Treatment of Hirsutism - Overview

The most important evaluation for the patient with hirsutism is to determine the source of the androgens. In the constitutional familial type there will be no obvious increase in androgens but essentially end organ sensitivity. In searching for abnormalities in the production of hormones in the adrenal glands and ovaries there are useful markers that can be tested in the blood.

If the hirsutism starts abruptly and progresses very quickly the suspicion for ovarian, adrenal or pituitary tumours is much higher. If the hirsutism is associated with the nipples, or the sides of the face and neck, androgens are usually ovarian in origin whereas those associated more with the upper abdomen, anterior chest, side of the neck and chin usually are adrenal in origin. The excess hair on the sides of the face and the back tend to be drug related.

In evaluating the patient with hirsutism the testosterone level needs to be checked. If the testosterone is normal or slightly elevated this can be part of constitutional hirsutism. If there is a slight elevation in the DHES this is ovarian in origin. If the DHES is increased and the cortisol level reduced this is seen in adrenal hirsutism. Prolactin levels are elevated in hyper-prolactinemia. If the testosterone levels are moderately elevated the possibility of polycystic ovary has to be considered. Markers for adrenal gland activity can show increased cortisol and DHES. To evaluate the ovarian source of elevated testosterone CT scans and ultrasound studies of the ovaries can be helpful to try to determine if there are any solid tumours.

Treatment of Hirsutism:

1) To rule out any underlying medical conditions

Suspect further tests need to be done if

• Rapid increase in hair growth
• Sudden onset of hair growth
• Signs of virilization (deepening voice, cliteromegaly)
• Signs of Cushing's syndrome

2) Treatment

• Self Treatment
• Growth Inhibitors
• Hormone Blockers
• Physical Treatment