A Hairy Issue: Dealing with Hirsuitism

Some women grow hair in places that we do not want it (the neck and chin, the back, the chest). Some of us have to deal thinning hair on our scalps. And some of us have to deal with both excess hair and thinning hair. Whether we like it or not, cysters have hairy issues to deal with in the literal sense. The question is what do we do and how we deal with the fact we have unwanted hair in some areas. 

Hirsutism: What is it? 

Hirsutism is the medical term for excess body or facial hair in women. It is usually caused by an increased production of androgens (the male hormones) or an increased sensitivity of  androgen receptors in the follicles of the skin. 

How is Hirsutism Diagnosed? 

Two methods are used to diagnose hirsutism. The Ferriman-Gallwey model requires a visual inspection for the presence of excess hair growth. This model quantifies the amount of hair growth on nine areas of the body. Hair growth is rated using a scale of 0 (no terminal hair) to 4 (maximal growth) for a total score of 36. A score of 8 or more indicates the presence of excess androgens (Patel and Korytkowski, 2000). The problem is that visual inspection is not enough to indicate that there is a hirsutism problem. Many women pluck, shave, or otherwise remove the hair so that it is not present at the time of examination. 

Another method for determining hirsutism is blood tests for excess androgens. These tests include free testosterone, total testosterone, and dehydropiandosterone sulfate (DHEAS). Women with PCOS tend to have elevated levels of free testosterone in their systems because they do not have enough sex hormone-binding globulin produced by the liver. Normally, testosterone will bind with the sex hormone-binding globulin. Because the testosterone is unbound, it causes the symptoms of excess androgens (Nestler, Power, Matt, et. al, 1991).

DHEAS is a weak androgen produced by the andrenal glands. Although DHEAS is a less potent androgen, it can be peripherally converted to androstenedione and testosterone. This conversion process can also contribute to androgen excess in a PCOS patient. 

Tell the medical professional you are seeing about any excess hair growth you may be experiencing. Mention the excess hair problem to your medical professional if you have plucked, waxed, shaved or used another method to remove hair before your visit. 

Removing Excess Hair 

There are a number of ways to get rid of the excess hair: plucking, waxing or shaving; medications, electrolysis; and laser treatments. Some work better than others and all are not really permanent. A women with PCOS may have to go back several times in order to get the problem under control. 

Plucking is one way to to hide excess hair in the early stages. Although it is a quick and easy fix, plucking the hair from the follicle can distort the follicle and can cause the hair to thicken and become darker. Mary Ghorbanian, owner of M.G. Institute Ltd., recommended that women take a pair of fine tipped scissors and clip the hair during a recent PCOSupport Chat. "That way, the follicle does not become distorted." she said. "You'll also avoid the problems of little bumps on the skin as well." 

As the hirsutism worsens, women may choose a number of methods for removing unwanted hair. The first solution may be the use of depilatories. Depilatories remove hair by using chemicals that dissolve the hair and then allow you to wipe it away. It works fairly quickly, the harsh chemicals in the lotion can cause skin irritation. 

Waxing may also be used to remove excess hair. Warm wax is spread over the affected area. A cloth strip is placed over the hair and rubbed into the wax. The skin is held taut and then the cloth strip is pulled off, taking the hair and wax with it. Waxing can cause several problems. First, like plucking, waxing can distort the follicle since it essentially yanks the hair out from the follicle. Second, if not done properly, it can damage the skin causing bruiselike marks called "breaks". Waxing can cause ingrown hairs as well. 

Shaving is another quick solution. Although shaving is quick, it not only removes the problem hair, but the finer hair that has not been affected by androgens yet. Shaving may have to be done daily (or in extreme cases, more than once a day) in order to avoid having stubble or five o'clock shadow. 

As the hirsutism worsens, women turn to their doctors for medications and to other professionals for electrolysis or laser hair removal. Many doctors prescribe oral contraceptives (OCs)as a way to decrease the number of androgens circulating in their body. OCs can decrease the androgen production from the ovaries and adrenal glands, decrease the amount of circulating concentrations of total testosterone and androstenediones, and increase the production of sex hormone-binding globulin (Patel and Korytkowski, 2000). However, treatment with OCs can aggravate preexisiting insulin resistance. 

Doctors can also prescribe antiandrogen medications such as spironolactone, flutamide, and finasteride. Spironolactone and flutamide inhibit the actions of androgens by binding to and blocking androgen receptors. Finasteride inhibits the activity of the enzyme that is responsible for conversion of testosterone into a more potent androgen called dihydrogentestosterone. (Patel and Korytkowski, 2000). The use of these drugs will cause the hair to become finer and less apparent over time. It takes about six months to see any change. All of these drugs must be stopped during pregnancy because they affect the sexual development of the fetus (especially in the male fetus). 

Vaniqa (eflornithine hydrocloride) is the newest drug for hirsutism that has been approved by the FDA and it should be out in early or mid September. Vaniqa works by blocking an enzyme found in the hair follicles and inhibiting the growth of facial hair.  It takes between 4 to 8 weeks for any differences to be noticed. Until that time, it is recommended that you keep using medications and any other methods to control excess hair. 

Some women opt for electrolysis as a method for controlling excess hair. Before the treatment begins, a mild topical anesthetic is used to deaden the area to be treated. A very fine needle is inserted along the shaft of the hair and then an electrical pulse is sent into the root. The hair releases from the follicle and can be gently pulled out using a pair of tweezers. Electrolysis costs anywhere from $50-75 dollars an hour and may involve several weeks to several months worth of treatment before the amount of hair lessens. It can be painful depending where in your cycle you are, how much caffeine you have consumed, and how deep the roots are. According to Gail Chastant, an electrologist in the Houston Metro Area, you need to make sure that you are also seeking medical treatment for the hirsutism as well for the electrolysis to be most beneficial.  

The final and most expensive option for treating hirsutism is the laser hair removal. The light from the laser destroys multiple hairs in an area. The pigment in the hair absorbs the heat energy from the laser which destroys the hairs. Alexandrite lasers are the most recent kind of lasers to be used and work best on people with dark hair and light skin. With darker pigmented skin, the skin and the hair "compete" for the laser's heat. This "competition" can lead to damage to the skin. Laser treatments should be used in combination with medications to suppress the excess androgen production and prevent growth of new hairs in other areas. 

Tanning should be avoided when you are doing laser treatments. Waxing, plucking, and bleaching should be avoided for at least several weeks prior to treatment. It is fine to trim or shave the hairs, in fact it is best to freshly shave the area just prior to treatment. If you are adverse to shaving, clipping the hairs short is o.k. Laser treatments can cost in the neighborhood of $200-700 dollars for small to moderate areas and a few thousand dollars for larger areas. 

There are many options for dealing with the excess hair problem that can be a part of PCOS. What you decide to do for treatment is up to you and to some degree your budget. However, taking care of the hairy issues of PCOS can make you feel better about yourself.

References:

References

Nestler JE, Powers LP, Matt DW, et al. A direct effect of hyperinsulinemia on serum sex hormone-binding globulin levels in obese women with polycystic ovarian syndrome. J Clin Endocrinol Metab. 1991; 72:83-89

Patel SR, and Korytkowski, MT. Polycystic Ovary Syndrome: How Best to Establish the Diagnosis. Women's Health in Primary Care. 2000;1:55-69.

Patel SR, and Korytkowski, MT. Treating Polycystic Ovary Syndrome: Today's Approach. Women's Health in Primary Care. 2000;2:109-113.