I’m a girl and I’m growing hair on my face. Please just tell me why!

The third and final post in this series directed at young women beginning to develop hirsutism.  The first article dealt with what to expect in the doctor’s office and the second article dealt with some of the main tests you will likely undergo.  Now we will talk about what those test results may tell the doctor, and what can be done about them.

I’m a girl and I’m growing hair on my face.  Please just tell me why!

The “why?” and the “what can be done?” are too intertwined to separate.  And I’m afraid the bad news is, unless the cause is a tumor or organ that can be removed, or a medications that can be stopped, there is no current “cure.”

And no, laser hair removal is not a cure, despite what laymen, some laser hair removal companies, and even some doctors will tell you.  Especially if you are hirsute, your hormones will be able to coax your laser-burned hair follicles right back to life.  This happened to me.  If you wish to try laser hair removal, ensure you know the cause of your hirsutism first and have that under control.  I have both read and been told by my own specialist medications combined with supposedly “permanent” methods like laser hair removal are much more successful, and for a longer period of time.

Regardless, learning to love and accept yourself as a whole (not as a “bearded lady” or a “hirsute woman”, but as a woman) seems to be the best treatment available.  But I have a whole blog to talk about that.  Let’s move on to the immediate topic of concern:


What could the diagnosis be? 

Medications or steroid use - Sometimes the answer could be as simple as something you are putting in your body yourself that is causing the hormone imbalance.  Certain treatments for asthma, epilepsy, and endometriosis can do this, to name a few.  If the medication is not essential or can be changed, your doctor can discuss with you the safe way to taper them off.


Polycystic Ovarian Syndrome (PCOS) - The most common diagnosis.  In PCOS, the ovaries are producing excessive amounts of androgens, for a few possible reasons.  The high androgen levels are what cause the hirsutism, as well as other symptoms relating to too much “male” hormone like:

• acne
• thinning of scalp hair
• irregular (and otherwise abnormal and uncomfortable) periods
• lack of ovulation (and thus difficulty becoming pregnant)
• a series of small cysts like a “necklace” on the ovaries,
• issues with metabolism like weight gain and insulin resistance

And these are just the most obvious symptoms.  Although this is the most common diagnosis, you should know that some doctors immediately jump to this conclusion without ruling out the other possibilities.  The tricky thing about PCOS is that it has such a wide range of symptoms, and not all of them will appear in every woman.  Many women won’t get cysts on their ovaries at all, some women never have weight issues, some don’t grow unwanted hair. 

This is usually a syndrome that, depending on how it presents in you personally, will need to be treated, because it can put women at higher risk for many other conditions such as diabetes and cardiovascular disease.  Treatment of PCOS can include:

• Diet and medications to bring insulin sensitivity under control, which can in turn help the other symptoms. 
• Oral contraceptives to help regulate your cycle, if starting a family is not your immediate goal. 
• If hirsutism is the primary concern, you can also be prescribed the same anti-androgen medications as other women with hirsutism, as long as you are not planning to conceive. 
• If conception is your main goal, there are ovulation-inducing medications, and assisted reproductive technology is an option.

And the nice thing is, there is a lot of support out there for you at places like SoulCysters.


Obesity - Similar to PCOS, hirsutism can be caused by hormonal imbalances from obesity.  And considering obesity can be a symptom of things like PCOS, Cushing’s syndrome or hypothyroidism (discussed later), it may all be related anyway, but I thought it was worth mentioning.


Cushing’s Syndrome - Too much cortisol in the body.  This can be caused by certain drugs, or disorders like Cushing’s disease, wherein the pituitary creates too much ACTH (telling the adrenal glands to make lots of cortisol) or the adrenal glands themselves secrete too much cortisol (or, rarely, a tumor not related to the endocrine system is secreting the ACTH itself).  Aside from hirsutism, other symptoms include:

• acne
• weight gain
• excessive sweating
• easy bruising and skin dryness
• high blood pressure,
• insulin resistance
• gastrointestinal problems
• irregular periods or lack of ovulation
• changes in libido
• insomnia

Often, Cushing’s syndrome is caused by other medications, which you can gradually stop taking, if possible.  If you have Cushing’s disease and it is caused by a benign tumor on the pituitary or adrenals, treatment usually involves surgically removing it.  Either way, it takes some time for the endocrine system to recover, and usually some hormone therapy will be required. 


