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Unwanted female body hair

The unwanted or excessive body hair in females called hirsutism. The condition is characterized by coarse and dark hairs on body and face especially on lips, chin, abdomen, and back. It is also called male-pattern hairs. Generally, all females have facial and body hair but are fine and light-colored. In hirsutism, the difference is only in the hair texture. The condition arises due to excess male hormone (androgen), especially testosterone.

It affects 5-10%3 of women. Though the condition is not serious, it may decrease self-confidence or may compromise the health due to underlying hormonal balance.

Model to access the hair pattern:

It is a simple model to access the hair pattern in females is given by a study consisted of 0-4 scores. It confirms hirsutism if the total score for various body parts (chin, upper abdomen, and lower abdomen) exceeds 8. The conditions for scoring are given below:

 0: No hair growth

1: Fine hair or a few stray hairs

2: Thicker, and more consistent

3: Very thick, and consistent hair

4: Male-pattern hair growth

Symptoms:

  • Stiff and dark-colored body hair on the parts where generally men have hairs such as lips, chin, abdomen, thighs, and back

  • High androgen level over time called virilization, characterized by signs of voice deepening, baldness, acne, decreased breast size, increased muscles, clitoris enlargement

Causes:
Genetic factors: Sometimes, hirsutism is genetically determined and runs in families. It is more common in the Middle East, South Asia, and the Mediterranean people.

Hormonal factors: All females produce androgens but in a small amount. In certain medical conditions, the level of androgens gets elevated, which, causes male-pattern hair growth and other male characteristics.

  • Polycystic ovary syndrome (PCOS): The small cysts or fluid-filled sacs are formed in the ovary, which, causes elevation of androgen levels. It accounts for 72 to 82%4 of hirsutism cases in women. Treatment with hormonal therapy or birth control pills can control the condition. 

  • Adrenal gland disorders: It involves the following conditions. The various conditions affect androgen production. 

1. Congenital adrenal hyperplasia: It is a rare disorder that affects the adrenal glands to produce abnormal levels of androgens.

2. Adrenal cancer/tumors

3. Cushing’s disease: It causes to raise cortisol levels. It is a stress hormone, which also affects androgen production.

  • Other conditions:

1. Hyperprolactinemia: The condition in which the body produces high levels of the prolactin hormone.

2. Thyroid disorders: It causes thyroid malfunction, which causes excess body hair.

3. Idiopathic hyperandrogenemia: Due to the apparent reason the body produces an excess of androgens.

4. Idiopathic hirsutism: Hirsutism of unknown cause.

Medications: 
Some medications cause excessive hair growth such as antidepressants, some antibiotics, anabolic steroids, testosterone analogs, immunosuppressants such as cyclosporine, minoxidil.

Risk factors:
Family history: Females with a family history of hirsutism, PCOS, or other androgen disorders have high chances of developing hirsutism.

Ancestry: Women of the Mediterranean, Middle East, and South Asian ancestry are more likely to have body hair than other women.

Obesity:  It causes increased androgen production, which can worsen the hirsutism condition.

Diagnosis:
If the initial examination is suggestive of hirsutism, the doctor tries to diagnose underlying cause by a blood test, taking a detailed menstrual history, imaging for any tumor growth.

Treatment: 
Hormonal management:

  • Obesity: Weight loss treatment in obese patients.

  • Antiandrogen treatment: Steroidal and nonsteroidal (or pure) antiandrogens are given to block the androgen receptors so that to reduce androgen production from the adrenal glands, ovaries, and pituitary glands.

  • Birth control pills: The combination of estrogen and progesterone will help to shrink the cysts in PCOS. Additionally, estrogen can also help to reduce excess hair. In the long term, after three to six months of treatment, they show good improvement in hirsutism.

  • Eflornithine topical cream: It reduces facial hair growth on two-three months of treatment. It shows side effects such as skin rash and irritation.

Hair removal:

  • Waxing, shaving, and depilatories: These are normal methods of hair removal. They can also be used in hirsutism to remove hairs. They are affordable, show immediate effect, and can be used more proactively

  • Bleaching: It lightens hair color, making it less noticeable. As bleaching products, hydrogen peroxide-based may cause skin irritation. 

  • Plucking: It is only useful to remove a few stray hairs but not for removing a large area of hair. This is a temporary method of hair removal. It may uses tweezers, thin threads (threading), or other devices. 

  • Laser hair removal: It involves concentrated light rays that permanently damage hair follicles. It shows the long-lasting effect as damaged follicles can’t produce hair again. After a long treatment, permanent or near-permanent hair removal is possible.

  • Electrolysis: It involves the removal of hair using an electric current. It takes a longer time, as each hair follicle needs to treat individually.

Both the laser and electrolysis hair removal is expensive and require multiple sessions to achieve desirable results. 

Prevention: 
As such, there is no prevention for hirsutism. The weight loss may reduce the chances of hirsutism in patients with PCOS.

Complications: 
Hirsutism does not cause physical complications, however, the underlying cause needs to treat. It may give self-consciousness and sometimes develops depression. 

During hormonal treatment for hirsutism, pregnancy should be avoided due to the chances of birth defects.

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