What is hirsutism?
Hirsutism is the term used to describe excessive growth of hair in women of a male type and distribution, especially on the face, chest, and abdomen below the navel. The hair follicles are sensitive to male hormones. Hirsutism results when increasing levels of these hormones promote the rate of hair growth and the transformation of fine, soft or “vellus” hair to coarser “terminal” hair. This effect occurs in hair on the face and the body but not on the scalp.
Causes of Hirsutism
- The most common cause of hirsutism is a slight over-production of male hormones from the ovaries and from the adrenal glands. This slight increase can be detected in blood tests and although it does not cause any ill-effects upon health or fertility, it does stimulate the annoying growth of body hair. In some women with mild hirsutism blood levels of male hormones are completely normal and the fault lies in excessive sensitivity of their hair follicles to normal levels of male hormones. There is often a family history of hirsutism in related females and it occurs most commonly in women of Southern European and Middle Eastern descent. Racial and genetic factors are obviously important. Hirsutism is rare among oriental women.
- Women who are overweight are more likely to suffer with hirsutism because their excessive amounts of fat are associated with higher levels of male hormones. If they lose weight, their levels of male hormones usually decrease with a corresponding reduction in facial and body hair. see Syndrome X,
- The gynaecological disorder of “Polycystic Ovarian Syndrome” can cause hirsutism. In this condition, the ovaries may become enlarged and develop many small follicle cysts around the periphery. This problem is quite common, and one in every six women probably has a tendency to the condition. These polycystic ovaries secrete excessive amounts of male hormones that may result in hirsutism, acne and infrequent menstruation. Many women with polycystic ovaries are overweight and weight loss may in itself restore regular menstruation and normal levels of male hormones. Conversely, if such women gain weight, their menstrual periods become less frequent and acne and excess hair increase. The tendency to polycystic ovaries is inherited and may be triggered by stress or weight gain.
- Some medications may increase body and facial hair such as the anabolic steroids used by athletes and body builders. Other drugs such as danazol, phenytoin (‘Dilantin’) and some brands of the oral contraceptive pill containing the masculine progestogen levonorgestrel may also increase facial and body hair.
- Hirsutism is generally mild to moderate in degree but if it is severe or of rapid onset and progression, tests must be done to check for a severe glandular disorder that may lead to extreme masculine changes in appearance called virilization.
Treatment and general recommendations
- As mentioned above, if you are overweight, weight loss is vital.
- There are various methods of hair removal that can be undertaken, preferably under the supervision of a beautician.
- Shaving and plucking will not increase hair growth as common myths would have you believe, but they will only provide short term relief.
- Waxing is effective but is not recommended for very coarse hair. It should not be used frequently on the face, but can be used elsewhere, such as on the legs.
- Depilatory creams are beneficial, but should also not be used too often on the face.
- Bleaching facial hair, like the moustache area, with peroxides produces acceptable results for fine hair.
- Coarse hairs are best dealt with by electrolysis. This is suitable for small areas only and must be performed by skilled personnel.
If you are overweight follow the principles of eating outlined in my book Can’t Lose Weight? Unlock the Secrets that KEEP you Fat. The Android body type most commonly suffers with this imbalance. Try the body type questionnaire.
Avoid sugar and minimize foods high in carbohydrate because these foods increase your body’s sensitivity to normal levels of testosterone.
If you are not overweight follow the eating principles outlined on pages 20-27 of The Healthy Liver and Bowel Book by Dr Cabot
The following juice recipes are recommended:
• Any of the “Liver Dysfunction” juices on p116 of Raw Juicing Can Save Your Life
• “Body Shaping Juice” for your type p53. See the body shaping questionnaire.
- Take 2 capsules twice a day before food. This formula contains phyto estrogen herbs that have a feminizing effect.
- One dose = 1/2 turn of the self-dispensing lid = 1/4 teaspoon of the cream = 35mg of progesterone.
Orthodox Medical Treatment
- For women with moderate to severe facial hair, it is usually necessary to use drugs with a hormonal action that will either reduce the body’s production of male hormones and/or block the action of male hormones upon the hair follicles. These drugs are extremely effective and, under strict medical supervision, are safe. They need to be given for a long time and you need to feel that the improvement in your appearance warrants the expense and slight risk in taking this long term medication. One of the drugs that can be used is cyproterone acetate (‘Androcur’) which is the most powerful anti-male hormone available and reverses hirsutism in 80 percent of women after nine to twelve months of use. It is usually given with the oral contraceptive pill, as it is important for women taking cyproterone acetate to avoid pregnancy because its anti-male hormone properties may stop the sexual development in a male foetus. In post-menopausal women, or women who have had a hysterectomy, pregnancy is not a concern and so the drug can be taken without regard to contraception. Generally speaking, cyproterone acetate is well tolerated by most women. However, because it is a potent anti-male hormone, high doses may cause a reduction in sex drive, reduced concentration, fatigue and mild depression. Such side effects can usually be avoided if the dosage is reduced. Indeed, in the long term the lowest possible dose that can control hirsutism should be used and your doctor can guide you on this.
- An alternative treatment is spironolactone (‘Aldactone’) which has the dual action of being not only a diuretic but also an effective anti-male hormone. It is not as powerful in its anti-male hormone effect as cyproterone acetate, but may be sufficient for some women. It is often preferable to use it in women with obesity, high blood pressure, fluid retention, severe depression, or in older women who smoke or are unable to tolerate the oral contraceptive pill. If breakthrough bleeding occurs or if contraception is required, spironolactone can be taken together with the oral contraceptive pill. You must not become pregnant while taking it as, like cyproterone acetate, it may cause feminisation of the developing male foetus. Spironolactone may cause minor side effects such as breakthrough bleeding, slight breast enlargement, nausea, muscle cramps and an imbalance in potassium levels, but these may be avoided by reducing the dose.
- In some women with mild hirsutism, a good result can be obtained simply by taking the female hormone estrogen, such as the natural estrogens used for hormone replacement therapy. This will reduce the production of male hormones by the ovaries. In women with a uterus it is also necessary to give progesterone to regulate menstrual bleeding and only natural progesterone without male (androgenic) properties should be used. Many of today’s oral contraceptive pills contain androgenic progestogens and should be avoided, as they may worsen your facial and body hair. In Australia, commercially available contraceptive pills containing oestrogen and non-androgenic progestogens such as desogestrel, cyproterone acetate or gestodene i+B21nclude “Marvelon”, “Diane-35”, “Minulet” and “Trioden”. Menopausal and post-menopausal women with hirsutism often find that a small dose of cyproterone acetate or spironolactone added to the natural oestrogen in their hormone replacement therapy greatly reduces this problem.
- Excessive male hormone production from the adrenal glands can be suppressed by taking a very small dose of a cortisone-type preparation such as dexamethasone once a night upon retiring. One should use only the smallest possible dose of cortisone-type drugs, as an impaired response to stress may occur.
The above statements have not been evaluated by the FDA and are not intended to diagnose, treat or cure any disease.