Congenital Adrenal Hyperplasia (CAH) - A genetic disorder that is present at birth.  It has several different forms, but in the forms relevant to hirsutism the adrenal glands produce excessive amounts of androgens.  This can cause symptoms in girls and women besides hirsutism, including:

• irregular cycles
• lack of ovulation and infertility
• early or delayed puberty
• ambiguous genitalia
• mineral imbalances

There are hormones that can be applied to reduce the hyperplasia, and in young ones hormone therapy of testosterone or estrogen can be applied at puberty.  And, as in PCOS, there are anti-androgen medications that can reduce the effect of the angrogens on your skin and hair, though these will not reduce the excessive production.

In many countries, newborns are screened for CAH, but it is a good idea to be tested for this again simply for family planning.  As a recessive gene, if you and your partner both carry it, there is a greater chance this disorder will present in your children, and with greater severity.


Hypothyroidism - The thyroid is not making enough thyroid hormone.  This can be thanks to the thyroid gland itself, the pituitary gland not communicating properly with the thyroid, or the hypothalamus is not talking enough to the pituitary gland.

Some sources will cite hirsutism as a symptom of hypothyroidism, and others do not.  It seems to be a rare occurrence, but happens often enough to be connected.  And considering hypothyroidism’s other symptoms include affects on the menstrual cycle, libido, scalp hair loss, and weight gain, like in the previously mentioned conditions, it is worth putting on the list. 

I won’t go into it much more than that, but this can be treated by medications containing synthetic thyroid hormones.


Tumor - I must emphasize again that this is quite rare, and remind that tumor does not equal cancer.  Aside from the tumors mentioned in Cushing’s syndrome, it is possible that a tumor, frequently on an ovary, is secreting the androgens right into your system, and its removal will help restore balance to your body.


Idiopathic Hirsutism - Just as tricky as PCOS, if not more-so because different doctors use the term in different ways.  To many, “idiopathic hirsutism” means “I don’t know what it is, or why it is.”  And maybe that’s party true.  But if all the other possibilities have been excluded, and your only symptom is hirsutism with no evident cause (not even high androgen levels), there is still an explanation. 

Doctors may not be able to explain yet why this happens, but some women are just more sensitive to the normal levels of hormones in their body.  These normal hormones are just tootling along, minding their own business, and the androgen receptors completely misunderstand and tell the woman’s skin to do things like get oil and sprout dark, coarse hair where a light, vellus filament once grew before.

Since there is no known underlying cause to treat, you can choose to manage your hair with the previously mentioned anti-androgen medications if you wish.  As I said, these don’t lower your androgen levels, but they interfere with the way they interact with your androgen receptors.  This will reduce, but not always erase, your excess body hair.  But as mentioned in the outset, once you have determined which medication (if any) works best, you might find some more aggressive hair removal methods (such as electrolysis or laser hair removal) are more effective.




There is a lot of information out there that is more detailed about each of these conditions and their treatment, including what the medications are like and how they help, as well as their side-effects.  Since I have idiopathic hirsutism, I mainly talk about the anti-androgen medications here.  I have tried Spironolactone with and without oral contraceptives (Alesse and Diane-35) and Finasteride, which you can read about by following the links.

I also talk about methods of hiding body hair, from plucking and trimming to bleaching and chemical depilatories to shaving and more.  I personally endorse shaving as the least invasive and easiest method.  And I sometimes review products that I feel others might be curious about or that have been helpful to me.


Because this post is so full of information, most of which you will not need, I will post next week the summary of how I have learned to deal emotionally with hirsutism.  Your thoughts and feelings will be the most important part of your treatment.

