What is Excessive Hair Growth (Hirsutism)? Symptoms, Causes, and Treatment

Excessive Hair Growth (Hirsutism)

Excessive hair growth is the appearance of thicker, darker hair in women than normal. It is generally associated with hyperandrogenism. Hyperandrogenism is the production of male hormones in greater quantities than necessary. This condition can lead to menstrual irregularities, acne, alopecia (hair loss), and hirsutism in women. The elevation of multiple androgen hormones can affect the severity of hirsutism. The most common cause of excessive hair growth in women is polycystic ovary syndrome. However, certain diseases, medications, and tumors can also be among the causes of hirsutism. It affects approximately 5-10% of women and can lead to intense emotional stress. Although hirsutism commonly affects women, it can also occur in some men, but dark and thick hair growth may not be as easily detected as in women. However, the development of hirsutism in children and infants is rarer and may be an indicator of early puberty. Ethnicity and family history are influential factors in the development of excessive hair growth. Diagnosis can be made with the help of multiple tests and methods. Depending on the underlying cause, medication use and hair removal methods may be preferred.

What is Excessive Hair Growth (Hirsutism)?

Hirsutism, known as excessive hair growth, is a male-pattern hair growth condition in women. Dark and thick hair can form in areas where women generally have fine hair or no hair at all. Excessive hair growth can frequently be seen on the upper lip, chin, chest, back, buttocks, abdomen, thighs, and genital area. Excessive hair growth is primarily caused by the excessive secretion of androgens, which are called male hormones. Although androgens are normally secreted in small amounts, they are hormones produced in all women. Testosterone, DHEAS, and dihydrotestosterone are androgen hormones. Testosterone stimulates excessive hair growth, particularly in the armpit and groin areas. Dihydrotestosterone, on the other hand, is a hormone that stimulates facial hair growth and hair loss. The disruption of the balance between androgens and estrogen can trigger hirsutism. Androgen produced by the ovaries and adrenal glands in women can be produced more than normal in some cases. This condition can primarily cause acne, hormonal problems, and excessive hair growth. Generally, hirsutism does not affect health status on its own, but it can bring along psychological problems such as anxiety, stress, and depression.

What Are the Symptoms of Excessive Hair Growth?

Hirsutism manifests itself as excessive hair growth in body areas where women typically have less hair. Darker, thicker, and denser hair or hairs emerge from these hair follicles. Hirsutism resulting from high androgen levels may show additional symptoms. Hirsutism and high androgens can cause virilization, which increases masculine characteristics in women. Androgen hormones support male individuals entering puberty to reach physical maturity. In addition, it helps the formation of secondary sex characteristics in males. The main symptoms of hirsutism and secondary sex characteristics caused by virilization are:

Increased muscle mass and development,

Thicker and deeper voice,

Acne,

Alopecia (hair loss),

Increased sexual desire,

Clitoral enlargement,

Infrequent menstruation,

Loss of feminine body contours,

Odorously sweating,

Decrease in breast mass.

The increase in the proportion of androgen hormone relative to estrogen hormone in women can put female developmental characteristics in the background. While a decrease in female sex characteristics is observed, male characteristics can come to the forefront. This situation may be related to the intensity of hormone production.

What Causes Excessive Hair Growth?

There can be many different causes of excessive hair growth. These causes can be divided into two categories: hyperandrogenic (excessive production of androgen hormone in the body) and non-hyperandrogenic. Hyperandrogenic causes are mostly linked to high androgen production from the adrenal glands and ovaries in women. The main hyperandrogenic causes of excessive hair growth can be listed as follows:

Polycystic ovary syndrome (PCOS): It is the most common culprit of hirsutism cases, accounting for approximately 75% of cases. The exact cause of PCOS is unknown. It is characterized by the formation of small follicles in the ovaries. It can show symptoms such as excessive hair growth and menstrual irregularity, weight gain, acne, insulin resistance, and acanthosis nigricans.

Ovarian/adrenal tumors: Ovarian or adrenal gland tumors are a rare cause of hirsutism. In these cases, androgen levels are very high.

Non-classical congenital adrenal hyperplasia: It is a recessive health problem resulting from 21-hydroxylase enzyme deficiency. After puberty, it is characterized by hirsutism, acne, infertility, hair loss, menstrual irregularity, or absence of menstruation.

Non-hyperandrogenic causes may include medication use, pregnancy, the postmenopausal period, and endocrinopathies. In addition, there are cases of hirsutism of unknown cause despite normal ovarian physiology and androgen levels. This condition is called idiopathic hirsutism and is seen in approximately 10% of all cases.

How is Excessive Hair Growth Diagnosed?

The diagnosis of excessive hair growth involves a physical examination along with medical history, family history, tests, and imaging techniques. Within the scope of the physical examination, areas with excessive hair growth are checked, and the presence of symptoms such as acne and alopecia is evaluated. A pelvic examination may be necessary to detect possible tumors and cysts in the lower abdominal region. Following the diagnosis of hirsutism, the Ferriman-Gallwey scale can be used to measure its severity. According to this scale, nine body regions are examined: upper lip, chin, chest, upper abdomen and lower abdomen, thighs, upper arms, upper back, and lower back/buttocks. The degree of hair growth in these areas is determined by a number between 0 and 4.

