Hirsutism
Overview
Hirsutism or frazonism is the excessive hairiness on women in those parts of the body where terminal hair
Terminal hair
Terminal hairs are thick, long, and dark, as compared with vellus hair. During puberty, the increase in androgenic hormone levels causes vellus hair to be replaced with terminal hair in certain parts of the human body...

 does not normally occur or is minimal - for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair
Androgenic hair
Androgenic hair, colloquially body hair, is the terminal hair that develops on the body during and after puberty. It is differentiated from the head hair and less visible vellus hair, which are much finer and lighter in color. The growth of androgenic hair is related to the level of androgens in...

) and it is therefore primarily of cosmetic
Beauty
Beauty is a characteristic of a person, animal, place, object, or idea that provides a perceptual experience of pleasure, meaning, or satisfaction. Beauty is studied as part of aesthetics, sociology, social psychology, and culture...

 and psychological concern. Hirsutism is a symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

 rather than a disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 and may be a sign of a more serious medical condition, especially if it develops well after puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...

.
Encyclopedia
Hirsutism or frazonism is the excessive hairiness on women in those parts of the body where terminal hair
Terminal hair
Terminal hairs are thick, long, and dark, as compared with vellus hair. During puberty, the increase in androgenic hormone levels causes vellus hair to be replaced with terminal hair in certain parts of the human body...

 does not normally occur or is minimal - for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair
Androgenic hair
Androgenic hair, colloquially body hair, is the terminal hair that develops on the body during and after puberty. It is differentiated from the head hair and less visible vellus hair, which are much finer and lighter in color. The growth of androgenic hair is related to the level of androgens in...

) and it is therefore primarily of cosmetic
Beauty
Beauty is a characteristic of a person, animal, place, object, or idea that provides a perceptual experience of pleasure, meaning, or satisfaction. Beauty is studied as part of aesthetics, sociology, social psychology, and culture...

 and psychological concern. Hirsutism is a symptom
Symptom
A symptom is a departure from normal function or feeling which is noticed by a patient, indicating the presence of disease or abnormality...

 rather than a disease
Disease
A disease is an abnormal condition affecting the body of an organism. It is often construed to be a medical condition associated with specific symptoms and signs. It may be caused by external factors, such as infectious disease, or it may be caused by internal dysfunctions, such as autoimmune...

 and may be a sign of a more serious medical condition, especially if it develops well after puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...

. The amount and location of the hair is measured by a Ferriman-Gallwey score
Ferriman-Gallwey score
The Ferriman-Gallwey score is a method of evaluating and quantifying hirsutism in women. The method was originally published in 1961 by D. Ferriman and J.D. Gallwey in the Journal of Clinical Endocrinology...

.

Signs and symptoms

Hirsutism affects women and sometimes men, since the rising of androgens causes a male pattern of body hair, sometimes excessive, particularly in locations where women normally do not develop terminal hair within their puberty
Puberty
Puberty is the process of physical changes by which a child's body matures into an adult body capable of reproduction, as initiated by hormonal signals from the brain to the gonads; the ovaries in a girl, the testes in a boy...

 (chest
Chest hair
The term chest hair is generally used to describe hair that grows on the chest of human males, in the region between the neck and the abdomen. Chest hair, which is a secondary sex characteristic, develops during and after puberty...

, abdomen
Abdominal hair
The term abdominal hair refers to the hair that grows on the abdomen of humans and non-human mammals, in the region between the pubic area and the thorax . The growth of abdominal hair follows the same pattern on nearly all mammals, vertically from the pubic area upwards and from the thorax...

, back and face
Facial hair
Facial hair is a secondary sex characteristic of human males. Men often start developing facial hair in the later years of puberty or adolescence, approximately between 17–20 years of age, and most do not finish developing a fully adult beard until their early 20s or even later...

). The medical term for excessive hair growth that affect both men and women is hypertrichosis
Hypertrichosis
Hypertrichosis is an abnormal amount of hair growth on the body; extensive cases of hypertrichosis have informally been called werewolf syndrome. There are two distinct types of hypertrichosis: generalized hypertrichosis, which occurs over the entire body, and localized hypertrichosis, which is...