I’m a girl and I’m growing hair on my face. What will happen?

 This post is a continuation of a series of little articles for girls with hirsutism who have just started looking for answers.  Read the previous post here.




I’m a girl and I’m growing hair on my face.  What will happen?

 Last week I talked about what it means to have hirsutism and what your initial doctor's visit will probably be like.  After they do their physical exam (you'd be surprised how much this can tell a dcotor--I can barely comprehend it myself!) and ask for more information about your symptoms, they will either give you an order for some tests, or refer you to a specialist who will give you an order for some tests.


What kind of tests will I undergo?

You are growing coarse dark hair in these odd places because male hormones called androgens are telling those hair follicles to grow it (including testosterone--and forgive me for using the term “male hormones”, which is misleading; it’s a hormone women need too). This can be caused by too much of that hormone or a sensitivity to that hormone.  There are many different parts of the endocrine system that can affect this change in you.

This list is not exhaustive, but it gives you some of the main tests the doctor will likely order:

• Tests to measure the amount of androgens in your blood like Testosterone, SHBG (Sex Hormone Binding Globulin), and/or Free Androgen Index

• Tests to measure your thyroid activity such as TSH (Thyroid Stimulating Hormone) and sometimes Free T4 (Free Thyroxine)

• Tests to measure pituitary function like FSH (Follicle Stimulating Hormone)

• Tests to measure adrenal function including Testosterone, DHEAS (DHEA-SO4, DHEA Sulfate, Dehydroepiandrosterone Sulfate) and 17H (17-hydroxy-progesterone)

• A fasting glucose test will also tell them a lot about how your endocrine system is working

They may not order all of these tests if you aren’t presenting symptoms besides the hair that call for concern in these areas.  Or they may order others besides these, like estrogen, cortisol or insulin, which are relevant for certain conditions that cause unwanted hair growth.

Don’t stress over these tests.  They can only reveal so much.  Every woman is supposed to have some level of "male" hormones in her body, and I was shocked to learn that it is actually very difficult to determine what amount is “normal.”  Hormone levels fluctuate throughout your cycle; even throughout the day.  (Some tests even have to be taken at a certain phase of your cycle for pertinent results, and the doctor will tell you about that if it is necessary.) 

The labs are given a range to judge by.  The computer might rank you as "high" but you might simply fall on the high side of normal, which is completely normal for you.  This was what happened in my case.  My family doctor told me I had too much testosterone, while my endocrinologist blinked with surprise and said that my levels were fine.  It comes down to this: What might be average for one woman could be an extreme for another.  That is why it is so good to have an endocrinologist on your side--they have experience interpreting these tricky tests.


Depending on the results of these tests, the doctor may order more tests.

Some of the afore-listed tests can be ordered as follow-ups to other tests.  For example, a doctor may order only a TSH test at first, then ask you to get your Free T4 evaluated afterward.  And keep in mind that once you decide on a treatment path, the doctor may want to test you periodically for side-effects.  Be prepared for multiple trips to the clinic or lab.  For example:

• If your 17H test comes back with results in certain range, they will want you to take an ACTH stimulation or "CAH" test.  This is a test that involves an injection of ACTH, and then subsequent blood tests to monitor how your adrenal glands react.  (I have done this test, it’s a lot better than it sounds.  You can read about it here.)

• Your DHEAS and corstisol levels might also point to requiring a closer look at the pituitary and/or adrenal glands by CT scan or ultrasound.

• Several results might indicate a pelvic ultrasound would be useful.  Testosterone, DHEAS, FSH, Glucose could all point the finger at your ovaries for the source of the elevated hormones or sensitivity that is causing your hair. 

• TSH or T4 results may show the need to check out the thyroid in detail, by ultrasound or sometimes using radioactive iodine in a scan.

This is certainly not a comprehensive list of tests, but it gives you an idea of how much work it can be to pinpoint the underlying cause of your hirsutism.  That’s why it’s good to start now.  Knowing the reason provides a huge amount of peace of mind, I can tell you, even if you don’t like the reason.  And while some reasons do not require treatment unless you want to manage the hair growth, your hirsutism may be a sign of a condition that could cause complications later on in your life.

