HIRSUTISM (Part 1)

Adults have two types of hair: vellus hair (soft, fine, short, and colorless) and terminal hair (long, dark, and coarse). Women have vellus hair on their face, arms, chest, and back, with terminal hair limited to the armpits and pubic region. Men have terminal hairs all over their bodies because their androgen hormone levels are far higher than females (usually 4-20 times higher).

Androgens are a type of sexual hormone. They aid in the initiation of puberty and play a role in reproductive health and body development. Androgens are produced by both sexes, but men produce more. The most common androgen is testosterone. If a woman’s hair follicles are exposed to high androgen levels or become more sensitive to normal androgen levels, her soft, vellus hairs can transform into terminal hairs, a condition known as Hirsutism.

WHAT IS HIRSUTISM?

This is a condition in which a woman’s coarse body hair grows in a pattern similar to that of men. Increased amounts of soft hair are more indicative of nonhormonal causes of hair growth, which are more common in various ethnicities. Increased amounts of coarse and often dark hair, such as that seen in the pubic region, are more indicative of a hormonal cause of hair growth.

This is most common on the face, back, midline chest, lower abdomen, inner thigh, and buttocks. Arm hair can also darken, making the hair appear thicker. Extra hair growth caused by excess male hormones (Androgens), primarily testosterone, is common in hirsutism.

THE ANDROGEN HORMONES

Androgens are a class of hormones that influence male characteristics and reproductive activity. The primary androgens found in both males and females are Testosterone and Androstenedione. Androgens are sometimes referred to as male hormone, but don’t be misled by the name. Androgens are produced by both male and female bodies, albeit in different amounts. In fact, androgens have over 200 actions in women and are present in higher concentrations than estrogens. They are, of course, much more prevalent in men and play an important role in male characteristics and reproductive activity. Dihydrotestosterone (DHT), Dehydroepiandrosterone (DHEA), and DHEA sulfate are some other androgens (DHEA-S). One of the primary functions of androgens in a woman’s body is to be converted into female hormones known as estrogens.

Androgens in Women

Androgens are produced in the ovaries, adrenal glands, and fat cells in women. Women may produce too many or too few of these hormones. Androgen excess and deficiency disorders are among the most common hormonal disorders in women. Androgens play an important role in the hormonal cascade that initiates puberty in women, stimulating hair growth in the pubic and underarm areas. Furthermore, it is thought that these hormones regulate the function of many organs, including the reproductive tract, bone, kidneys, liver, and muscle. Androgens are required for estrogen synthesis in adult women and have been shown to play an important role in bone loss prevention as well as sexual desire and satisfaction. Excess androgens can cause virilizing effects such as acne, hirsutism (excess hair growth in inappropriate places such as the chin or upper lip), and hair thinning on the head (balding).

SYMPTOMS OF HIRSURISM

When high androgen levels cause hirsutism, other symptoms, known as virilization, may develop over time. Virilization symptoms could include:

• Deepening voice
• Balding
• Acne
• Decreased breast size
• Increased muscle mass
• Enlargement of the clitoris

CAUSES OF HIRSURISM

Hirsutism may be caused by:

Genetics: Women whose immediate family members experience symptoms of hirsutism are more likely to experience it themselves.

Polycystic ovary syndrome (PCOS):  The most common ovarian cause of hirsutism is polycystic ovary syndrome (PCOS). The syndrome is characterized by irregular ovulation and, as a result, irregular menstrual cycles, increased hair growth or the presence of acne, and, in some cases, polycystic ovaries (small growing follicles – not true cysts). The majority of PCOS women are overweight or obese, resulting in elevated insulin levels, insulin resistance, or diabetes. Insulin is closely linked to androgenic hormone production in PCOS patients. Elevated insulin levels are frequently associated with increased levels or activity of androgenic hormones, resulting in increased hair growth.

Cushing syndrome:  Cushing’s syndrome, a rare disease, can also cause hirsutism. Cushing syndrome is caused by the adrenal glands producing too much cortisol. Although hirsutism is seen in Cushing syndrome patients, high blood pressure, diabetes, muscle weakness, fatigue, red stretch marks, and obesity are all common signs and symptoms. In such clinical presentations, specific and advanced hormone testing is recommended to differentiate Cushing syndrome from hirsutism. Cushing syndrome symptoms can also be found in women who are on long-term steroid therapy.

Congenital adrenal hyperplasia:  This inherited condition is characterized by adrenal glands’ abnormal production of steroid hormones such as Cortisol and Androgen. The most common adrenal gland abnormality that can cause hirsutism is Non-classical Adrenal Hyperplasia (NCAH), which causes the adrenal glands to overproduce androgens. NCAH, like PCOS, is associated with irregular menstrual cycles………… TO BE CONTINUED