Excessive Hairiness Diagnosis

  • Diagnosis

    The medical term for excessive hairiness is hirsutism. The term is usually applied to excessive hairiness in women. In women, hirsutism appears as dark, visible, and often abundant hair growth in a male-type pattern. The hairs usually occur on the face, chest, abdomen, upper pubic triangle between the groin and navel, inner thighs, and back. Hirsutism occurs in 5% to 10% of women.

    Hirsutism may be caused by medical conditions that cause the body to have an excess of certain hormones, or by some medications. Hirsuitism is sometimes linked to changes that make the body more masculine (virilization), which can happen to both males and females. Signs of virilization include deepening of the voice, increased muscle mass, decreased breast size, enlarged genitals, and increased libido. Hirsutism linked to virulization is a concern and should prompt a visit to a physician.

    Some ethnic groups normally have more body hair than others. Women of Mediterranean, Middle-Eastern, Hispanic, or African-American ancestry tend to have more body hair than women of other ethnicities. Regardless of how pronounced or minimal her body hair, if a woman is bothered by unusual hairiness she should see a doctor.

    Treatment for hirsutism consists of lifestyle changes, medication, and physical removal of unwanted hair. Losing weight and getting exercise can add to the benefits of drug therapy, since obesity has been associated with an increase in the male hormones that can cause hirsutism. Medication alone is not usually enough; some people with hirsutism may want to have their hair physically removed as well.

    Several medical conditions can cause the growth of unwanted dark, visible hair.

    • Polycystic ovary syndrome (PCOS), the most common cause of hirsutism, occurs when the body overproduces male hormones (androgens). Polycystic ovary syndrome may cause decreased menstruation, unusual growth of cells in the ovaries (ovarian hyperplasia), unusually high levels of blood fats (hyperlipemia), glucose intolerance or resistance to insulin (diabetes), obesity, and a predisposition to heart disease. These symptoms often develop before puberty.
    • Cyst or tumor of the ovary. Cysts and tumors are abnormal growths in the body. When they occur on the ovary, they can cause a hormonal imbalance, leading to hirsutism.
    • Adrenal gland disorders. The adrenal gland produces hormones that affect many bodily processes. Conditions that interfere with the adrenal gland’s normal function can upset a body’s hormonal balance, and lead to hirsutism. Cancer of the adrenal gland is one such condition. Adrenal hyperplasia—an increase in the number of cells of the adrenal gland—is another such condition. Cushing's syndrome, characterized by obesity around the midsection, muscle weakness, altered mood, purple stretch marks, and easy bruising, is caused by the production of an excess amount of the hormone cortisol by the adrenals.
    • Acromegaly. Also known as gigantism, acromegaly causes enlargement of the head, face, hands, feet, and upper torso. It is due to the excess production of growth hormone by the pituitary gland.
    • Increased prolactin hormone levels (hyperprolactinemia). Prolactin is a hormone that is involved in milk secretion from the breast. Increased levels of this hormone can lead to hirsuitism, as well as milk leakage from the breast and menstrual cycle disturbances.
    • Deficiency of 21-hydroxylase, an enzyme that is needed to produce cortisol (a steroid that maintains blood sugar levels and maintains body fluids and electrolytes) and aldosterone (a hormone that maintains the body's salt and water balance.)
    • Severe insulin resistance or diabetes causes the ovaries to increase their production of androgens.

    In addition, other conditions that are linked to hirsutism, include obesity, pregnancy, and menopause. These conditions are all similar in that they cause production of hormones (usually androgens like testosterone) that can increase hair growth. In the case of pregnancy, the hair growth tends to stop once the child is delivered. In the cases of obesity the hair growth will be controlled once the problem is addressed by weight loss or hormone therapy.

    Taking certain medications may cause or contribute to hirsutism Table 01. The underlying reason for hair growth often has to do with a problem in the body’s production of hormones. For example, if the body produces an excess of androgens (male hormones), the result will often be increased hair growth. At the same time, drugs that are hormones or that stimulate the production of hormones can also stimulate hair growth. Classes of drugs commonly understood to cause hair growth include the following:

    • Sex hormones. These are hormones such as estrogens or androgens that are produced by the ovaries, testicles, or the adrenal gland. Androgens are hormones, such as testosterone, that drive male sex characteristics.
    • Steroids. The adrenal glands naturally produce steroid hormones to help control stress, maintain body mass and muscle tone, and perform other essential functions. If someone takes synthetic steroids, the drugs will prevent the adrenals from making their own supply. At the same time, if a large dose is required, the drugs may cause hair growth and other bodily changes, exactly as if the adrenals were producing too much hormone. This effect, however, applies more to anabolic or androgenic steroids than to glucocorticoids.
    • Drugs that stimulate the pituitary or adrenal glands. The pituitary gland is located in the head and controls other organs in the body that make hormones, including the ovaries and the adrenals. Some drugs can stimulate the pituitary, causing it in turn to signal other hormone-producing glands.
    • Anti-seizure medications. The mechanism is not clear, but anti-seizure medications tend to have hirsutism as a side effect.