Combining your description of all your symptoms, a physical exam and these tests, a specialist can then come to a conclusion and advise treatment.  We’ll talk about some of the possible conclusions next week.

To read about all my tests (read: me whining about needles and full bladders) go here.

A really good site about lab tests, what they’re used for and why: Lab Tests Online (Not intended to replace a doctor’s advice!)


Read the next post in this series here.

I’m a girl and I’m growing hair on my face. What do I do?

Did you know, I recently realized I never did articles like this, as was my intention from the very start?




I’m a girl and I’m growing hair on my face.  What do I do?

The words I was too frightened to type into a search engine from the time I was 14 years old, even though it was the question I wanted an answer for more than anything else.  Until my early 20’s, as I was most of the way through college and had already spent what I would have considered a “fortune” on laser hair removal, I didn’t dare look for an explanation.  Now I see them everywhere--Yahoo!Answers, tumblr, forums, in the comments section of beauty articles.  My impression in communicating with some of my readers is that most of you have been living with excessive body hair for a while and already know why you have it.

But what about those girls out there who are in the stage where they cannot yet admit to themselves that they know something is “wrong” with their bodies, or who are just starting to concede to it and aren’t sure what to do next?  (Note, I am about to start addressing girls who can be qualified as ‘hirsute,’ that is, have pronounced male pattern hair growth--not a surplus of soft blond hair, not a thin mustache or darker arm hair accountable to certain ethnicities, not a couple of stray buggers on the chin or nipples.  Hirsute means you have dark and often coarse hair in some or all of the places a man tends to have it--chest, back, stomach, face, etc.)

To you, I would like to start by saying: Don’t panic.

I promise it’s not as bad as it might seem right now, regardless of the reason why you’re growing dark hair in surprising places.

Next, the thing I wish someone had told me before anything else: Abnormalities in hair growth are a symptom, not a sickness.  They indicate a hormonal issue, not a skin issue. 

What you need to do is go to your doctor. 

I know it can be embarrassing talking about it to your parents, never mind someone else.  You’re probably hoping if you ignore it, it will go away.  If you’re a young person whose hormones are in the midst of a change already, perhaps it will.  But most likely, your excessive body hair is a clue to something that doesn’t automatically fix itself. 

Is it serious?  Well, serious compared to what?  If your body hair is robbing you of confidence and changing the way you live your life, is that not serious enough?  You are in control of your own happiness.  Start by taking charge of your health.  If you don’t, you will always be wondering what is going on in your body that you can’t see.  You deserve the peace of mind, and the knowledge that will allow you to make good decisions about how to manage your body hair from day to day.


Three things your doctor will want to know:

When was your last period?/How regular are your cycles?/What are your periods  usually like?  (Heavy flow?  Cramps that last longer than the first few days of your period?)  - Your answers to these is often a very good indicator that something funky is going on with your hormones.  They can even hint at where the hormonal issue might lie in your endocrine system. 

How quickly did the hair appear? - If severe body hair growth has cropped up in a short amount of time, this can direct the doctor’s attention towards certain causes.

What is your family history? - Often you will not find hirsutism in your family history.  Doctors aren't quite sure how or even if hirsutism is passed on, with the exception of one or two disorders that have hirsutism as a symptom.

Any other symptoms? - Some things you may want to mention to the doctor include:

• changes in mood, energy, appetite, concentration, libido.
• difficulty losing weight.
• oily skin and hair, acne, thinning scalp hair.
• any body pain, changes in breasts, cramps, bloating, headaches.
• challenges with conceiving.

Aside from this, they will also do a physical examination (checking your blood pressure, feeling your abdomen, etc.)

See all my personal blog entries on visits to doctors.


What next?

