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a) What is Hirsutism?

Millions of women struggle with unwanted hair, frequently attributed to a hormonal condition known as hirsutism. In other cases, unwanted hair can emerge as hormonal levels shift, or when normal hair growth in women is considered “unwanted” by cultural beauty standards. Excessive hair has too often been cast aside as a “beauty issue.”

Hirsutism occurs when a woman's hair follicles that would normally produce pale, fine vellus hairs have switched to producing darker, coarser terminal hairs in areas of the body that are sensitive to the hormone androgen. In women with hirsutism, androgen-sensitive areas include:

• Face, commonly around the chin or as an extension of the hairline
• Thick body hair on the abdomen, often an extension of the pubic hairline
• Chest
• Breast
• Lower back
• Buttocks
• Inner thigh
• External genitalia

Hirsutism describes an excess of what is normal for our ethnic group. Hirsutism is not the same as healthy, normal growth that we may think is excessive and therefore abnormal, but in actuality is normal. Hirsutism in women most often resembles a male pattern hair growth, which in women is an excess.

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b) What is idiopathic hirsutism?

Generally, hirsutism starts around puberty and progresses slowly over many years. This is also the progression of hirsutism associated with polycystic ovarian syndrome, or PCOS. There are many causes of hirsutism which are discussed later on.

Hirsutism not associated with any particular disease or condition is known as idiopathic hirsutism and may run in families. About 20 percent of women fall into this category.

Idiopathic hirsutism is a term used by doctors that have not been able to associate excessive hair with any disease or condition. Instead, it may be diagnosed as genetic or having ‘sensitive' hair follicles.

So, how it that some hair follicles remain vellus and other turn dark?

Hair is developmentally and genetically predisposed to turn terminal during puberty, late adolescence, pregnancy, and menopause. However, if the hair follicles are exposed to androgens for other reasons (e.g., disease, stress, or diet), the vellus hair could change to terminal hair. It is wholly dependent on our skins' reaction to 5-alpha-reductase activity that causes the change.

For some women, the androgen reaction in their skin doesn't lead to hirsutism; instead, they get acne, seborrhea, alopecia, or a combination of those conditions.

For other women, the androgen effects on their skin turn the terminal hair on their scalp into vellus hair, yet their vellus hair turns terminal in other places (akin to bald men with beards).

Why can idiopathic hirsutism be particularly difficult to deal with?

Male pattern hair growth in women can be draining both physically and mentally. The psychological aspect of the condition is the same whether it is caused by ‘sensitivity' to hormones or a medical condition.

If hirsutism is caused by a medical condition, help may be offered through the NHS. This would form part of the overall treatment plan for the underlying condition. Laser hair removal is likely that treatment. If there is no underlying condition to treat, support may not be offered to us. Instead, our condition may be deemed as aesthetic or beauty in nature.

If hirsutism is suspected, visiting a doctor is recommended. If we are diagnosed as ‘normal' for us, it can make us feel worse, particularly if we have already decided we aren't. A diagnosis remains important to rule out any medical conditions. If support is not offered we shouldn't despair, with the right treatment approach we can be kept things under control.

There is no cure for idiopathic hirsutism.

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c) Common medical causes of hirsutism

• Polycystic ovarian syndrome PCOS – is linked to too much androgen production.
• Cushing's syndrome – is rare and unfortunately, 99% percent of cases are caused by excessive amounts of glucocorticoid, which is used to treat inflammation and immune disorders and diseases, such as asthma, lupus, and arthritis.
• Rare endocrine disorders – several rare endocrine disorders can cause androgens levels to increase to the point where hyperandrogenemia is considered. These disorders are usually accompanied by hirsutism.
• Obesity – fat cells can make androgen just as they can make oestrogen, thus causing hirsutism.
• Stress – in response to stressful situations, adrenal glands release stress hormones that speed up the body. Because adrenal glands also make androgens, increased stress can increase circulating androgens and cause excessive hair growth.
• Tumours – tumours of an ovary or the adrenal cortex are associated with hirsutism.

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d) What are the treatment options for hirsutism?

Cosmetic hair removal

Hair removal does not treat hirsutism, and cannot be considered a treatment; however, it is a method to cope with hirsutism. Despite cosmetic hair removal, terminal hair will continue to grow with the exception of electrolysis. Cosmetic hair removal is great in conjunction with hormone therapy.

Antiandrogen therapy

Hormone therapy and pharmacological drugs do not make excess hair disappear, rather they stop the growth of new hair. Sometimes this therapy will thin the terminal hair, or make the strands a little tighter. However, the reduction in hirsutism lasts only as long as we take the therapy, with occasional positive effects continuing for a short time after you stop.

Antiandrogens inhibit androgen receptors in our body that is, hair follicles. Antiandrogens can reduce hirsutism by 30 to 60 percent and reduce the diameter of hair shafts. They are dose-dependent and a doctor may try different doses.

Antiandrogens should not be used if we are sexually active without excellent contraception because the hormones can cause fetal deformities if used during pregnancy. Lifestyle and treatment options should be discussed with a doctor during the childbearing years.

Oral contraceptives

Oral contraceptives work by suppressing the androgens secreted by our ovaries, thereby reducing free androgen concentrations in our body and slightly reducing androgen secreted by our adrenal glands.

This is a simplified description, but in general terms, contraception works on many levels in our endocrine system to block the processes that cause androgen excess and therefore hirsutism. The benefits of oral contraceptives-

• Reduce the incidence of endometrial and ovarian cancers
• Reduce the likelihood of developing fibrocystic breast condition
• Reduce the likelihood of developing ovarian cysts
• Reduce the chance of developing iron-deficiency anaemia due to less menstrual blood loss and more regular cycles
• Reduce the severity of menstrual cramps and premenstrual syndrome (PMS)
• Tend to improve androgen-related side effects such as acne and unwanted hair.
• Improve cholesterol levels depending on the type of oral contraceptive.