    Sometimes hirsutism can occur without any underlying cause. This is called idiopathic hirsutism.

    Table 1.  Medications That Can Cause or Contribute to Excess Hair Growth

    Drug Use
    Sex hormones
    Androgens and estrogens (varied) Combination of male and female hormones often prescribed for symptoms of menopause
    Androgenic progestin (varied) Hormone used for a number of reasons, including regulation of the menstrual cycle
    Contraceptives (varied) Prevent pregnancy
    Danazol (Danocrine) Used to treat endometriosis, cysts in the breast, breast cancer, and hereditary swelling of parts of the body (angioedema)
    Dehydroepiandrosterone sulfate (DHEAS) Prescribed in older people to help offset a decrease in lean body and bone mass.
    Testosterone (Android, Testoderm, Androgel) Male hormone sometimes used to replacement therapy in deficiency or absence of endogenous testosterone; also used to treat breast cancer in women (Androbid).
    Steroids
    Anabolic steroids (Primobolan, Parabolan) Prescribed to help rebuild tissue after a serious injury or illness, to treat some anemias, to treat some kinds of breast cancer in women, and to treat hereditary swelling of various parts of the body (angioedema)
    Corticosteroids (varied) Used to treat inflammation-based diseases like asthma and lupus, and to prevent rejection of transplanted organs
    Medications affecting the adrenal or pituitary gland
    Aminoglutethimide (Cytadren) Treats tumors that affect the adrenal cortex.
    Corticotropin (Acthargel) Stimulates production of hormones by the adrenal gland
    Metyrapone (Metopirone) Used to test for proper function of adrenal glands
    Anti-seizure medications
    Acetazolamide (Diamox) Used to treat glaucoma, epileptic seizures, edema due to congestive heart failure, and to lessen the effects of climbing to high altitudes
    Phenytoin (Dilantin) Treats epileptic seizures
    Valproate (Depakote) Used to treat epileptic seizures and bipolar disorder
    Miscellaneous medications
    Cyclosporin (Ciclosporin) Prevents rejection of transplanted organs, treats rheumatoid arthritis
    Diazoxide (Hyperstat) Treats low blood sugar (hypoglycemia) and high blood pressure (hypertension)
    Hexachlorobenzene Pesticide that may be ingested with contaminated food, water, or air. Although this is not a medication, when it is accidentally ingested it can cause hirsutism.
    Metoclopramide (Reglan) Treats symptoms of a stomach problem called diabetic gastroparesis, treats heartburn in patients with esophageal injury due to backflow of gastric acid, used to treat chemotherapy-induced nausea and vomiting, and to diagnose some problems of the stomach or intestines
    Minoxidil (Loniten, Rogaine) Treats high blood pressure (Loniten); can be used to promote hair growth (Rogaine)
    Penicillamine (Cuprimine) Used for treatment of Wilson's disease (excessive copper in the body), rheumatoid arthritis, and lead poisoning. Prevents kidney stones
    Phenobarbital (Luminal) Can be used before surgery to relieve anxiety or tension, treat trouble in sleeping (insomnia); treatment of seizures (generalized, tonic-clonic and cortical focal)
    Phenothiazine derivatives (varied) Antihistamines to relieve allergy or hay fever symptoms
    Psoralens (varied) Used, along with ultraviolet light, to treat vitiligo (a disease in which skin color is lost) and psoriasis (a skin condition characterized by red, scaly patches.) Sometimes used to treat white blood cells in a type of lymphoma

    Hirsutism is the presence of dark, visible hairs in a male pattern. It may be accompanied by infertility or irregular menstruation. Hirsutism is characterized by dark, thick hair on the upper lip, chest, abdomen, and back. These hairs are different than the fine “baby” hairs that most women have on their upper lip, chin, breasts, or stomach.

    Women with a family history of polycystic ovary syndrome or congenital (familial) adrenal hyperplasia are at risk for developing hirsutism. Both of these diseases are thought to have a hereditary, or genetic component. Congenital adrenal hyperplasia means excessive growth (and usually excessive hormone production) by both adrenal glands—a problem that is passed down through generations of a particular family. If your family is prone to any of these conditions or to hirsutism, see your doctor for early diagnosis. If caught before symptoms appear, therapy can correct the underlying problem and prevent hirsutism from developing. If the underlying causes of hirsutism are not treated, longer-term health risks due to ongoing hormone excess may arise. These include diabetes mellitus, high blood pressure (hypertension), hardening of the arteries (atherosclerosis), and endometrial cancer. In addition, many women with hirsutism suffer from depression.

    The extensive use of androgens or steroids can cause excess or unusual hair growth. Although these drugs are prescribed for a number of conditions, in some cases they can drive certain bodily changes, including increased hair growth. This is true whether they are being used illicitly or under the supervision of a doctor.

    Postmenopausal women are more likely to have unwanted hair growth. This is because their ovaries are no longer active. Ovarian hormones such as estrogen counteract and stabilize the activity of androgens produced by other glands in the body.

    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.

    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.

  • 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.

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