Your doctor may order some tests to try to pinpoint abnormalities before doing anything else.  Or, they may refer you to a specialist who will order the tests for you.  Either way, the specialist you will eventually want to be referred to is an endocrinologist.  They are experts in hormones.  Many women have received great care from their gynecologist, but keep in mind that the endocrine system involves so much more than the lady parts.  Indeed, the cause of your hirsutism might have nothing at all to do with the reproductive systems.  That’s not to say OBGYNs can’t be well versed in hirsutism.  Some dermatologists might be familiar with those tests too.  But frankly, they have a lot of other stuff they need to know as well.  Wouldn’t it make sense that an expert in the entire endocrine system is more likely to catch all clues towards your diagnosis, having both the specialization and the experience?


Over the next few weeks I’ll go a little further into the kinds of tests you can expect, possible causes for your unwanted body hair, and what can be done about them.

Read the next post in this series here.

Unrelated - Gynaecologist

Why are all my referrals to parts of the city I never drive in?  Stress upon stress!

But it feels so good when it’s over.  I didn’t know what to expect from this consultation, what they’d found on the latest ultrasound, and even if they’d be able to speak to my concerns about the severe pain I sometimes got in my lower abdomen.  I really hadn’t had any full-blown attacks since that one in August 2010, the one that spurred me to tell the endo that being on Spiro by itself might be making the attacks more frequent.  It had been a year and a half since the last bout.  Were they going to laugh at me for asking them to explain exactly what is on my ovary and what it means for me, and shoo me out of the office for wasting their time?  Was the pain going to be completely unrelated to the cyst they found in the ultrasound and I’d be back at square one?  Was I going to get intimidated and forget everything I wanted to say?  I’d gone so long without knowing, too scared to find out what it was.

I waited for half an hour in the examination room, the ominous bed with stirrups, two stainless steel kidney-shaped bowls and a tube of lubricant for company (none of them ended up applying to me, since being a virgin they can’t do the physical exam).  So I reviewed the list I’d spent the last couple of evenings compiling, with records of every episode of that particular abdominal pain, the ultrasounds, and medications I was on at the time, as well as compiling a list of questions to ask (for which the Mayo Clinic website was helpful). 

They’d told me a resident would be coming in first, and I liked her right away.  She was very sympathetic, paid close attention to what I told her and took lots of notes.  I was glad I had prepared so diligently the last few nights, because it made me more aware of the key things to tell her so I didn’t rely on her promptings to share all my observations.  She happily explained exactly what kind of cyst I had--which is a simple cyst caused by an egg-bearing follicle failing to reabsorb into the ovary.  It’s filled with fluid, which is a good sign its benign, and apparently this kind is very common in women; most don’t know they have them, as they do eventually reabsorb without pain.  Sometimes, as it seems to be in my case, they rupture, causing that severe but  fairly brief pain I have been experiencing at random.  My latest ultrasound showed that this one on my right ovary is still stable, and in fact possibly shrinking a little bit.  And the fact that I haven’t had any full-blown attacks of pain since starting birth control proves that the medications I’m on right now are controlling the problem, since my ovaries are not being told to release eggs.

The thought of cysts bursting and draining fluid into my abdominal cavity causing irritation and pain was not too encouraging, but I was told this is generally not a danger with small fluid-filled cysts.  The real danger is when the cysts get larger (2 or 3 times the size of mine) and can shift things around in your abdomen.  Really all that can be done for me is to wait and see--if I elected to have surgery to remove it, I could lose the ovary.  It is stable, and will likely reabsorb in six months to a year or so.  If this cyst bursts, all they can really do is give me a stronger pain killer to ride out the painful bit.  It was definitely reassuring to hear that other women have described this as some of the worst pain they’ve ever experienced.  And it’s gone pretty quickly.

She explained this all to me so clearly and patiently, I wanted to cry.  If only I could have had this answer years ago when I first told my family doctor.  After the resident made her diagnosis, she took it out to the gynaecologist, and who then came in to meet me and agreed with her conclusion.  She was just as sweet as the resident, and neither of them made me feel like my problem was trivial.  The OBGYN even gave me a lab requisition so that I could check the progress of the cyst in six months for my own peace of mind.  I felt grateful tears in my eyes.  A simple “thank you” was all I could give.  My second most troubling health concern (under hirsutism) has an explanation. 

