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What is hirsutism?
What is Hirsutism?
When unwanted facial hair includes thick dark hairs (terminal hairs) it is classified as hirsutism (i.e. terminal hair growth in women in the androgen-sensitive regions of the body in a pattern not considered normal for a woman).
Unwanted facial hair is perceived by most affected women as a cosmetic nuisance and a cause of social embarrassment, which is often unrelated to the severity of the problem. It can therefore adversely affect a woman’s quality of life.
Importantly unwanted facial hair can sometimes be a clinical manifestation of a significant hormonal disorder.
How common is hirsutism?
It is difficult to assess the prevalence of the condition in Australia because of the heterogeneity of the population. Studies indicate that hirsutism affects 5-17% of women. However, unwanted facial hair is undoubtedly more common than this, as indicated by the extent to which Australian woman use hair removal treatments such as laser, waxing and electrolysis.
What causes hirsutism?
Most women who present with unwanted facial hair have either idiopathic hirsutism (i.e. no known cause) or a variant of polycystic ovarian syndrome (PCOS). For more information see PCOS
How can I tell the difference?
When first assessing hirsutism, several important features are important to give a clue if there is any hormonal disorder :
- Onset of hirsutism with respect to puberty - Idiopathic hirsutism and PCOS are classically associated with puberty. Both forms develop at about the time of puberty or in the late teens. Menstrual irregularity in this setting would strongly point towards a PCOS diagnosis.
- The rate of onset - Abrupt onset or rapid progression of hirsutism might indicate significant underlying endocrine (hormonal) pathology.
- Family history of hirsutism - This is common in patients with idiopathic hirsutism. On questioning, patients may state that male family members have excessive body hair.
- Other changes – Menstrual irregularities, infertility and obesity may suggest PCOS. In addition, diabetes may occur in women with PCOS. Deepening of the voice, increased libido, loss of scalp hair and clitoral enlargement indicate elevated androgen levels.
Do you need investigations?
Recommendations as to the extent of appropriate investigations needed in patients with hirsutism vary between different authorities, but a suggested protocol is:
- Mild-to moderate hirsutism and regular menses – no investigations required.
- Severe hirsutism and regular menses – testosterone (total or free), sex hormone – binding globulin (SHBG), dehydroepiandrosterone (DHEA) and early morning 17 – hydroxyprogesterone.
- Hirsutism and irregular menses (suggesting PCOS) – the above investigations complemented by follicle stimulating hormone (FSH), luteinising hormone (LH) and prolactin, plus pelvic ultrasound.
Normal results in women with regular menses indicate idiopathic hirsutism. Serum testosterone levels above 6nmol/L indicate significant pathology and should be followed up with an ovarian ultrasound, adrenal CT scan and 24-hour urinary steroid determinations.
Treatment options
Optimal management should be tailored to the individual needs of the patient and may involve a combination of prescription medications in conjunction with cosmetic measures such as laser hair removal and lifestyle changes such as weight loss.
For more information see Laser Hair Removal - Women
