Hirsutism (excessive body hair growth) and virilism (masculinisation).- Chapter 8:

Q 8. 1 What is hirsutism?

Hirsutism is characterised by excessive growth of pigmented thick hair in a typically male distribution. It may be particularly obvious when it is on the moustache or beard areas. The other common sites are the chest, abdomen, thighs and back. Pubic hair growth may extend upward from the usual bikini-line to the middle of the abdomen (umbilicus) (Figure 8.1).

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 2 What is virilism?

Virilism is more extensive than hirsutism, with additional evidence of masculinisation. There may be acne, oily skin, temporal scalp baldness, enlargement of the clitoris, voice deepening, breast size reduction, and irregular or absent periods. Occasionally, there may be increased libido and aggression.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen-dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism?
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 3 What makes a hair?

Each hair is formed from a hair follicle in the skin and each follicle lives for about three years. A hair consists of a column of dead cells derived from the living hair follicle. There is a central medulla, which contains the coloured melanin, and a hard external cuticle. Sebaceous glands are connected to the follicle. The sebaceous glands and the hair follicles are sensitive to the circulating androgens (masculinising sex hormones – Q 2. 9). Acne and excess body hair may be associated with increased levels of androgens.

Our skin is covered by hair follicles but those in the typical male distribution are sensitive to androgens which increase hair production, and oestrogens (female sex hormones) which decrease it. These sex hormones are carried in the blood on a protein called sex hormone-binding globulin (SHBG). Androgens decrease the amount of circulating SHBG and oestrogens increase the SHBG. If there is less SHBG, more of the androgen is ‘free’ (unbound to protein) and available to act on the hair follicles. (Q 2.10).

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen-dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism?
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?

In one survey 15% of women thought they had excess body hair although doctors found objective evidence of hirsutism in only 7%. There is a variation in normal hair production between ethnic groups.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen-dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism?
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 5 How can the severity of hirsutism be assessed?

A scoring system for assessing hirsutism was first described in North London by Ferriman and Galway nearly forty years ago. The hair production at eleven sites is scored from 1 representing a few hairs to 4 representing heavy hair growth. The sites evaluated are the upper lip, chin, chest, upper and lower back, upper and lower abdomen, arms, forearms, thighs and legs. The scoring system allows an initial assessment and facilitates comparison whilst on treatment.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen-dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism?
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 6 What are the effects of increased androgen levels on the skin and hair?

The skin and hair follicles are sensitive to the levels of free circulating androgens that are produced in the ovaries, adrenal glands and locally within the skin. There are enzymes (biological catalysts) in the skin that can convert inactive androgens or precursors to potent androgens. The effects are increased hair production and acne if the sebaceous glands secrete an increased amount of thickened sebum. The scalp hair growth may also recede in a typical male pattern.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen-dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism?
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 7 What are the effects of increased androgen levels in women?

The first signs of increased androgen levels (hyperandrogenism) are hirsutism and acne. The sensitivities of individuals to hormone levels vary considerably. When there are high androgen levels, other signs of masculinisation may be found including muscle enlargement, deepening of the voice, reduction or absence of periods, reduced breast size and enlargement of the clitoris. About 50% of women with hirsutism have normal hormone levels although there is likely to be increased activity of the skin enzyme ‘5 alpha- reductase’, which raises local androgen levels. Eventually there may be male pattern balding.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen-dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism?
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 8 What are the sources of androgen-dependent hirsutism?

The increased androgen can originate from the ovaries, the adrenal glands, or from medication. The commonest cause of hirsutism is polycystic ovary syndrome (Q 7.2). Hormone-secreting tumours of an ovary or an adrenal gland causing hirsutism are extremely uncommon.

The adrenogenital syndrome (congenital adrenal hyperplasia) usually presents in early life. The adrenal glands produce a variety of hormones. When they are unable to produce cortisol, the pituitary gland produces increased amounts of the hormone ACTH and this results in an increased production of androgens. If the cortisol synthesis is only partly deficient the adrenogenital syndrome may not be apparent during childhood but presents later in life with hirsutism or virilism. Some medicines can cause hirsutism and virilism and there are some rare diseases, such as porphyria, which are associated with hirsutism.

References:

The etiology of hyperandrogenism in women (1995) 08-08-659

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 9 How can the cause of my hirsutism or virilism be determined?

The story and examination findings may suggest the cause. Investigations including blood tests to determine hormone levels, and ultrasound are usually required. A simple flowchart (Figure 8.2) indicates the basic investigations and how they lead to a diagnosis.

Ultrasound examination and blood tests help to determine the cause. If you have polycystic ovaries, ultrasound examination will usually demonstrate the typical picture (Q 7. 1). Tumours of an ovary or adrenal gland are uncommon but could be shown by the ultrasound examination. An elevated LH in the blood during the first eight days of the menstrual cycle suggests polycystic ovary syndrome unless the FSH is also high suggesting the menopause. Testosterone may be slightly elevated in polycystic ovary syndrome or higher if there is a hormone secreting tumour. An elevated 17 alpha hydroxyprogesterone level suggests the adrenogenital syndrome. Sometimes the tests demonstrate no obvious abnormality and we assume that the skin is particularly sensitive to androgens; this may be a familial problem.

