Hirsutism

and Sabine Schrör, medical journalist

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts

Sabine Schrör is a freelance writer for the medical team. She studied business administration and public relations in Cologne. As a freelance editor, she has been at home in a wide variety of industries for more than 15 years. Health is one of her favorite subjects.

More about the experts All content is checked by medical journalists.

One speaks of hirsutism when women are very hairy in areas that are typical of male body hair. These include the chin and upper lip (“lady's beard”), cheeks, upper arms, back and stomach. Possible triggers are hormonal diseases or tumors. Usually, however, there is no underlying disease behind the increased body hair (idiopathic hirsutism). Read more about the forms, causes and treatment options of hirsutism here.

Brief overview

Description: Excessive hair growth in women in typical male hair areas, for example upper lip, chin, back, stomach.
Causes: e.g. impaired testosterone production in the ovaries or adrenal glands, ovarian or adrenal gland tumors, Cushing's disease, porphyrias (group of metabolic diseases) or neurological disorders, certain drugs (such as anabolic steroids, glucocorticoids). Mostly, however, idiopathic hirsutism, with no underlying disease. The cause is then presumably a hereditary over-sensitivity of the hair follicles to testosterone.
Treatment: If the underlying disease is triggered, this is treated. For drug-induced hirsutism: Replacement of the causative drugs with other active ingredients. In idiopathic hirsutism: drug therapy (e.g. with antiandrogens).
Self-treatment: shaving, epilation, chemical hair removal, laser hair removal, sclerosing hair follicles.
When to the doctor In the case of suddenly appearing, strong male body hair, especially if additional symptoms are added, such as a lower voice pitch or a greatly enlarged clitoris.
Diagnosis: taking a medical history (anamnesis), physical examination, blood tests (with hormone measurements). If you suspect tumors of the ovaries or adrenal glands, computed tomography (CT) or ultrasound examination.

Hirsutism: description

Women with hirsutism suffer from increased hair growth on typical male hair areas such as the chin and upper lip (“lady's beard”), chest, stomach, arms or legs. Instead of the light, soft hairs (vellus hairs) that normally sprout in women in these areas, dark, thick hairs (terminal hairs) appear. Sometimes hirsutism is only very mild, but there are also severe forms.

The possible causes of the symptom are many. Some of these are associated with high levels of testosterone in the blood, while others are not. Testosterone is the most important representative of male sex hormones (androgens). Mostly, hirsutism develops as a result of hormonal changes, especially during puberty, pregnancy and menopause. Dark skin and hair types seem to be more at risk than light ones.

Differentiation between hirsutism and hypertrichosis

Hypertrichosis must be distinguished from hirsutism. Normal body hair increases (thickens), either all over the body or in localized areas. Androgen-dependent parts of the body (e.g. beard area) are not preferred, as is the case with hirsutism. Androgens such as testosterone do not seem to play a role in the development of hypertrichosis.

Virilization (masculinization)

Sometimes other typically masculine changes accompany hirsutism. In this way, the voice of the affected woman can become deeper, while the hair on the head becomes thinner and even bald. Cycle disorders are also typical of virilization (masculinization). In addition, increased muscle formation is observed in some of the women affected, while the breasts shrink and sag. The increased formation of male sex hormones is always responsible for this masculinization.

Hirsutism: causes

Hirsutism can have very different causes:

Idiopathic hirsutism

Around 90 percent of those affected suffer from idiopathic hirsutism. This means that hirsutism cannot be traced back to an underlying disease. Rather, the symptom is based on a genetic predisposition. It is believed that the hair follicles of those affected are hypersensitive to testosterone (with normal testosterone levels).

Hirsutism: causes in the ovarian area

The ovaries (ovaries) are the main testosterone production facility in women. If they produce too much of the male sex hormone, the testosterone level in the blood rises. Doctors then also say: The free testosterone index is increased.

Testosterone overproduction in the ovaries occurs, for example, in polycystic ovarian syndrome (PCOS). This complex ovarian dysfunction is associated with menstrual cycle disorders, obesity (adiposity) and hirsutism.

A very rare ovarian cause of hirsutism is an ovarian tumor that produces male sex hormones.

Hirsutism: causes affecting the adrenal glands

Hirsutism can also be caused by a dysfunction of the adrenal glands - testosterone is also produced there in women. One example is the so-called adrenogenital syndrome (AGS). This term covers a group of metabolic diseases in which the production of hormones in the adrenal glands is disturbed. Among other things, androgens such as testosterone are increasingly produced.

