Hairiness (hirsutismus)

Hairiness (HIRSUTISM)
Op.Dr.Kenan Ertopcu

Hairiness or hirsutism, as it is called in medicine, is the growth and increase of black hair in women where it should not be (mustache, chin area, between and around the breasts, in the midline below the navel). In general, approximately 5-8% of women of reproductive age have hair growth from puberty.
Hair growth usually occurs with the increase of male hormones (Androgens) secreted from the ovaries and sometimes from the adrenal gland.
Most women with hair growth will have normal blood hormone levels. This is called Idiopathic Hirsutism and is the most common cause of hair growth. The sensitivity of hair follicles to testosterone (male hormones) has increased.
Patients with Polycystic Ovary usually have mild hair growth in the mustache, chin area, between and around the breasts, under the umbilicus, in the midline.
If the blood Testosterone of women with hair is high, 65-85% of them have polycystic ovary syndrome. Polycystic ovaries are observed in one of every 4 or 5 young women.
Observation of more than 10 small cysts with a diameter of 3-5 mm in both ovaries with ultrasonography makes the diagnosis. In many cases, there is no need for extra hormone analysis.
In cases with polycystic ovary syndrome, delays in menstrual bleeding, tendency to gain weight and hair growth are high. Hormone levels may be found to be normal or different. Generally, blood Testosterone levels are a little high. (hormone analysis should be done on the third day of menstruation in the blood with fasting). Due to the high level of Insulin Growth Factor 1, the risk of diabetes mellitus (Diabetes Mellitus) is high and some experts use antidiabetic drugs for treatment.
Findings in polycystic ovary syndrome will continue from puberty to menopause. Since menstrual and ovulation irregularities are common, patients with polycystic ovary syndrome may need to use ovulation-supporting drugs only when they want a child. It is known that even just losing weight increases ovulation rates up to 30%.
For the cases with polycystic ovary who do not want children for now, it is useful to know that the best contraceptive method is birth control pills.
Since birth control pills contain both hormones (estrogen + progesterone) that are normally secreted from the ovaries, those who use the pill will have regular menstruation. Also, women with polycystic ovary syndrome will experience more as they get older (due to decreased ovulation and estrogen dominance), which we call hyperplasia of the inner lining of the uterus. Changes that may go as far as uterine lining cancer will be reduced by 50% with the effect of birth control pills. In addition, the growth of simple cysts, which are more common in women with polycystic ovaries, and the occurrence of additional risks associated with these, will decrease by more than 75% in those who use birth control pills. It is worth emphasizing that birth control pills reduce the risk of ovarian (ovarian) cancer by 50% and the risk of colon (large intestine) cancer by 20-30%. In addition, fibroids (benign tumors of the uterus) that we see in about half of pre-menopausal women will occur 30% less in those who use birth control pills.
In some rare types of ovarian cancer, there will be rapid onset and severe hair growth, and Testosterone levels will usually be much higher.
It should not be forgotten that obesity also plays a very important role in female hair growth.
Testosterone hormone responsible for hair growth, which is secreted at a certain rate from the female ovary under normal conditions, will turn into Dihydrotestosterone, which is a two-fold strong hormone in the subcutaneous adipose tissue, and hair growth will increase.
Even just losing weight will reduce the rate of increase in hair growth.
The increase in hair growth from the adrenal gland, which is less common, is very severe.
All parts of the body can become more hairy than a man’s, hair falls out, beards can grow (Virilization). At the same time, other signs of masculinization, such as deepening of the voice, may occur. DHEA and DHEAS secreted mainly from the adrenal gland in blood tests
hormone levels are too high. The adrenal gland is overworked. Tumors of adrenal gland (adrenal) origin should be differentiated by ultrasonography or tomography.
Another hormone whose blood level should be measured in women with hair growth is 17 OH PROGESTERONE. It occurs due to a congenital or acquired enzyme (21-hydroxylase) deficiency. In this case, which is called Androgenital Syndrome, changes in female genital organs such as clitoris hypertrophy (overgrowth of the clitoris) are observed along with virilization findings.
Excessive hair growth is sometimes caused by drugs such as danazol, anabolic steroids, cortisone, progesterone, phenytoin, diazoxide, cyclosporine, streptomycin, minoxidil, which are used for various reasons. Some of these are drugs that have an androgen (male hormone) effect, and some of them are drugs that directly stimulate hair growth.
Drug-induced hair growth is usually not permanent and regresses within a few months after drug discontinuation.
Much more rarely, excessive work of a gland called the pituitary gland located in the anterior part of the brain, which regulates the secretion of hormones by the adrenal glands and ovaries, can lead to diseases such as Cushing’s and Acromegaly, Hypothyroidism (goiter) and excessive hair growth, which is one of their symptoms.
Treatment is directed towards the underlying cause.
In treatment, cosmetic applications and drug treatment may be required at the same time or at different times. Generally, both approaches should be used.
Despite effective hair removal applications, there is no ideal treatment method yet.
Shaving is not recommended. It can be done on the network. The best is laser hair removal. It is a more beneficial approach to use these methods together with drug therapy. Which of the laser devices with different models and different features can be applied to which people and at what time should be determined by a dermatologist who has experience in the subject. Thus, precautions will be taken against adverse complications related to laser application on the skin, which can sometimes be permanent. Selecting the laser device suitable for the skin and hair type of the person will lead to more permanent results and success in the treatment of hair growth.
Hirsutism treatment requires patience. The life expectancy of hair follicles is 6 months. For this reason, the treatment should continue for at least 6 months in order to see the effect with drug treatments. Hirsutism usually subsides over 6-18 months with drug therapy and goes into stagnation.
Low-dose birth control pills, which can be used from the age of 15 until menopause, seem to be the most appropriate option for the treatment of hair growth, especially in polycystic ovarian syndrome.
All birth control pills can be used to treat hair growth, acne and acne. It is observed that birth control pills containing especially cyproterone acetate, chlormadinone acetate and drospirenone are slightly more successful in suppressing the androgen (male hormone) level in the blood compared to those containing other hormones.
It is stated in the latest sources evaluated by the World Health Organization and the United States CDC (disease control and control center) that using birth control pills even during breastfeeding is not harmful to breast milk.
Only those over the age of 35 who smoke excessively, have a risk of thrombosis (clogged with a clot in the deep veins of the leg), thromboembolism (clot in the lungs, brain), high blood pressure and advanced diabetes cannot use it.
Being a carrier of obesity (obesity), varicose veins, thyroid diseases (goiter) and hepatitis does not prevent the use of birth control pills. Birth control pills can be used safely with antibiotics, drugs used in the treatment of fungi and parasites.
Considering that it reduces the risk of uterine lining and ovarian cancers, we can say that birth control pills are a good treatment for years of hair growth and a good protection option against new hairs that may appear.
Spironolactone, cyproterone acetate, finasteride and flutamide are other drugs used in treatment. Metformin (antidiabetic) may be helpful if you have polycystic ovaries.
Wishing you healthy days…

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