Because the medications I’ve been taking for the hirsutism were relevant to the symptoms of pain I was experiencing, I did talk to the resident a bit about that part of my life.  I was impressed with how knowledgable she was about it.  Because hair growth is always a hormone problem and not always caused by the ovaries, I preferred going to an endocrinologist and never expected an OBGYN to be as familiar with all the tests and medications.  But I have to say I wouldn’t have had any qualms with that office treating my hirsutism if it had worked out that way.  I was just so pleased.  (She also said she could see no indications of hirsutism on me.  Thank you, Spiro and Cover Girl!)

6 Months on Spiro with Diane-35

I was back at the endocrinologist's last week for my six month follow-up since starting the combination of 200 mg Spiro and Diane-35.  (I am too impressed by my iPhone, taking pictures of my own feet in the waiting room...)

I was able to report to her that I am quite happy with the current treatment, so neither of us feel the need to change my meds.  The Diane keeps my periods regular with no mid-cycle spotting, and though I think it makes my stomach sour sometimes, it is very very tolerable.  And I think the little bit of cyproterone in the bcp might help... either that or being on Spiro longer is allowing me to see even more effects.  I'm not shaving my chest anymore, and the hair on my stomach is light enough that I would only trim it if I were going to wear a bikini for some reason.  The hair on my thighs is lighter and even on my face there is definitely a bit of thinning out.  The endo said she rarely sees the facial hair disappear altogether on medication, and indeed it is the most stubborn part of a hirsute woman's body.  She again mentioned that I might be happy with the result of laser hair removal now, and I am still seriously considering it.

From here, my family doctor (if we ever decide on one) can continue to prescribe the medications, and there will be no need to keep going back to the endo.  Admittedly, I was a little sad about that.  She was the one who finally helped me find answers.  Also from this point, we can even begin to start tapering off the medications and see how low we can get them before I start to notice the hair returning.  Though she says there is no cumulative risk for being on these medications and any serious side effects are rare, especially in my age, there are always risks, and it's up to each individual whether or not they feel the results are worth putting these chemicals in their bodies.

For me, right now, it's worth it.  I'm trying to stay fit and do my monthly breast exams.  Even if the prescriptions won't help me far enough to achieve my dream of one day waking up and not having a beard to shave, they are making life easier by reducing the hair, the acne, and the shine.  I know it's a temporary solution, but aren't crutches designed to support you until you can walk on your own?  I like having the little extra help now.

So, since I hope these are helpful (they help me prepare for my endo appointments)... photographic evidence, such as I can accomplish:

(Click for larger view)

Again, my stomach, as this is an area of dramatic change.  Would anyone benefit from seeing other areas, if I can figure out how to post those body parts modestly?  

From left to right:  Before any medication; 6 months on Spiro (100mg); 4 months on Spiro (200mg); 2.5 months on Finasteride; 6 months on Alesse and Spiro (200mg); 6 months on Diane and Spiro (200mg).

A Little Ovary Update

It’s the way it always goes; I was out running errands when the endocrinologist’s office called, and got their message that my results were in about five minutes after the office had closed for the weekend.  And, of course, it was a long weekend, with a lovely statutory holiday right at the end of it.  So I tried not to think about my nervousness after the ultrasound, and waited until Tuesday morning to call them, just before work. 

The receptionist just looked at my file and told me right there that the cyst was there, and it was stable.  Using my background in health insurance, I take that to mean it hasn’t grown or shrunk, which I suppose is good.  I would have much preferred to hear it was gone, and that the black spot I kept seeing on the ultrasound was just an ovary, but... (shrug) oh well.

