Hirsutism – Masculine Hair on Women – Requires Diagnosis Before Treatment

Hirsutism is a concern for many womenHirsutism is when females grow noticeable hair in places that are typical to men, such as on the face or on the chest. Hirsutism is not a disease, but it is a symptom of an underlying condition.

Women naturally have low levels of androgens, such as testosterone. Hirsutism can be caused by increased levels of androgens. This could signal underlying hyperandrogentic-related conditions. Polycystic ovary syndrome (PCOS) may be the underlying cause in most cases of hyperandrogenism.1

If hirsurism is accompanied by hair loss and acne, the list of possible causes grows to include POCS or one of these rare conditions: late onset congenital adrenal hyperplasia (a problem with the adrenal glands) or an androgen producing tumor from the ovary or adrenal gland.1

Treating the symptoms without a diagnosis can be dangerous. A complete examination from a dermatologist, and possibly from a reproductive endocrinologist, is needed for a diagnosis. “When treating patients with hair loss, I investigate the underlying cause,” said dermatologist Lawrence Shapiro. “Just slapping on a cream is foolhardy. Hair loss or masculine hair on a woman can indicate a serious condition. Even if the condition is not serious, a doctor of dermatology will develop an efficient, rational plan course of treatment.”

Another category of causes of hirsutism is when the hair follicles are oversensitive to male hormones such as testosterone.

Women who are obese tend to become resistant to insulin (Type II diabetes), and are at high risk of developing hirsutism. Hirsutism is a sign of hormone imbalance, possibly due to high circulating levels of insulin in their systems. The theory is that insulin, at sufficiently high levels of concentration, stimulates the ovarian theca cells to produce androgens.2 Larger quantities of male hormones are produced, resulting in masculine hair growth or hirsutism.

Other conditions that may increase a woman’s male hormone levels and result in hirsutism include Cushing’s disease, certain medications, and Stromal Hyperthecosis (in postmenopausal women).

Treatment could include addressing any serious underlying conditions, balancing the hormone levels, and/or offering cosmetic options.

1. “Getting to the root: Look below the surface for cause of hyperandrogenic symptoms” by Nancy A. Melville, Dermatology Times, August 2009
2. Wikipedia: Hirsutism