Many patients presenting with hirsutism are understandably anxious to exclude a major medical problem. Reassurance that investigations are normal or show just a minor imbalance may be all that they are seeking.

References:

Congenital Adrenal Hyperplasia:

21-hydroxylase deficiency in female hyperandrogenism: Screening and diagnosis. (1989) 08-09-3510

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 10 Is it always possible to determine the cause of hirsutism?

Usually clinical assessment and investigation will identify a cause but this is not always the case.

A twenty three year old lady was referred for investigation of increasing hirsutism and infrequent periods. Her periods arrived at 21 – 60 day intervals. She had needed waxing to remove her unwanted body hair. Her hormone profile demonstrated slightly elevated testosterone and LH levels but ultrasound did not show a picture typical of PCO. No other abnormality was detected. Although we had not shown conclusive evidence of PCO it seemed appropriate to treat her as if she had this condition. She elected to commence Dianette (Q8.13), which corrected the hirsutism, regulated her menstrual cycle and provided contraception.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 11 What cosmetic treatments are available to treat my hirsutism?

There are a variety of cosmetic treatments, which may be all that you require, although each may be associated with occasional problems.

• Shaving is the simplest and most effective in the short term but some find this psychologically unacceptable.

• Bleaching is not usually suitable for severe hirsutism.

• Plucking, waxing, sugaring, depilatory creams are effective but on occasion they can result in skin irritation or infection.

• Electrolysis is effective but expensive, time-consuming, and painful.

There is no evidence that any of these treatments aggravate hirsutism.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 12 If I lose weight, would my hirsutism improve?

Fat tissue is involved in altering some sex steroids to androgens. If you are overweight, this will tend to increase body hair production. Going on a diet and increasing your exercise should help you lose some of the unwanted hair and also help your general health.

Insulin resistance is common in polycystic ovary syndrome and this may be associated with weight gain, which in turn increases hirsutism. A diet designed to reduce weight may reverse this trend.

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 13 What medical treatments are available for my hirsutism?

There are medical treatments that:

• inhibit gonadotrophins (Q2.11).

Combined oral contraceptive pills, and in particular one containing the anti-androgen cyproterone acetate (Dianette – Schering) are the most popular treatments for hirsutism (Q8.14):

• inhibit overproduction of androgens.

Steroids such as dexamethasone may be used if there is evidence of congenital adrenal hyperplasia. There is some evidence that a small dose of steroids can be an effective treatment when no obvious cause can be found.

Suppression of ovarian hormone production with GnRH analogues (Q 33.16) is expensive and they can only be used by themselves for short spells. Combinations of GnRH and ‘add-back’ hormone replacement therapy (Q 27.35) may have an occasional place.

• increase SHBG (Q2.10).

Combined oral contraceptive pill.

• block androgen receptor sites.

Cyproterone acetate (Q8.15)

• increase sensitivity to insulin.

There is accumulating evidence that the clinical manifestations, including hirsutism, associated with PCOS can be related to insulin resistance (Q7.3). Metformin is a drug that increases insulin sensitivity and it has been used from the 1950s in the management of diabetes. Recent studies have demonstrated that metformin may be of value in the treatment of hirsutism associated with PCOS.

Patients often present with a combination of hirsutism and infertility. Investigation to establish the cause is required. Several medical treatments for hirsutism, such as the combined oral contraceptive, would clearly be inappropriate when pregnancy is being contemplated. Metformin may have a place in the treatment of PCOS associated hirsutism and anovulatory infertility. Currently we recommend that the drug should be discontinued as soon as pregnancy is confirmed.

References:

Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism (2001) 08-13-3246

Comparison of finasteride and flutamide in the treatment of idiopathic hirsutism. (1999) 08-13-2720

A prospective randomized trial comparing low dose flutamide, finasteride, ketoconazole, and cyproterone acetate-estrogen regimens in the treatment of hirsutism. (1999) 08-13-2687

Treatment of hirsutism: Comparisons between different antiandrogens with central and peripheral effects. (1999) 08-13-2561

The addition of dexamethasone to antiandrogen therapy for hirsutism prolongs the duration of remission. (1998) 08-13-2692

Effects of two antiandrogen treatments on hirsutism and insulin sensitivity in women with polycystic ovary syndrome. (1998) 08-13-2690

The efficacy of 250 mg/day flutamide in the treatment of patients with hirsutism (1996) 08-13-1527

Comparison of spironolactone-oral contraceptive versus cyproterone acetate-estrogen regimens in the treatment of hirsutism (1996) 08-13-1526

Flutamide in the treatment of hirsutism: Long-term clinical effects, endocrine changes, and androgen receptor behavior (1995) 08-13-947

Treatment of hirsutism with a gonadotropin-releasing hormone agonist and estrogen replacement therapy (1994) 08-13-507

Treatment of hirsutism with flutamide and a low-dosage oral contraceptive in polycystic ovarian disease patients (1994) 08-13-391

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.