I felt weird asking questions about my scan of the receptionist, but when she said that the cyst needed no further follow-up, I asked if that meant I would not be referred to an OBGYN.  It didn’t say anything on my file, so she said she’d check and get back to me.  I don’t necessarily want to go to an OBGYN, but when I first found out about the cyst and asked questions of the endo (questions I can’t even remember at this point) she said she was not in the best field to respond to them.  I’d at least like to hear from an OBGYN what I have to watch for to make sure this cyst doesn’t cause serious problems, or how to catch such problems in time.

Hearing from the doctor always beings that stupid ovary to the front of my mind.  It gets me all emotional, and it was bad enough that this past weekend was the second anniversary of an attempted suicide in my family.  I’d succeeded in not thinking about it up until I heard about another attempted suicide that had happened that very weekend.  So I was a little “off” yesterday.  I haven’t had any really bad mood swings on Diane-35, but I do get the odd day like this, where things affect me more than they would on the average day.

I got a call today from the endo's office (and thankfully I was home to catch it), and found out I am being referred after all.  I don't expect to actually be given an appointment date for a while yet, that's how referrals to specialists go.  But that's good too; means it's not an emergency, right?

And that’s my update.  Official “rules” for guest blogging will go up tomorrow!  :)

Back to the Endo

Okay, so the week before last was my latest visit to the endocrinologist. Got a little more lost than usual finding my way through that maze of corridors, but it was the least anxious I've felt going to see her. I told her I was finding myself happy with the results of the Spiro, though she was disappointed to hear it still was making no difference to the hair on my face, either in quantity, coarseness or speed of growth. She brought up laser hair removal again, and I'm finally game to try that a second time. But I'd like to see how this next step in the treatment goes, and I'd also like to time it so that I can enjoy a summer without shaving my face. Maybe I can go camping then, or travel with other people...

I told her what I really wanted at this point was to find a better birth control pill that would regulate my cycles and eliminate the spotting, so she suggested Diane-35 and I said okay. Diane-35 has a small amount of cyproterone acetate right in it, and though it's generally not used for birth control alone, it is often prescribed to acne sufferers as it has the androgen blocker right in. It is our hope that maybe the combination of Spiro and Diane will make the results even better.

I see a lot of distaste for Diane-35 on the web, and yes, I am a little nervous about it. Not only is it a new pill and I am never confident in my body's tolerance, but it has been reported in certain studies to have a higher-than-normal risk of blood clots. However, that higher-than-normal risk is still a rare one. The endo only offered it, she didn't say: "This is what we're doing next." She would have allowed me to say no if I wanted to. But from my readings about the type of male and female hormones it contains, it's on the right track. Moreso than Alesse. And I have heard some very happy reports from some ladies who have used it long-term. It's different for everyone.

There's a little more hormone in this one, which is why I think it will help with the mid-cycle spotting that Spiro seems determined to cause. So I am on the lookout for severe mood swings and breast lumps and things like that. I assure you all I'm being cautious. Longtime readers know what a fearful creature I am.

Unrelated to hirsutism, the cyst on my ovary came up in conversation when I was telling the endo that my family doctor had moved off to the other end of the city, leaving my file behind. When I said that I still wished to see a gynecologist to talk more about the cyst, she said she would be happy to refer me herself. First, though, she wants me to have another ultrasound, because I haven't had that severe pain in six months and it may be that the cyst was reabsorbed. I have read that bcp's can sometimes help with cysts. Could it be that being on Alesse has helped in that way?

I've been on Diane for a week now and have nothing to report. Possibly some mild nausea in the mornings, but I'm known for stomach trouble anyway so it might not be the pill at all. And in the meantime, the Spiro continues to do it's job and I continue to enjoy the reduced hair everywhere else. Can you believe that? I'm enjoying the results of the medication.

Idiopathic Hirsutism and Defending Doctors

There is a certain amount of negativity attached to the diagnosis of idiopathic hirsutism. Even before I was diagnosed with this myself, I was aware that a prevailing opinion was that being told you had idiopathic hirsutism was the diplomatic equivalent having your condition swept under the rug. And I felt that way myself, early on in my quest to find out what was going on with my body. I imagined how I would feel if a doctor essentially said, "I don't know what it is," or even, "It's not important enough to investigate further." I decided I'd be pretty angry, and probably seek out a second opinion.

