Hair Growth in all the Wrong Places - Notes from a San Francisco Bay Area Dermatologist

We all have heard about the “bearded lady” on display at carnival shows, but have you ever wondered about the medical cause for this condition?  Or perhaps you yourself struggle with hair growth in unwanted places?

Well let’s shed some light on what can often be an embarrassing and under discussed topic.  This condition that affects many women and is known as hirsutism.  Hirsutism is defined as coarse pigmented hair appearing in regions of the female body where hair is not commonly found – primarily the face (upper lip, chin, and cheeks), neck, mid-chest, and low back.

Hirsutism is typically caused by excessive action of the male sex hormones (androgens) secreted by the ovaries and adrenal glands.  This can occur for a variety of reasons, with the most common cause being polycystic ovarian syndrome (PCOS).  Abnormally high androgen levels can also occur in women suffering from underlying adrenal and other central endocrine abnormalities.  Occasionally (less than 20% of the time), hirsutism occurs in the absence of excessive androgen levels and other underlying pathology, and may be attributed to an abnormal relationship between circulating androgen and the androgen receptor sites in the hair follicles.

Why do conditions, such as Polycystic Ovarian Syndrome, stimulate excess hair growth?  When more androgens (male sex hormones) are secreted by both the ovaries and the adrenal glands, it leads to an increase in their circulation and availability in the body.  The androgen receptor sites that lie within the hair follicle also have an increased affinity to these circulating androgens.  In other words, they are have a stronger attraction to these circulating hormones and cause a greater number of hormones to bind to available receptor sites.  When androgens attach to the androgen receptor sites in the hair follicles, they cause an increase hair diameter, growth rate, length, and pigmentation.

Hirsutism affects 5-10% of women that are of reproductive age and even a greater percentage of women that are of Mediterranean and African descent.  We see many women in our office for hair removal (commonly facial hair, central chest, and lower back) with hirsutism.  If a woman has hirsutism, we are sure to inform them that they will not get the 80% reduction most women receive after 4-6 hair laser removal treatments because of the constant supply of hormones (androgens).

The best way to treat this condition is often with a combination of medical therapy (typically, birth control pills and/or a medication called Spironolactone) in conjunction with the removal of the unwanted hair.  The goal of using medications to help manage hirsutism is intended to correct any underlying abnormal hormonal imbalances in an effort to help reduce excessive hair growth.  Medications can suppress the secretion of androgens from the ovaries and adrenal glands (the 2 main sites of androgen origin), bind to circulating androgens making them unavailable to attach to the receptor sites within the hair follicles, reduce the conversion of weak androgens into stronger androgens and block androgen receptor sites within the hair follicle so available circulating androgens have no where to land.

A topical medication that can also be helpful is Vaniqua (eflornithine hydrochloride) Topical Cream.  This a topical medication indicated for the reduction of unwanted facial hair in women.  It slows the rate of hair growth by interfering with an enzyme that is necessary for hair growth.  It should be applied twice a day and used in conjunction with laser hair removal.

If you are a female and have struggled with hair growth in not so feminine places, contact a dermatologist.  He or she can help determine if hirsutism is playing a role by ordering a few simple lab tests.  There is hope for controlling this condition!

Tags: androgen, bay area dermatologist, hair growth, hirsutism, san francisco bay area dermatologist

This entry was posted on Tuesday, July 21st, 2009 at 11:34 am and is filed under Skin Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.