Topical skin cream

A topical cream called eflornithine hydrochloride cream for the face reduces the rate of hair growth for many women. It is an irreversible inhibitor of ornithine decarboxylase, an enzyme necessary for hair growth. Results are noticeable in six to eight weeks. Once the application of the cream is discontinued, the hair returns to pretreatment levels after about eight weeks.

The prescription medication, called Vaniqa, can be used alone or in conjunction with other therapies.

All hormonal therapies should be discussed and prescribed by a medical professional. Any information displayed is for reference only.

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e) Hair removal methods that work

Laser hair removal & electrolysis

Electrolysis and laser treatments are so effective and popular, dedicated posts are throughout the site combining laser hair and electrolysis for greater results. An electrolysis guide electrolysis the only permanent hair removal method and a treatment post for laser hair in deep skin Nd:YAG the optimal laser for dark skin hair removal.

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Shaving

You've probably heard that one of the worst ways to remove hair is by shaving. And it certainly seems true because when we shave the hair appears to grow back thicker and coarser. However, that stubbly feeling is simply the result of cutting the hair at its thickest point-the remainder of the hair strand then has a blunt feeling. Although shaving causes the hair to grow back faster as compared to yanking methods, shaving does not increase the hair follicle's growth rate or strengthen it as other methods can, it does not affect the actual follicle.

Shaving does not cause hair to thicken, which is another common misconception. In fact, hirsutism studies have shown that shaving cannot influence hair density in any way. Shaving is a good way to exfoliate the skin, which can improve the texture.

Shaving can cause problems however, such as razor burn (raised and puffy bumps), ingrown hair and folliculitis, which are especially painful in the groin, bikini, and pubic areas. Such conditions may be remedied with chemical peels and AHA exfoliators but you may wish to try a triple-blade razor gives a faster, cleaner shave than the less expensive single or double blades or those marketed to women with sensitive skin.

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If you have coarse or thick hair, try men's razors. You may also like to try men's shaving cream/gel. Besides smelling great, they can be more effective at holding the hair in the razor for a smoother shave.

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Tweezing

A one-time investment in a good pair of sturdy tweezers that are easy to manipulate is essential. The cheaper ones are made of flimsy material and often the ends don't match up well enough to grab the hair.

Tweezing sparse facial hairs on the chin, out of moles, around your nipples, on your upper lip area, on your toes, under your belly button, or elsewhere on the body can give immediate short-term gratification-followed by long-term aggravation when the hair grows back stronger and coarser, generally worsening your hair problem.

Scar tissue can also form during tweezing, which may be as undesirable as the original hair.

Over tweezing or digging too deep with tweezers can cause our skin to look pitted. Be very careful when tweezing and don't break the skin to remove an ingrown hair, let it grow out naturally. Try a loofah sponge or chemical exfoliator to remove dead skin cells that may be blocking a hair.

Tweezing offers fast results and can be successful providing adequate exfoliation of the skin is performed. Tweezing is a terrible way to remove hair from large areas, great for brow shaping.

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Epilators

These devices round up the hair with an electronic spinning motion and remove hair from the root. Epilators can be painful with certain areas more sensitive than others. Epilators can cause skin irritation, leading to folliculitis or ingrown hairs. And like other methods of plucking, epilators strengthen the follicle.

Hair removal is temporary and stimulation of the hair follicles can cause them to grow stronger. Hair that doesn't grow back maybe as a result of scar tissue in the follicle. Like tweezing, epilators give short-term gratification but the device allows large areas to be treated quickly.

Braun Silk-Épil 9 9/980 SkinSpa SensoSmart

Braun silk-epil nine sensosmart is the world's 1st smart epilator. The silk-epil skinspa is a complete 4-in-1 epilation, exfoliation and skincare system. The epilator includes sensosmart pressure sensor technology to guide your epilation and remove even more hair in one stroke. Braun’s wet and dry epilator comes with two body exfoliation brushes to help reduce ingrown hairs. With 13 extras, including a shaver and trimmer cap for sensitive areas, bikini trimmer, skin contact cap, facial cap, pouch, and stand.

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Hair removal cream

Hair removal cream does less damage to the hair follicle than does epilation and does not worsen hirsutism as epilation methods can do. Hair removal cream works by chemically dissolving the hard keratin of the hair shaft so that the hair does not grow back stubbly as it does with shaving.

The active ingredients in most creams are thioglycolates, which disrupt disulfide bonds in the hair. You'll notice that they smell a little bit like sulfur.

Hair removal cream is great for long hair and is a lot quicker than shaving. If prone to razor burn or ingrown hairs, hair removal cream is a good choice.

One downside of hair removal cream is that it may irritate the soft keratin of our skin. The chemicals can cause contact dermatitis in some people. If you have thick, coarse hair or sensitive skin, look for creams marketed to men for their facial hair.

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Waxing

Waxing entails applying hot wax to the hair and pressing paper or cloth into it. When the wax sets, it's ripped off quickly, pulling removing the hair with the wax. Many people report the pain as excruciating, especially in sensitive areas. Others say it doesn't hurt much or they get used to it over time.

Hair inevitably grows back sooner than hoped, and so repeat treatments are needed which can make waxing expensive over time. The rate hair grows back depends on genes, not on the waxing or technique.

Another downside to waxing is that regrowth is required for repeat treatment. That means allowing hair to grow in areas you may be embarrassed to show in the meantime.

Like tweezing, waxing stimulates the roots and hair follicles. Ingrown hairs are a common side effect, and waxing can cause skin irritation. Many women wax for years without problems and find this method satisfying.

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