Hirsutism
One-third of women between 15-44 years of age have terminal hair growth on the upper lip, lower abdomen, or breasts. Approximately seven percent have terminal hair growth on their chin or side of their face. There are significant variations in body hair distribution, however, course terminal hair suggests an excess of male hormones (androgens).
Causes of androgen dependent hirsutism include: polycystic ovary syndrome, congenital adrenal hyperplasia, ovarian tumors, adrenal tumors, Cushing's syndrome, acromegaly, ACTH secreting tumors, and HAIR-AN syndrome (hyperandrogenism- insulin resistance, acanthosis nigricans syndrome). If the hirsutism is mild or moderate, is not associated with virilizing signs or symptoms (male pattern baldness, voice changes, clitoromegaly), and has been slowly progressive since puberty an extensive hormonal evaluation is usually unnecessary.
If, however, hirsutism is of recent onset and severe, or there is evidence of virilization, a work up should be performed. Testosterone is the best marker for ovarian androgens secretion. Approximately two-thirds of circulating testosterone is attributed to the ovary. When levels are greater than 200 ng/dl an androgens secreting ovarian tumor may be present. DHEA Sulfate is almost exclusively an adrenal product.
When values are greater than 700 ug/dL one must consider an adrenal tumor as a source of androgens. An elevated 17 hydroxyprogesterone level suggests congenital adrenal hyperplasia, a 21-hydroxylase deficiency. Bioavailabe testosterone levels assess the free testosterone circulating in the serum and correlates with clinical findings when the total testosterone level is normal.
Oral contraceptives are presently the mainstay of therapy for isolated hirsutism as they decrease adrenal and ovarian androgen production and reduce hair growth in nearly two-thirds of patients. Additional medical treatments include medroxyprogesterone acetate, GnRH agonists, dexamethasone, ketaconazole, spironolactone, cyproterone acetate, flutamide, cimetadine, finasteride, and insulin lowering agents.
A thorough evaluation and assessment of the causes of hirsutism by your reproductive endocrinologist will suggest the most beneficial treatment for your situation.
