How does hirsutism differ from hypertrichosis?
With hirsutism, thin vellus hair turns into coarse and dark hair precisely in androgen-dependent zones - this is the reaction of the follicles to male sex hormones. Hypertrichosis is another condition: increased hair growth throughout the body, including areas not affected by androgens, such as the forehead or forearms. Separately, it is worth taking into account ethnic and family characteristics: in women of a number of nationalities, more pronounced hair growth is considered a variant of the norm if the cycle is regular and there are no complaints about other hormonal problems.
- Hirsutism - coarse hair in male areas
- Hypertrichosis - excess hair everywhere, without connection with androgens
- Family characteristics are not a disease
- Regularity of the cycle and speed of hair appearance are important
Reasons
The most common cause is polycystic ovary syndrome, which disrupts ovulation and increases the production of androgens. Less common is the non-classical form of congenital dysfunction of the adrenal cortex. A separate group consists of medicinal causes: anabolic steroids, some hormonal drugs and drugs used in sports. Tumors of the ovaries and adrenal glands that produce androgens are rare, but they are the ones that give a rapid and pronounced increase in symptoms, so they are always excluded.
- Polycystic ovary syndrome
- Nonclassical congenital adrenal dysfunction
- Insulin resistance and obesity
- Hyperprolactinemia
- Cushing's syndrome
- Androgen-producing tumors of the ovaries or adrenal glands
- Taking anabolic steroids, testosterone, and some other drugs
Associated symptoms
Hirsutism is rarely the only complaint. Often accompanied by irregular and infrequent menstruation, acne, oily skin, difficulty conceiving, weight gain and dark velvety spots in the folds of the skin - a sign of insulin resistance. The more such symptoms, the higher the likelihood that the problem is not cosmetics, but a hormonal disease that should be identified and treated.
- Infrequent or absent periods
- Acne and oily skin
- Weight gain, especially in the abdominal area
- Dark patches of skin on the neck and armpits
- Difficulty getting pregnant
- Male pattern thinning of scalp hair
Survey
The doctor evaluates the distribution and nature of the hair, examines the skin and thyroid gland, and clarifies the cycle history and medications taken. Blood is donated for hormones in the morning, for women with a preserved cycle - usually in the first phase. Elevated DHEA sulfate indicates an adrenal source, increased 17-OH-progesterone indicates congenital dysfunction of the adrenal cortex, very high testosterone makes one look for a tumor. Ultrasound shows the structure of the ovaries and helps confirm PCOS.
- Total and free testosterone
- DHEA sulfate
- 17-OH-progesterone
- Prolactin, TSH
- Ultrasound of the uterus and ovaries
- Glucose and insulin if insulin resistance is suspected
- According to indications - CT or MRI of the adrenal glands
Treatment
It is not the hair that is treated, but the cause. With PCOS, the basis is weight loss, even by a few kilograms, physical activity and medications selected by a doctor - combined oral contraceptives and drugs with antiandrogenic effects. The effect develops slowly: already grown coarse hair will not disappear on its own, the therapy stops the appearance of new ones, so the result is assessed no earlier than six months later. At the same time, cosmetic methods are used - laser hair removal and photoepilation, which give the most lasting results on dark hair. Tweezing and waxing are okay, but they irritate the skin and promote ingrown hairs.
- Weight loss and physical activity
- Hormonal therapy as prescribed by a doctor
- Laser or photoepilation for already grown hair
- Treatment of acne and correction of insulin resistance
- Refusal from anabolic steroids and self-prescribed hormones
- Control of the effect no earlier than after 6 months