It is marked as 0 when the density of hair growth is very low, and 4 points when it is severe. The scores of the examined areas are summed up, and the degree of hirsutism is determined based on the height of the number. In addition, blood tests can be performed to examine general hormone levels. An ultrasound can be performed to visualize the uterus and ovaries. In addition, as part of ruling out other health problems, the adrenal glands and ovaries can be observed with X-rays.

How is Excessive Hair Growth Treated?

Excessive hair growth treatment aims to identify and eliminate the underlying cause. In addition, hair removal methods, home care recommendations, and medication therapy can be recommended. Medications used within the scope of hirsutism treatment commonly include:

Birth control pills: They support lowering androgen production and help control conditions such as excessive hair growth and menstrual irregularity. They are also medications that prevent pregnancy.

Anti-androgens: They may be prescribed when success cannot be achieved with birth control medications. They generally help lower androgen levels in mild cases of hirsutism.

Steroid medications: Low-dose steroid medications may be recommended if hirsutism is due to excessive adrenal gland activity.

Topical cream: This cream, applied to areas with excessive hair growth, does not directly destroy the hair, but it can control it by slowing down the growth rate of the hair. When you stop using the cream, the hair continues to grow at the same speed as before treatment.

In addition to drug treatments, certain medical procedures may be preferred. These procedures can provide more long-term results compared to personal care methods. These procedures can be listed as follows:

Laser treatment: It is the process of sending a high-intensity heat and light beam through the skin to damage hair follicles and prevent them from growing. It can have side effects such as light or dark pigmentation on the skin, burns, blisters, and scarring. It is an application frequently preferred for excessive hair growth on the face.

Electrolysis: It involves entering each hair follicle with a fine needle and delivering an electric shock. Therefore, it can be a long-term and painful procedure on large areas.

Frequently Asked Questions

Hirsutism is one of the symptoms of polycystic ovary. PCOS, which is the most common cause of hirsutism, is characterized by hormonal imbalance, high androgen levels, and menstrual irregularity. It is a chronic health problem and a common cause of infertility. It can cause cysts in the ovaries and negatively affect egg production. There is no definitive cure, but symptoms can be controlled. Excessive hair growth can occur due to hormonal disorders and mainly originates from the androgen group of hormones. These hormones are primarily testosterone, DHEAS, and dihydrotestosterone. Androgens are male hormones, but it is normal for small amounts to be secreted in women. Androgens produced in all women are in balance with other hormones such as estrogen. Due to various reasons, the production of androgen hormones in women may increase and lead to hirsutism. Fine and sparse hair growth in women is normal, but this situation may change depending on the hormonal balance. Thicker and darker hair growth than normal in areas with fine hair or no hair can indicate a high androgen hormone picture. Excessive hair growth, known as hirsutism, can generally stem from factors such as PCOS, tumors, and medication use. Hirsutism may not completely disappear with laser treatment. The reason for this is that laser treatment is not directed at the factor causing hirsutism. Although laser treatment provides long-term hair growth control, it is not a definitive treatment method. In addition to medical treatments, lasers can be applied upon doctor's recommendation. Laser application may not be suitable for everyone and can cause many side effects. Treatment for excessive hair growth in women requires continuity. Treatment options alone may not eliminate excessive hair growth in a short time. However, it can contribute to the hair growing slower and becoming sparser. In addition to medical interventions, other methods such as electrolysis and laser treatment can also be applied. Hirsutism can generally be diagnosed with a physical examination. Several tests can be performed for mild hirsutism and for hirsutism seen in men. Hormone tests can be performed for excessive hair growth, and other diseases that may cause hirsutism can be identified with ultrasound and X-rays. After hirsutism is diagnosed, the degree of the disease can be determined with the Ferriman-Gallwey scale. For the problem of excessive hair growth in women, the department of endocrinology and metabolic diseases can be visited. For excessive facial hair growth, you can also make an appointment with the dermatology department. In the presence of pregnancy and hirsutism, you can apply to the obstetrics and gynecology department. One of the treatment options for excessive hair growth is birth control pills. Birth control pills containing estrogen and progesterone hormones can help lower high testosterone levels. In addition, it can be effective in preventing pregnancy and controlling menstrual irregularity. It has side effects such as breast tenderness and swelling, nausea, and mood swings. Obesity can be among the causes of excessive hair growth in women. Excess weight or obesity can negatively affect hormone production in the body. Therefore, weight loss should be a part of the treatment when necessary in the treatment of hirsutism. Controlled loss of body weight can provide a drop in androgen levels. Excessive hair growth in women may not disappear completely. This situation can depend on the intensity of excessive hair growth and the continuity of treatments. While more visible success can be achieved with milder hirsutism, the same situation may not be observed in some individuals. When hirsutism does not completely disappear, psychological health in particular can be negatively affected, and anxiety, stress, and depression may manifest themselves.

Excessive hair growth (hirsutism) is a health problem that can negatively affect the quality of life both physically and psychologically. Proper evaluation of the underlying hormonal balance forms the basis of an effective treatment plan.

At Hisar Hospital Intercontinental, with the multidisciplinary approach of Endocrinology and Metabolic Diseases, the causes of excessive hair growth are investigated in detail, and personalized treatment plans are created.

If you have complaints of excessive hair growth, you can make an appointment with the specialist physicians of Hisar Hospital Endocrinology and Metabolic Diseases for early diagnosis and correct treatment.