.

Causes

Hirsutism can be caused by either an increased level of androgen
Androgen
Androgen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors...

s, the male hormone
Hormone
A hormone is a chemical released by a cell or a gland in one part of the body that sends out messages that affect cells in other parts of the organism. Only a small amount of hormone is required to alter cell metabolism. In essence, it is a chemical messenger that transports a signal from one...

s, or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone
Testosterone
Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...

 stimulate hair growth, increase size and intensify the growth and pigmentation of hair. Other symptoms associated with a high level of male hormones include acne
Acne vulgaris
Acne vulgaris is a common human skin disease, characterized by areas of skin with seborrhea , comedones , papules , pustules , Nodules and possibly scarring...

 and deepening of the voice and increased muscle mass.

Growing evidence implicates high circulating levels of insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....

 in women for the development of hirsutism. This theory is speculated to be consistent with the observation that obese (and thus presumably insulin resistant hyperinsulinemic) women are at high risk of becoming hirsute. Further, treatments that lower insulin
Insulin
Insulin is a hormone central to regulating carbohydrate and fat metabolism in the body. Insulin causes cells in the liver, muscle, and fat tissue to take up glucose from the blood, storing it as glycogen in the liver and muscle....

 levels will lead to a reduction in hirsutism.

It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells. Again, the result is increased androgen production.

The following may be some of the conditions that may increase a woman's normally low level of male hormones:
  • Polycystic ovary syndrome
    Polycystic ovary syndrome
    Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....

    , abbreviated PCOS, (the most common)
  • Congenital adrenal hyperplasia
    Congenital adrenal hyperplasia
    Congenital adrenal hyperplasia refers to any of several autosomal recessive diseases resulting from mutations of genes for enzymes mediating the biochemical steps of production of cortisol from cholesterol by the adrenal glands ....

    , in turn mostly caused by 21-α hydroxylase deficiency
    Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
    Congenital adrenal hyperplasia due to 21-hydroxylase deficiency , in all its forms, accounts for over 95% of diagnosed cases of congenital adrenal hyperplasia, and "CAH" in most contexts refers to 21-hydroxylase deficiency...

  • Cushing's disease
    Cushing's disease
    Cushing's disease is a cause of Cushing's Syndrome characterised by increased secretion of adrenocorticotropic hormone from the anterior pituitary. This is most often as a result of a pituitary adenoma...

  • Tumor
    Tumor
    A tumor or tumour is commonly used as a synonym for a neoplasm that appears enlarged in size. Tumor is not synonymous with cancer...

    s in the ovaries or adrenal gland
    Adrenal gland
    In mammals, the adrenal glands are endocrine glands that sit atop the kidneys; in humans, the right suprarenal gland is triangular shaped, while the left suprarenal gland is semilunar shaped...

     (cancer
    Cancer
    Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...

    )
  • Certain medications
  • Insulin resistance
    Insulin resistance
    Insulin resistance is a physiological condition where the natural hormone insulin becomes less effective at lowering blood sugars. The resulting increase in blood glucose may raise levels outside the normal range and cause adverse health effects, depending on dietary conditions. Certain cell types...

  • Stromal Hyperthecosis - in postmenopausal women
  • Obesity
    Obesity
    Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems...

    : As there is peripheral conversion of androgens to estrogen in these patients, this is the same mechanism as polycystic ovary syndrome, PCOS.
  • Use of drugs like Tetrahydrogestrinone
    Tetrahydrogestrinone
    Tetrahydrogestrinone is an anabolic steroid developed by Patrick Arnold. It has affinity to the androgen receptor and the progesterone receptor, but not to the estrogen receptor...


Diagnosis

One method of evaluating hirsutism is the Ferriman-Gallwey score
Ferriman-Gallwey score
The Ferriman-Gallwey score is a method of evaluating and quantifying hirsutism in women. The method was originally published in 1961 by D. Ferriman and J.D. Gallwey in the Journal of Clinical Endocrinology...

 which gives a score based on the amount and location of hair growth on a woman.

Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

 (because of the high prevalence of polycystic ovary syndrome
Polycystic ovary syndrome
Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....

, as well as 17-hydroxyprogesterone
17-Hydroxyprogesterone
17-Hydroxyprogesterone is a C-21 steroid hormone produced during the synthesis of glucocorticoids and sex steroids.As a hormone, 17OHP also interacts with the progesterone receptor.-Production:...

 (because of the possibility of finding nonclassic 21-hydroxylase deficiency
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency
Congenital adrenal hyperplasia due to 21-hydroxylase deficiency , in all its forms, accounts for over 95% of diagnosed cases of congenital adrenal hyperplasia, and "CAH" in most contexts refers to 21-hydroxylase deficiency...

.

Other blood value that may be evaluated in the workup of hirsutism include:
  • the androgen
    Androgen
    Androgen, also called androgenic hormone or testoid, is the generic term for any natural or synthetic compound, usually a steroid hormone, that stimulates or controls the development and maintenance of male characteristics in vertebrates by binding to androgen receptors...

    s testosterone
    Testosterone
    Testosterone is a steroid hormone from the androgen group and is found in mammals, reptiles, birds, and other vertebrates. In mammals, testosterone is primarily secreted in the testes of males and the ovaries of females, although small amounts are also secreted by the adrenal glands...

     and dehydroepiandrosterone sulfate
  • thyroid-stimulating hormone
    Thyroid-stimulating hormone
    Thyrotrophin-stimulating hormone is a peptide hormone synthesized and secreted by thyrotrope cells in the anterior pituitary gland, which regulates the endocrine function of the thyroid gland.- Physiology :...

  • prolactin
    Prolactin
    Prolactin also known as luteotropic hormone is a protein that in humans is encoded by the PRL gene.Prolactin is a peptide hormone discovered by Henry Friesen...



If no underlying cause can be identified, the condition is considered idiopathic
Idiopathic
Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios + πάθος, pathos , it means approximately "a disease of its own kind". It is technically a term from nosology, the classification of disease...

.

Treatment

Many women with unwanted hair seek methods of hair removal
Hair removal
Hair removal is the removal of body hair, and describes the methods used to achieve that result.Hair typically grows all over the human body during and after puberty. Men tend to have more body hair than women. Both men and women tend to have hair on the head, eyebrows, eyelashes, armpits, pubic...

. However, the causes of the hair growth should be evaluated by a physician, who can conduct blood tests, pinpoint the specific origin of the abnormal hair growth, and advise on the treatment.

The most effective treatment that was tested is the oral Flutamide for one year.

17 of 18 women with hirsutism treated with combination therapy of Flutamide 250 mg twice daily and an oral contraceptive pill had a rapid and marked reduction in their hirsutism score. Amongst these, one woman with pattern hair loss showed remarkable improvement.

Pharmacological treatment

  • Spironolactone
    Spironolactone
    Spironolactone , commonly referred to as simply spiro, is a diuretic and is used as an antiandrogen.It is a synthetic 17-lactone drug that is a renal competitive aldosterone antagonist in a class of pharmaceuticals called...

    : Antialdosterone antiandrogenic compound.
  • Cyproterone acetate: A progestin that also has strong antiandrogenic action. In addition to single form, it is also available in some formulations of combined oral contraceptives.
  • Finasteride
    Finasteride
    Finasteride is a synthetic antiandrogen that inhibits type II 5-alpha reductase, the enzyme that converts testosterone to dihydrotestosterone...

    : 5 alpha reductase inhibitor that inhibits conversion of testosterone to more active 5 alpha hydroxy testosterone.
  • Metformin
    Metformin
    Metformin is an oral antidiabetic drug in the biguanide class. It is the first-line drug of choice for the treatment of type 2 diabetes, in particular, in overweight and obese people and those with normal kidney function. Its use in gestational diabetes has been limited by safety concerns...

