Excessive Hairiness

Diagnosis

Your doctor will ask a series of questions to help diagnose the cause of your hirsutism. Your doctor to will want to know the history of your condition, as well as your family’s health history. Tell your doctor at what age your symptoms first appeared, and whether the hirsutism developed quickly or over a long period of time. Other questions your doctor may ask include:

• Have you experienced signs of virilization such as increased sexual desire, increased muscle bulk, voice deepening, decreased breast size, or clitoral englargement?
• Have you recently gained a lot of weight?
• Do you smoke?
• Do you exercise regularly?
• Do you have trouble with menstruation, such as very light periods or missing your period altogether?
• Have you ever been pregnant?
• Are you taking birth control pills?
• Do you experience symptoms of menopause, such as hot flashes?
• Are you secreting milk even though you are not breastfeeding?
• Are you taking medication known to cause hirsutism?

Your doctor will check your blood pressure and weight, and will perform a physical exam. During your exam, your doctor will help you determine the extent and pattern of hair growth. He or she will also look for other signs that might offer clues to the underlying disorder. In particular, your doctor will be looking for and need your help to see if you have signs of virilization indicating a problem that needs to be addressed immediately. These include thinning of the hair at the front of your scalp; an enlarged clitoris; bulky muscles, particularly in the shoulder area; and decreased breast size. Signs of Cushing's syndrome (high levels of the hormone cortisol in the blood), like thin skin, stretch marks, dilated vessels, or purplish patches caused by blood under the skin, are also a concern.

You will likely undergo lab tests to help diagnose the specific cause of your hirsutism. There is a variety of blood and imaging tests commonly used to help diagnose the cause of hirsutism:

• Blood tests. These might include small amounts of blood being drawn with a needle to test for elevated levels of hormones like testosterone and its precursors; blood sugar levels; high levels of cholesterol or other lipids (fats); or Cushing’s syndrome (increased levels of hormone cortisol).
• Ultrasound. This is a non-invasive test that uses sound waves to create images of organs such as the ovaries. It can be used to look for tumors and other abnormalities.
• CT (computed tomography) or MRI (magnetic resonance imaging). These are sophisticated, non-invasive imaging tests similar to radiographs or x-rays. They provide detailed photographs of the body that can be used to detect adrenal tumors, for example. The adrenals sit on top of either kidney and cannot be clearly seen by ultrasound.
• Catheterization of the ovarian and adrenal veins to measure androgen levels may be used if your doctor is having a difficult time diagnosing the cause of your hirsutism. This is an invasive test performed by threading a small tube into the veins. It provides a clearer definition of the levels of sex hormones in the blood.

Prevention and Screening

Hirsutism can be prevented in some cases. If you have more body hair because of your ethnicity, there is not much you can do other than remove the unwanted hair physically. However, other forms of hirsutism may be prevented with the help of your doctor. Share information about any drugs or herbal medications you are taking, and share information about family members who have suffered from this condition. Early detection and treatment can prevent many of the problems connected to hirsutism. Hirsuitism linked to obesity can be prevented by maintaining a normal weight.