How Is Hirsutism Diagnosed?
Hirsutism is the presence of male pattern hair growth in a woman, meaning that there is darker, coarser hair in areas where men typically have it, such as the chin, chest, arms and legs, back and buttocks. In many women, increased body hair is an unwanted feature.
Hirsutism can appear due to it being a familial (genetic) trait, a medical condition such as Polycystic Ovary Syndrome (PCOS), occur due to certain long term medications, or have no identifiable cause (in this case, it would be called “idiopathic hirsutism”).
Sometimes hirsutism can also be associated with signs of virilization such as increased muscle mass, male pattern balding, acne, deep voice, breast atrophy and enlarging clitoris. However hirsutism, the excess body hair, may be the first sign due to excessive androgen levels in the female body.
What are Androgens?
Androgens are “male” sex hormones, meaning that they are the hormones that lead to the development of body characteristics that are considered typically male. Both men and women produce androgens, however women in most cases in much smaller amounts. The androgen levels increase during puberty in both boys and girls. There are several types of androgens in the body:
- Testosterone – The most well known androgen. This hormone is mainly produced by the testicles in men and in small amounts in ovaries of women. A certain amount of testosterone is necessary in healthy women for proper growth and functioning.
- Dihydrotestosterone (DHT) – It is a metabolite of testosterone. DHT is more potent than testosterone as it binds well to androgen receptors for action. DHT causes the differentiation of penis, scrotum and prostate in male fetuses while inside the uterus. In adults, DHT causes the growth of the prostate, sebaceous gland activity and balding in males.
- Dehydroepiandrosterone (DHEA), Androstenedione and Androstenediol – These are androgens produced by the adrenal glands of both men and women. They are also responsible for developing male sexual characteristics.
Excess of any type of androgens can lead to hirsutism, the excess growth of hair in women.
The amount of body hair you have, its color, thickness and distribution differs from one person to another. This is mainly determined by your genetic composition. According to your culture and ethnicity, the amount of hair you have will be considered too little, too much or just right. However various reasons can tip the balance and cause an increased hair growth in women.
What are the causes of Hirsutism?
- Familial (genetic) Hirsutism
Women with familial Hirsutism have excessive amounts of testosterone in their bodies, and the main reason behind this is their genes. This causes excessive hair in unwanted places in women and it may run in families.
- Polycystic Ovary Syndrome (PCOS)
Polycystic ovary syndrome (PCOS) is the most common cause of Hirsutism in women. If women are affected by PCOS, they can experience symptoms such as obesity, irregular menstruation, subfertility, multiple follicles (bubble like cysts) in their ovaries, acne, anxiety and depression along with hirsutism. Some also develop insulin resistance, which when left unmanaged, can lead to diabetes.
PCOS is a chronic hormonal disorder which affects around 10% of women of reproductive age, and can lead to an increased risk for conditions such as diabetes, cardiovascular disease or endometrial cancer.
- Tumors
In rare cases, tumors are the reason why there is excess androgen. 10% of all ovarian tumors can secrete androgens, which leads to hirsutism. Some of these ovarian tumors which secrete testosterone are gonadoblastoma, ovarian carcinoid, surface epithelial tumors (Brenner tumor) and metastatic tumors.
There are also adrenal tumors that can produce excess androgens. These tumors can occur in cortex of the adrenal glands which produce androgens leading to hirsutism. Adrenal tumors can produce increased levels of cortisol and aldosterone hormones in addition to high testosterone levels. This may cause high blood pressure, weight gain and diabetes.
During your doctors appointment for Hirsutism, your doctor will check for them, and in case they are the cause for your Hirsutism, define the right treatment path for you.
- Congenital Adrenal Hyperplasia
Congenital Adrenal Hyperplasia (CAH) is an inherited disorder. In CAH, androgens are produced in excess which may be visible when the person develops hirsutism. Severe CAH can be detected in infancy. Milder forms of CAH may be evident from childhood. Affected female babies can have genital ambiguity due to enlarged clitoris and genitals at birth. The treatment will aim at reducing excessive androgen production and replacing deficient hormones. Reconstructive surgery is offered to female babies with ambiguous genitals.
With proper management, hormone replacement therapy and follow up, women affected by CAH can lead normal lives.
Cushing syndrome
If the body is exposed to high levels of Cortisol hormone due to an overproduction of cortisol from your adrenal glands or due to prolonged administration of prednisolone (as in asthma, auto immune diseases etc), it can lead to features of hirsutism.
- Medications
Certain medications such as anabolic steroids, fluoxetine (Prozac) and Danazole can cause hirsutism in women. Find more information about these medications here.
How is Hirsutism diagnosed?
If you are worried about excessive hair growth, you should definitely seek help from a doctor. It can be difficult to raise the topic first, but if you work together with your doctor, you can find a treatment that works best for you.
To help you prepare for the appointment, let’s quickly run through how hirsutism is diagnosed:
Hirsutism is diagnosed clinically by a thorough physical examination by your doctor. He /She determines the severity of hirsutism by the extent of hair growth, thickness and distribution, most likely by using the Ferriman-Gallwey score. The doctor will also look for other associated signs of virilization such as acne, muscle mass, features of male pattern hair loss, signs of breast atrophy etc.
They will also do an abdominal and pelvic examination to examine for any abdominal masses or fluid in the abdomen, which can occur in cancers in ovaries and adrenals. Your blood pressure is also checked, as adrenal tumors can cause high blood pressure.
If your history is suggestive of taking certain long term medications which can cause hirsutism as a side effect, the doctor will try to omit or change the medication.
As there can be many reasons causing hirsutism, you may have to go through a variety of tests such as these:
- Blood tests
- Hormone levels in the blood
- Fasting blood sugar
- Serum lipid profile
- Ultra sound scan of abdomen
An ultrasound scan of abdomen may be performed to visualize your ovaries and uterus. The doctor will specifically look for polycystic ovaries, which means that the ovaries could be enlarged and have a string of pearl appearance due to multiple cysts/follicles in them.
- Radiological imaging
A variety of X -Rays and CT scan of abdomen or MRI scanning may be done to evaluate your adrenal glands and ovaries. They will be evaluated for any tumors or cysts.
Management of Hirsutism in Women
The management of Hirsutism depends on proper diagnosis and treatment of the underlying cause. Based on the underlying cause, your doctor will suggest treatment options for you.
Also, many women are using hair removal methods to help getting rid of the excess hair. They include semi-permanent or permanent hair removal methods such as laser hair removal and electrolysis, as well as other methods such as shaving, waxing and plucking.
Maintaining a healthy weight, eating a balanced diet and regular exercise is also encouraged. Stress management with yoga and meditation techniques is helpful. It may also be useful to look into ways to treat anxiety and depression, if these are symptoms that are experienced.
How do you Prevent Getting Hirsutism?
If you have an underlying cause, you cannot prevent developing hirsutism. However, seeking help early will help with an early diagnosis and necessary treatment can be started soon. Unless the underlying cause is addressed, hirsutism cannot be controlled well. This is why it’s important to talk to a doctor if you are experiencing symptoms of hirsutism.
