Author: Zuo Yagang (Peking Union Medical College Hospital)
1. What are the symptoms of hirsutism?
Appearance changes: Increased hair, acne (pimples), hair loss, facial fat, raised back muscles.
Female masculinization: Increased voice tone, enlarged clitoris, hairy breasts and sides of the face.
Female Reproductive System: Shorter periods, irregular periods, amenorrhea, infertility, uterine bleeding.
Breast aspects: Nipple discharge, female breast underdevelopment.
Precocious puberty: Early appearance of armpit and pubic hair.
Losing or disappearing libido.
High blood pressure, abnormal blood sugar, purple streaks on the skin.
Image source: Zhanku Hailuo
2. What are the common causes of hirsutism?
Hirsutism is mostly caused by the excessive secretion of male hormones by the ovaries and adrenal glands or the body’s sensitivity to androgens. These factors will increase the secretion of male hormones, and androgens can increase the size of hair follicles, thicken hair, promote The role of hair growth in hormone-sensitive areas, resulting in hirsutism.
Idiopathic hirsutism
refers to female patients with hirsutism with no obvious cause and normal androgen levels, which can occur during menopause and pregnancy, worsen during pregnancy, and some symptoms may subside after childbirth.
Non-neoplastic ovarian disease
Mainly seen in polycystic ovary syndrome.
neoplastic disease
Tumors in the ovaries, adrenal glands, respiratory tract, and digestive tract can lead to elevated androgen levels.
Pituitary factors and adrenal hyperplasia, hyperplasia
Liver factors
A protein produced by the liver that binds serum androgens decreases, resulting in excess free androgens.
Drug factors
Use adequate amounts of androgens, such as dihydrotestosterone, methylandrostenediol, 19-nortestosterone, etc.
Some oral contraceptives can cause hirsutism.
Glucocorticoids, immunosuppressive cyclosporine, etc.
Cushing’s syndrome
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3. Who is prone to hirsutism?
Women of all periods can develop hirsutism. Polycystic ovary syndrome is more common in adolescent women; women of childbearing age and premenopausal women are mostly caused by tumors.
4. What conditions require immediate medical attention?
If you experience hirsutism-related symptoms, such as increased hair, acne, etc., seek medical attention as soon as possible.
5. How do doctors diagnose hirsutism?
The doctor will ask the patient in detail about symptoms, take a medical history, conduct a detailed physical examination, and assist with serum sex hormone tests, Ferriman-Gallwey scale and imaging tests to confirm the diagnosis.
Serum sex hormone test: Find out if it is true hirsutism, assess menstrual status, and identify the source of androgens.
Ferriman-Gallwey Scale: Grades hair growth.
Abdominal, pelvic ultrasound or CT: to see if adrenal, ovarian, and gastrointestinal tumors are present.
Cranial CT or Magnetic Resonance Imaging (MRI): Learn about the pituitary gland.
Blood lipids, liver and kidney function, electrocardiogram: Assess cardiovascular risk.
6. What questions might doctors ask their patients?
Does anyone in the family have ovarian or adrenal related disorders?
At what age do hairiness begin? Where do you grow hair?
Do you have acne? Hair loss?
Is your period normal? How is your menstrual flow? Is your menstrual cycle stable?
Are you taking medication for a long time? Like hormones and cyclosporine?
Have you had an endocrine test before?
Have you used hormone ointment?
How is your blood pressure? Is your blood sugar normal?
Image source: Zhanku Hailuo
7. What questions might patients ask their doctors?
What is hirsutism?
Why hirsutism?
What tests are needed to confirm the diagnosis?
What is the treatment?
Are there any adverse reactions to medication?
What do I need to pay attention to in my life?
Is it possible to relapse after treatment? Are there any precautions?
8. How to treat hirsutism?
Treatment is mainly based on the cause, including medication, topical therapy, and physical therapy.
Medication
Oral contraceptives and anti-androgens: Can lower androgen levels.
Oral corticosteroids: Used to treat hyperandrogenism in which the adrenal glands synthesize too much androgen, such as dexamethasone and prednisone.
Other treatments
Topical eflunithine treatment: There is currently no market in China.
Laser and IPL: It is currently difficult to remove all hair, but it can reduce, thin, and lighten general hair, and is effective for dark hair good. However, there is a risk of adverse reactions such as pigmentation and scarring.
Electrolytic Hair Removal: Fine needles are inserted into the hair follicles of the skin to directly destroy the hair follicles, which can achieve permanent hair removal.
Surgery: Removal of a diseased ovary or tumor if necessary.
References
[1] Zhu Xuejun. Dermatology (2nd edition) [M]. Beijing: Peking University Medical Press, 2015: 1135.
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