What Causes Hirsutism?
Generally speaking, hirsutism is a condition caused by excess androgen hormones (such as testosterone) in women. This excess of androgens can have various reasons, but may also be idiopathic (no identifiable cause). Many women diagnosed with hirsutism also suffer from polycystic ovary syndrome (PCOS). Sometimes medication, genes or other endocrine conditions cause the male pattern hair growth.
Hirsutism and Hormones
Hirsutism is caused by high levels of androgens (such as testosterone) in the female system. Besides male pattern hair growth, androgens often also cause acne, oily skin and hair in women. A common reason for elevated levels of testosterone is polycystic ovary syndrome (PCOS). Other medical conditions causing the hormonal imbalance are Cushing’s syndrome, tumors in the adrenal glands, acromegaly, prolactinoma, thyroid or congenital adrenal hyperplasia.
A high percentage of women diagnosed with hirsutism also suffer from PCOS.
Polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is a condition that causes reproductive hormones in women to be out of balance. Besides causing hirsutism, PCOS can lead to acne, weight gain, irregular menstruation, infertility, pre-diabetes, anxiety and depression.
Hormones are responsible for making certain processes in the body happen. The key hormones affected by PCOS are androgens, the gonadotropins LH and FSH, as well as Insulin.
PCOS affects around 10% of women of reproductive age.
Medication
Some drugs can cause a rise in male hormones and cause hirsutism. According to Cleveland Clinic, those include:
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- Anabolic steroids
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- Testosterone
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- Glucocorticoids
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- Cyclosporine (Sandimmune®)
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- Minoxidil (Loniten®, Rogaine®)
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- Danazol (Danocrine®)
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- Phenytoin (Dilantin®)
Genes and idiopathic hirsutism
Sometimes hirsutism cannot be traced back to a certain cause or other medical conditions. Cosmetic treatments are usually recommended in those cases to help women who struggle with male pattern hair growth.
Some women may have a genetic predisposition to hirsutism.
Is hirsutism inherited?
If the mother is diagnosed with the condition, the likelihood that her daughter will have hirsutism, increases. So, yes, it does run in the family and can be “inherited”. Women from certain ethnic backgrounds are also more likely to have male-pattern hair growth. Regions with a higher percentage of women in whom hirsutism is observed are South Asia, the Mediterranean or the Middle East.
What causes my hirsutism?
In order to get a definite answer, it is recommended to consult a health care professional, who can diagnose and recommend an appropriate treatment for the condition.
Below is an overview of the most common causes of hirsutism including approximations as issued by the AAFP as well as historical and clinical clues used for diagnosis:
| Diagnosis | Percentage of Hirsutism Cases | Historical and Clinical Clues |
| Polycystic Ovary Syndrome | 72-82% | Irregular menses, elevated androgen levels, polycystic ovaries, central obesity, infertility, insulin resistance, acanthosis nigricans |
| Idiopathic hyperandrogenemia | 6-15% | Normal menses, normal ovaries on ultrasonography, elevated androgen levels, no other explainable cause |
| Idiopathic hirsutism | 4-7% | Normal menses, normal androgen levels, normal ovaries on ultrasonography, no other explainable cause |
| Adrenal hyperplasia | 1-4% | Family history of congenital adrenal hyperplasia, high risk ethnic group, ambiguous genitalia at birth (classic form), menstrual dysfunction or infertility (non-classic form), elevated 17-hydroxyprogesterone level before and after corticotropin stimulation test |