    : Antihyperglycemic drug used for diabetes mellitus. However, it is also effective in treatment of hirsutism associated with insulin resistance (e.g. polycystic ovary syndrome
    Polycystic ovary syndrome
    Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....

    )
  • Eflornithine
    Eflornithine
    Eflornithine is a drug found to be effective in the treatment of facial hirsutism as well as in African trypanosomiasis...

    : Blocks putrescine that is necessary for the growth of hair follicles.
  • Flutamide
    Flutamide
    Flutamide is an oral nonsteroidal antiandrogen drug primarily used to treat prostate cancer. It competes with testosterone and its powerful metabolite, dihydrotestosterone for binding to androgen receptors in the prostate gland. By doing so, it prevents them from stimulating the prostate cancer...

    : Androgen receptor antagonist.

Other methods

  • Epilation
    EPilation
    EPilation is the first full-length release from Brisbane musician Tara Simmons. Although a full-length, EPilation contains no new material and is a compilation of Tara's first two EPs Pendulum and All The Amendments...

  • Waxing
    Waxing
    Waxing is a method of semi-permanent hair removal which removes the hair from the root. New hair will not grow back in the previously waxed area for two to eight weeks, although some people will start to see regrowth in only a week. Almost any area of the body can be waxed, including eyebrows,...

  • Shaving
    Shaving
    Shaving is the removal of hair, by using a razor or any other kind of bladed implement, to slice it down to the level of the skin. Shaving is most commonly practiced by men to remove their facial hair and by women to remove their leg and underarm hair...

  • Laser Hair Removal
    Laser hair removal
    Laser hair removal was performed experimentally for about 20 years before it became commercially available in the mid 1990s. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998...


See also

  • Ferriman-Gallwey score
    Ferriman-Gallwey score
    The Ferriman-Gallwey score is a method of evaluating and quantifying hirsutism in women. The method was originally published in 1961 by D. Ferriman and J.D. Gallwey in the Journal of Clinical Endocrinology...

  • Androgenic hair
    Androgenic hair
    Androgenic hair, colloquially body hair, is the terminal hair that develops on the body during and after puberty. It is differentiated from the head hair and less visible vellus hair, which are much finer and lighter in color. The growth of androgenic hair is related to the level of androgens in...

  • Pubic hair
    Pubic hair
    Pubic hair is hair in the frontal genital area, the crotch, and sometimes at the top of the inside of the legs; these areas form the pubic region....

  • Hypertrichosis
    Hypertrichosis
    Hypertrichosis is an abnormal amount of hair growth on the body; extensive cases of hypertrichosis have informally been called werewolf syndrome. There are two distinct types of hypertrichosis: generalized hypertrichosis, which occurs over the entire body, and localized hypertrichosis, which is...

  • Hair removal
    Hair removal
    Hair removal is the removal of body hair, and describes the methods used to achieve that result.Hair typically grows all over the human body during and after puberty. Men tend to have more body hair than women. Both men and women tend to have hair on the head, eyebrows, eyelashes, armpits, pubic...

  • Laser hair removal
    Laser hair removal
    Laser hair removal was performed experimentally for about 20 years before it became commercially available in the mid 1990s. One of the first published articles describing laser hair removal was authored by the group at Massachusetts General Hospital in 1998...

  • Bearded lady
    Bearded Lady
    A bearded lady or bearded woman is a woman who has a visible beard. These women have long been a phenomenon of legend, curiosity, ridicule, and more recently, political statement and fashion statement. A small number of women are able to grow enough facial hair to have a distinct beard...

  • Trichophilia
    Trichophilia
    Trichophilia, hair partialism, or hair fetishism is a paraphilia in which one becomes sexually aroused by, or is extremely fond of, human hair; commonly head hair....

  • PCOS or Polycystic Ovary Syndrome
    Polycystic ovary syndrome
    Polycystic ovary syndrome is one of the most common female endocrine disorders. PCOS is a complex, heterogeneous disorder of uncertain aetiology, but there is strong evidence that it can to a large degree be classified as a genetic disease....


External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
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