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Which Doctor Should You See for Hirsutism

What Is Hirsutism?

Hirsutism is defined as the development of male pattern hair growth with increased amount of body hair in unwanted places in a female. It can occur due to a familial trait passing down through genes, a medical condition where there are excess androgens in the body, or due to prolonged intake of certain medicines which act like testosterone. 

How Does Hirsutism Affect a Woman?

In females, less body hair is considered more feminine, although what is determined just the right amount of body hair depends on the culture and ethnicity to which she belongs to. 

If you develop hirsutism, especially if it was sudden onset, you are likely to be very distressed. If there is an underlying medical condition, you can get symptoms of that particular disorder such as high blood pressure, high blood sugar, menstrual problems and may be subfertility too if you are trying to conceive. There may be associated symptoms of virilization like acne, increased muscle mass, breasts becoming smaller and enlarging clitoris, which may worry you further.

Which Doctor Is the Best for Treating Hirsutism?

There is no such thing called “The best doctor”, as the treatment should be multi- disciplinary, especially if there is an underlying medical condition. Multi-disciplinary approach means your management is done by a team of health care professionals such as Dermatologist, Endocrinologist, Gynecologist, Physician, Radiologist, Psychologist, Psychiatrist, Surgeon and Plastic surgeon. Each professional output will be important in optimizing your management.

Here are some tips for you to decide where to seek help:

• If you have familial hirsutism, which means excessive hair growth runs in your family’s genes, you can make an appointment with a dermatologist. As usually there are no underlying causes here, the dermatologist can offer you the necessary treatment options. The treatment is usually started with oral contraceptive pills (Birth control pills). They contain oestragen and progesterone which will act against androgen. The dermatologist will explain to you all the side effects such as possibility of nausea, vomiting, mood disturbances, headache, stomach disturbances and others, and the importance of continuing the treatment for at least 6 months. Your doctor may also combine your hormonal contraceptives with Spironolactone (Aldactone). These are commonly used to treat women with hirsutism who don’t want to become pregnant while on treatment. 

If the hirsutism is not severe, Eflornithine (Vaniqa) cream may be prescribed to be applied to the affected areas, so that new growth of hair will be reduced.

Dermatologists will also discuss other treatment procedures which are expensive but effective after multiple treatments. These are: 

• LASER treatment – LASER is a beam of highly concentrated light which is passed over the affected areas of skin, which damages the hair follicles and thus reduces hair growth. The possible side effects like skin irritation, swelling and redness will be explained to you by the dermatologist. 
• Electrolysis – Hair follicles are damaged by inserting a needle that emits a pulse of electrical current in to each hair follicle. 

As these procedures are painful, a local anesthetic is applied to numb the area of skin before the procedure.

• If you go to your family doctor, they will explain the home remedies and self-care options you can use to get rid of unwanted hair. They are waxing, shaving, threading, plucking, and use of chemical depilatories to remove the hair or bleaching to make the hair less visible. 

Detailed history will be taken and if you are found to be taking certain long term medications which can lead to hirsutism, the doctor will omit them or change to another drug.

• If you have features of virilization, abdominal distension, dizziness and other associated health issues, you should visit a physician or an endocrinologist. Blood tests will be done to assess hormone levels, blood sugar etc. If the examination reveals any abdominal masses, you may have to go through an ultra-sound scan and CT scan of abdomen to evaluate the cause where the assistance of the radiologist is needed for diagnosis. If any tumors are found, you will be referred to a surgeon for surgical removal of the tumor. If your ultra-sound scan reveals polycystic ovaries, you will be referred to a gynecologist, especially if you have menstrual problems and issues of subfertility, as this could be a sign of Polycystic Ovary Syndrome (PCOS).

• Endocrinologists will help you with managing conditions like congenital adrenal hyperplasia, where your hormones levels should be frequently monitored and replaced. They will also help with managing associated conditions such as diabetes.

Once the underlying cause is treated, the hirsutism will gradually disappear.

• If you experience any psychological issues such as anxiety or depression, you may be referred to a psychologist or a psychiatrist for support.

• If you are obese, you can discuss how to maintain a healthy weight and work on a nutrition plan together with a dietitian.