Hirsutism is defined as excessive and unwanted facial and/or body (say in the neck, chest and lower abdomen) hair in a male-like formulation. Estimates suggest that it affects between 5% and 15% of women, varying according to characteristics. At least 5% of women of reproductive age suffer from this ailment.

Hirsutism

It is a common issue causing significant social and psychological distress mainly among women, but modern diagnosis and treatment can surely take care of the problem.

Hair development biology

Our hair follicles first form in the fetal stage. The amount is approximately 5 million (20% of which is in the scalp) is genetically predetermined. To understand hirsutism better one needs to know the three hair types in humans and their life cycle.

• Lanugo hair: This soft, downy hair is first formed in the human fetus and disappears in late gestation or early postpartum stage.
• Vellus hair: It is non-pigmented, soft and short and occurs in the seemingly hairless body parts.
• Terminal hair: This is pigmented, dense, coarse and longer than vellus hair and makes the eyebrows, eyelashes, scalp hair, the pubic hair and axillary hair, etc.

The permanent conversion and development of vellus to terminal hair is a normal biological process triggered by androgens, testosterone and dihydrotestosterone (DHT) in body parts that are androgen receptive. This cycle normally starts at puberty, goes on during adult life and gradually diminishes with age and reproductive capacity in both sexes.

Diagnosis of Hirsutism

Medical diagnosis should obviously be done by a medical expert. Though hirsutism can be identified by the evident display of unwanted hair growth, it must not be mixed up with another similar syndrome called, hypertrichosis. Hypertrichosis also results in excessive hair growth but is of the non-terminal (vellus) kind and generally in non-sexual body parts. Its causes and treatment are also different.

The most prevalent technique of assessing hirsutism is that established by Ferriman and Gallwey in 1961. Hirsutism can be mild, moderate or severe as suggested by a pathological test. Generally, the diagnosis of hirsutism must start with a clinical history and physical check up to trace the signs and symptoms of the causes of hirsutism.

Investigation Advised

(1). Blood study will show increase in the male hormones and imbalance between the levels of the female hormones.

(2). Insulin level test.

(3). Thyroid level tests.

(4). Transvaginal ultrasound.

(5). Pelvic examination.

(6). CT scan, MRI- used to identify cyst or tumors on the ovaries or adrenal glands

Causes and associated disorders of Hirsutism

Hirsutism can be traced to three categories of causes:

1. Nonandrogenic factors are the one’s that are not related to disproportionate androgen activity.
2. Result of androgen excess.
3. Idiopathic hirsutism.

1. Nonandrogenic causes

This is less prevalent and can be divided in the following forms:

• Unnecessary hair growth of acromegalics.
• Coarsening of the hairs associated with chronic skin problems, since a major function of the hair is to protect the skin
• Non-androgenic anabolic drugs often cause a general increase of many tissues, particularly hair. This can also result in vellus hypertrichosis and not hirsutism.

2. Androgenic causes

This is the most common cause of hirsutism, accounting for around 75–85% cases. The various androgen dysfunction causes are listed below, with a percentage of their prevalence among hirsute patients (Please note that figures often vary in various surveys and reports):

• Polycystic Ovarian Syndrome (PCOS) – 70–80%
• Hyperandrogenism – 6.8%
• Hypothyroidism – 0.7%
• The hyperandrogenic insulin-resistant acanthosis nigricans syndrome (HAIR-AN) – 3 %
• 21-hydroxylase non-classic I adrenal hyperplasia (late-onset CAH) – 1.6%
• 21 -hydroxylase-deficient congenital adrenal hyperplasia – 0.7%
• Hyperprolactinemia – 0.3%
• Androgenic tumors – 0.2%
• Cushing’s syndrome – 0-1%

3. Idiopathic hirsutism

The idiopathic cause is traced in 4.7% patients and it’s associated symptoms are hirsutism and probable overactive 5 alpha-reductase action in skin and hair follicle. However, menses are regular.

How to remove unwanted hair?

(1). Bleaching- It is done to make the hair less noticeable by lightening it, using chemicals.

(2). Hair removal- It includes shaving, waxing, plucking or chemical depilation.

(3). Electrolysis- using electrical current to damage individual hair follicles so they do not grow back. This is expensive and requires multiple treatments.

(4). Laser hair removal- Individual hair follicles are damaged by using laser. This is a permanent method of hair removal requires multiple sittings and expensive too.
Homeopathic Treatment:

Homeopathy aims for a complete understanding of the disease pathology and treats it at the root cause. That is when the true healing is experienced.

Some of the medicines used for hirsutism and the problems associated with it are: Thuja occ, medorrhinum, sabal serulata, thyroidinum, calc carb, calc phos, pulsatilla, sepia, nat mur, ignatia, cortico, sep, plat, ol j etc