Hirsutism

What it is

Hirsutism is the growth of thick, dark hair in areas where women normally have little hair, such as the face, chin, chest, abdomen, back and inner thighs. It is related to an excess of male hormones (androgens) or to increased sensitivity of the hair follicles to them. The most common cause is polyendocrine metabolic ovarian syndrome (PMOS), but adrenal gland disorders, the use of certain medications and, more rarely, hormone-producing tumors can also be involved — especially when the growth is rapid or accompanied by other signs of virilization. The investigation includes the clinical history, physical examination and hormone level testing. Treatment combines controlling the underlying cause, medication that reduces the action of androgens, such as contraceptives and antiandrogens, and hair removal methods, such as laser and electrolysis, with gradual results over the months.

Most common symptoms

• Thick, dark hair on the face, chin and upper lip
• Hair on the chest, abdomen and around the areolas
• Hair on the back and inner thighs
• Acne and oily skin
• Male-pattern hair loss
• Irregular menstrual cycles
• Voice deepening or clitoral enlargement, in rare cases

Causes and risk factors

• Polyendocrine metabolic ovarian syndrome (PMOS)
• Increased sensitivity of the hair follicles to androgens
• Adrenal gland disorders
• Use of certain medications and anabolic steroids
• Hormone-producing tumors, more rarely
• Ethnic and family predisposition

How it is diagnosed

At the visit, your gynecologist assesses the distribution and intensity of the hair growth, how quickly it appeared, the regularity of the cycle, weight and medication use, and looks for other signs of excess androgens. Blood tests measure testosterone and other adrenal hormones, as well as prolactin, thyroid hormones and metabolic markers. Pelvic ultrasound helps identify PMOS. When growth is rapid or there are signs of virilization, imaging tests of the adrenal glands and ovaries may be ordered.

How we treat it at Femi Saúde

Treatment combines controlling the underlying cause and reducing the action of androgens on the hair follicles. The Femi Saúde gynecology team may recommend hormonal contraceptives and, depending on the case, antiandrogen medications, whose effect on hair growth usually appears gradually, over several months. When PMOS is present with insulin resistance, lifestyle changes and metabolic medications are part of the plan. At the same time, the patient is guided on hair removal methods, such as laser hair removal and electrolysis, which act on hair that has already grown. Follow-up is periodic and the plan is individualized.

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