The oestrogen in the combined oral contraceptive pill:

• increases the oestrogen levels in the blood and this directly reduces hirsutism.

• increases the SHBG levels and this reduces the amount of free androgen; the free androgen is largely responsible for hirsutism.

• suppresses gonadotrophin (FSH and LH) from the pituitary. Reducing LH production results in lower levels of ovarian androgen production.

Hormone replacement therapy involves administration of oestrogen and there is some evidence that it may have a part to play in the management of hirsutism when the pill is not acceptable.

References:

Does obesity diminish the positive effect of oral contraceptive treatment on hyperandrogenism in women with polycystic ovarian syndrome? (2001) 08-14-3265

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 15 What is cyproterone acetate?

Cyproterone acetate is an anti-androgen; it competes at the receptor sites (Q2.8) with androgens and reduces their effects. Dianette (Schering) is a special combined oral contraceptive pill that contains 2mg cyproterone acetate.

Higher dose cyproterone acetate may be considered. It is prescribed in a ‘reverse-sequential dose regimen’ when there is an inadequate response to previous medication. Usually, progestogens are taken in the latter half of cyclical oestrogen therapy, in HRT for example (Q 28.9). Cyproterone acetate is stored in the fat tissues and when it is administered late in the cycle there is a tendency for the period to be delayed. Cyproterone acetate 50mg or 100mg is, therefore, given on the first 10 days of each course of the pill. When cyproterone acetate is given in combination with the pill, it is likely to reduce hair growth, lighten the hair colour, and decrease the hair thickness in hirsute areas. Your doctor may request blood tests from time to time to check hormone levels and to ensure that your chemistry is not being affected adversely.

Medical treatments for hirsutism are not rapidly effective, overnight remedies. New hair follicles are developing all the time and each lasts for about three years. In one study of hirsute patients, 10-20% of patients were improving after six months and 90% were happy after 36 months. These treatments only work whilst they are being taken. They do not cure the underlying abnormality so that when treatment is discontinued the hirsutism may recur.

What is hirsutism?
What is viruslism?
Anatomy
How common is hirsutism?
How can the severity of hirsutism be assessed?
What are the effects of increased androgens on the skin and hair?
What are the effects of increased androgens in women?
What are the sources of excess androgens?
How can the cause of my hirsutism be determined?
Is it always possible to determine the cause of hirsutism?
What cosmetic treatments are available for my hirsutism?
If I lose weight will my hirsutism improve?
What medical treatments are available for my hirsutism?
How could the combined pill help my hirsutism?
What is cyproterone acetate?
What surgical procedures are available for my hirsutism?
Could you recommend some Web sites?

Q 8. 16 What surgical treatments are available for my hirsutism and virilism?

The commonest cause of hirsutism is polycystic ovary syndrome (PCOS). It has been known for sixty years that removing part of these ovaries surgically (wedge resection) can restore normal ovarian function. More recently, ovarian drilling puncturing small holes are in the surface of the ovaries at laparoscopy (Q 23.24) by cautery, diathermy or laser vaporisation has become possible. Ovarian drilling has had a definite part to play in infertility associated with PCOS usually when medical treatment has been unsuccessful. We must always consider the risks and benefits of treatment (Q4.21). There are risks associated with laparoscopic ovarian drilling and essentially we are treating a cosmetic problem. So far surgical treatment for hirsutism associated with PCOS does not seem to have been fully evaluated. It will be a while before the recently introduced metformin treatment will have been compared to ovarian drilling.

Hormone secreting tumours of the ovaries and adrenal glands are rare. If such a tumour is detected, surgical removal is required.

References:

Laser-assisted hair removal. (1997) 08-16-2689

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page

Q 8. 17 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter:-

Q 8. 1 What is hirsutism?
Q 8. 2 What is virilism?
Q 8. 3 What makes a hair?
Q 8. 4 I think that I have an excess of body hair. Is this a common complaint?
Q 8. 5 How can the severity of hirsutism be evaluated?
Q 8. 6 What are the effects of increased androgen levels on the skin and hair?
Q 8. 7 What are the effects of increased androgen levels in women?
Q 8. 8 What are the sources of androgen dependent hirsutism?
Q 8. 9 How can the cause of my hirsutism or virilism be determined?
Q 8. 10 Is it always possible to determine the cause of hirsutism?
Q 8. 11 What cosmetic treatments are available to treat my hirsutism?
Q 8. 12 If I lose weight, would my hirsutism improve?
Q 8. 13 What medical treatments are available for my hirsutism?
Q 8. 14 How could a combined oral contraceptive pill reduce my hirsutism.
Q 8. 15 What is cyproterone acetate?
Q 8. 16 What surgical treatments are available for my hirsutism and virilism?
Q 8. 17 Could I have some useful Web sites?
Women’s Health – Home Page