Very rarely is an androgen-producing tumor of the adrenal glands behind the hirsutism.

Drug-related hirsutism

Sometimes hirsutism develops as a result of long-term or high-dose treatment with certain drugs. These drugs include, for example:

Androgens (male sex hormones)
Anabolic steroids
Progestins (female sex hormones)
ACTH (adrenal stimulating hormone)
Glucocorticoids ("cortisone")
Minoxidil (antihypertensive and hair restorer)
Ciclosporin (after transplants and in autoimmune diseases)
Diazoxide (for hypoglycaemia)

Other causes of hirsutism

Other possible triggers of hirsutism are, for example:

Acromegaly (rare hormonal disorder with an excess of growth hormone)
Cushing's disease (excessive production of the ACTH hormone caused by a pituitary gland tumor)
Porphyria (group of metabolic diseases)
neurological diseases

Hirsutism: treatment

The treatment of hirsutism is individually adapted to each patient. It essentially depends on the cause of the disorder. In addition, the therapy for ladies' beard and co. Depends on how strong the disturbing body hair is and where it occurs. Other important factors are the patient's age, any previous illnesses and the desire to have children or to use contraception.

So there are different treatment options for hirsutism, which are sometimes combined with each other. Examples:

An underlying disease is treated if it can be identified as the cause of male body hair. For example, a hormone-producing tumor in the ovaries or adrenal glands is often surgically removed.

In the case of drug-induced hirsutism, the causative drug is discontinued or replaced, if possible - with a preparation that does not cause hirsutism. The increased hair then usually disappears by itself.

In addition, drugs against hirsutism are often used, for example:

Antiandrogens: Active ingredients such as cyproterone acetate reduce the effect of the male sex hormones on the hair follicles and thus inhibit excessive hair growth. Antiandrogens can be prescribed as a single substance (monotherapy) or in combination with a hormonal contraceptive (ethinylestradiol). The latter is advisable if contraception is also desired.
Ethinylestradiol: The ovulation inhibitor (ovulation inhibitor) reduces the release of testosterone from the ovaries.
GnRH analogues or glucocorticoids (cortisone)
Eflornithine: The doctor may prescribe a cream containing eflornithine for local treatment of hirsutism. This is applied thinly to the affected areas of the skin twice a day at least eight hours apart. The inhibiting effect on hair growth only becomes apparent after several weeks of treatment and is lost again when the cream is discontinued. Creams with eflornithine are mainly used for the treatment of hirsutism on the face.

Hirsutism: diagnosis

The doctor will first ask you about your medical history (anamnesis). For example, he asks when the male hair began to appear, whether other women in your family are affected, whether you suffer from certain underlying diseases and what medication you are taking.

You should also inform the doctor about other signs of virilization, for example about a lower pitch of the voice, a possible absence of menstrual bleeding or an unusually enlarged clitoris (clitoral hypertrophy). The doctor also pays attention to such changes and to the pattern of increased body hair during the physical examination.

This is followed by blood tests. The focus is on the measured values of various hormones such as testosterone, dehydroepiandrosterone sulfate (DHEAS, a precursor to testosterone and other sex hormones) and prolactin (which promotes breast milk production, among other things). These data provide important clues as to the possible cause of hirsutism:

If the levels of testosterone, DHEAS and prolactin are normal, the hirsutism is idiopathic or due to polycystic ovarian syndrome (PCOS).

If, on the other hand, testosterone and DHEAS values are normal, but the prolactin level is increased, this can indicate a benign tumor of the pituitary gland (pituitary adenoma). However, certain drugs can also increase the prolactin level.

Depending on the suspected cause, the doctor will conduct further examinations. For example, computer tomography (CT) or an ultrasound examination of the abdomen can detect tumors of the ovaries or adrenal glands.

Hirsutism: You Can Do It Yourself

A cosmetic treatment helps with mild hirsutism: For example, hair on the back or face can be shaved or epilated regularly. Chemical depilatories can also help against the annoying hair build-up. However, it is best to have an expert explain how to use it for the first time in order to avoid side effects such as skin irritation.

Hirsutism can also be slowed down by laser hair removal or by desolating the hair roots. Alternatively, you can bleach the dark terminal hair with hydrogen peroxide. You should definitely leave such treatments to an expert (dermatologist or specialist beautician)!

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