerosis, increase blood pressure and cause an ischemic cardiac damage.

MAY MODERN ACTIVE SUPPLEMENTS ON GLUCOSE METABOLISM BE USEFUL?

Yes they are, particularly in the forms related to Polycystic Ovary Sindrome and Micropolycystic Ovary Sindrome but the effect is quite slow. I would consider these products from a  health preservation point of view.

A REAL HOPE

In my opinion, there is a real hope for women suffering this problem. An accurate diagnosis and a suited therapeutic strategy are important, but much will depend on both patient and medical team persevera

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Filiberto Di Prospero
Medical Doctor, Consultant in Gynecology and Obstetrics, Endocrinology and Metabolism. Director of Gynecologic Endocrinology Unit at Civitanova Marche General Hospital (Italy). Private clinics in Civitanova Marche, Rome and Milan.

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