Diagnosing Hirsutism: Blood Tests, Ultrasound, X-Rays and Other Labs
Hirsutism is a condition experienced by around 5-10% of all women. It is the growth of too much hair on the face or other parts of the body. But hair growth is a subjective experience. What feels like too much body hair to one woman may be perfectly acceptable to another. It is also important to recognize that a combination of cultural norms and societal expectations shape different opinions on what too much hair is.
For women who feel like they have too much body hair, it can be a very distressing condition that impacts their self-esteem and confidence. The first step to dealing with the issue is to speak to your doctor to find out what the cause of the excess hair growth may be.
Hirsutism can be a symptom of a broader medical condition such as polycystic ovarian syndrome (PCOS) or it may be a diagnosis itself. Cushing’s disease, some medications and PCOS have all been known to cause hirsutism. A trip to your doctor will allow them to run a number of diagnostic tests to help determine the cause of hirsutism.
Do you have hirsutism?
Most women have fine, light-colored, and barely noticeable thin hairs. These are called vellus hairs and they’re found in most parts of the body. It is hair that’s usually referred to as peach fuzz. On the other end of the spectrum is the growth of terminal hair. Terminal hairs are coarse, visible and dark. If you suffer from hirsutism, it is the growth of terminal hairs in unwanted places like the face, chest, back and neck that you’ll notice.
Causes of hirsutism
Your doctor will attempt to find out the cause of hirsutism so that it can be treated properly. The most common causes of hirsutism are:
- Polycystic ovarian syndrome
- Cushing’s disease
- Adrenal hyperplasia
- Certain medications
Hirsutism can also be caused by genetics. If female family members (e.g. mom, sister, aunt) suffer from hirsutism, there is a higher risk of you having it too.
Below are the list of steps that doctors will follow to help diagnose the cause of excessive hair growth. The following is what you can expect.
1. Physical examination and history
A doctor or medical professional will start the process of diagnosis by first carrying out a physical exam and obtaining a medical history. You may be asked a number of questions such as:
- When the hirsutism was first noticed and if it has been getting worse with time
- If you have noticed other symptoms such as a deepening of your voice or hair balding
- Your menstrual cycle and reproductive history: infertility may be associated with polycystic ovarian syndrome and an irregular period may point to other possible causes
- Your past medical history
- Your medication history: use of androgenic medications (e.g. anabolic or androgenic steroids, danazol, oral contraceptives) may be associated with excessive hair growth.
- Family history: if hirsutism runs in your family
2. Physical exam
Your doctor will carry out a brief physical examination. They may also use a scoring scale known as the Ferriman-Gallwey visual scale. It is the most commonly used grading system amongst doctors that aids in the diagnosis of hirsutism.
Images in the Ferriman-Gallway scale are used to show different patterns of hair growth in nine areas of the body. It assigns a score from ‘0’ (absence of hair) to ‘4’ (extensive hair growth). In women without hirsutism or normal hair growth, the score is typically under 8. You can have a look at the scale for free online.
Your doctor will also take into consideration the places where you feel excessive hair growth is worse.
3. Blood tests
Blood tests are the next step in diagnosing hirsutism. These are basic blood tests that measure hormone levels and look at your basic biochemistry profile. Blood tests that your doctor may order include:
Tests for different hormones in the blood:
- Thyroid stimulating hormone (TSH)
- Follicle stimulating hormone (FSH)
- Other biochemistry tests like: 17-hydroxyprogesterone, DHEAS, androstenedione and Sex hormone-binding globulin
Taken together, these blood tests should give a more complete picture of what’s going on within the body.
4. Imaging and scans
If the above tests don’t result in a conclusive diagnosis or if they point towards a specific direction, the next step is imaging. Imaging is used to confirm a diagnosis or to rule out other possible causes.
Pelvic or abdominal ultrasound scan
An ultrasound scan is a non-invasive imaging technique that lets the doctor ‘see’ what the internal organs are doing. In the diagnosis of hirsutism, it’s very likely that an ultrasound scan of the pelvis will be carried out. Conditions such as polycystic ovarian syndrome can be seen via ultrasound scan.
Transvaginal ultrasound scan
A transvaginal ultrasound also called an endovaginal ultrasound, is a type of pelvic ultrasound used by doctors to examine female reproductive organs. It helps to visualize any abnormalities in the uterus (womb), cervix or lining of the womb.
A CT-scan of the adrenal glands may also be carried out. Adrenal disorders may be diagnosed during the evaluation for hirsutism. Doctors might be looking for the presence of an adrenal adenoma or adrenal carcinoma (uncommon in premenopausal women).
5. Ovarian and adrenal vein sampling
Although not used routinely, ovarian and adrenal vein sampling is another diagnostic modality. Androgen-producing ovarian tumors tend to be small and may not be detectable by conventional imaging. Ovarian and adrenal vein sampling is an invasive procedure that uses image guidance to insert a needle into a specific vein and remove blood samples.
This diagnostic test is very rarely used and is only ever needed in a small minority of patients. If undergoing this test, the doctor will give you further instructions about the benefits, risks and how the procedure is carried out.
Remember, polycystic ovary syndrome and idiopathic hirsutism (excess hair growth that occurs for unknown causes) are the most common causes behind hirsutism. PCOS accounts for 72 to 82 percent of all hirsutism cases. Therefore a woman’s history and physical examination are particularly important in evaluating excess hair growth. Speak to your doctor about any concerns you have regarding the blood tests or scans. They’ll be happy to talk you through them and explain the risks, benefits and side effects.