Yet here I am, content to know that what I have is idiopathic hirsutism. And I'm actually grateful that for once, most of the people around me are not educated in the world of extra body hair. To finally receive an answer, after years of wondering, is emotional in the extreme. If everyone I knew had come down on me with moues of disgust, saying, "Oh, your doctor's just writing you off," I would have felt pretty crappy. How easily others can turn your small triumph into defeat.

So, okay. Here's the thing. I read an article about the stress of a doctor's job, a long time ago, and it's always stuck with me. Sure, it's easy to nod and say, "Yeah, they've got a stressful job." But have you ever paused to really imagine it? The example that really wrenched things into perspective for me was from a doctor who recalled parents bringing their newborn baby to him for help, but he found there was nothing to be done, and he had to tell the parents that their child would be blind all his life. Before the doctor even had a chance to recover from the sorrow of the encounter, the next patient came in and expected to be cheerily welcomed. Often, we're so worried about our own symptoms that we don't even realize who our doctor might have seen before us.

And that stress starts early. They have to work hard to get into medical school. They're often confronted with cadavers pretty much right away. I've only seen a dead body once in my life, and it was thankfully not in a dissecting room. I can't imagine how awful that would be. When my art class planned to go down to the University to see corpses for anatomy studies, I flatly refused to go. And then, for medical students there's the hospital training. If I had to face fatal diseases and mortality every day when I was in college, I don't know how that could have changed me.

And with all that knowledge packed into their heads, they also have to figure out how to interact with people they help every day. Not everyone is a natural people person of course. And with all the natural fear and anxiety that comes with being ill, doctors often find themselves having to be counselors, too, as patients use them as a sounding board for their frustrations. And that's not even the difficult patients. And the longer a doctor practices, the more responsibility they have. It's a job where things never, ever get any easier with time.

Now, I've said before that it is everyone's right to choose their own treatments, get a second or third or fourth opinion, and to retain a doctor they feel confident in. We know I've had a doctor or two I've lost faith in thanks to a couple of errors in diagnosis. Most people have a story of misdiagnosis, or know of one. And I do feel neglected and overlooked that my most recent family physician did not call or send a note, or get her office staff to do so, to inform her patients that she was moving. But I don't know all the circumstances. I just have to take a deep breath and not take it personally. Because the inherent antagonism of doctors, the blind mistrust that sometimes colors peoples' attitudes, it makes me sad. It seems almost like a fashion to have a cynical opinion of the people responsible for our health. They are as human as we are. And they have chosen one of the most demanding jobs imaginable--but also one of the most rewarding.

So here are a few things I just want to emphasize, if you're searching for treatments for your hirsutism and are frustrated with your doctor.

• There is no FDA-approved drug for hirsutism out there. None. There are drugs that have side-effects that help manage the hair, but there is no Pill For Hirsutism. Unless it's caused by hormonal reasons where the cause is actually removable (like a testosterone-secreting tumor), there is really no permanent cure for excess hair growth.

• Your doctor has prescribed you a medication because the benefits outweigh the risks. This is written on practically every fact sheet I get with my prescriptions. Maybe the risks will be higher for you, but nobody knows until they try. If you are not comfortable with taking the drug, you can always refuse treatment and live with your hirsutism naturally. There's nothing wrong with that. (I can imagine myself doing that in the future.)

• Idiopathic hirsutism does have a definition, even if some doctors use it as a blanket name for medical mysteries. It means that, rather than having hormonal abnormalities or other factors, your hair follicles are simply more sensitive to testosterone. Even among men, there is a vast difference in amount of body hair. Some people, and indeed some ethnicities, simply have it written into their genes that their hair follicles will be more sensitive to testosterone, and thus they'll have more and darker body hair.
  

If you don't feel that this is the cause of your hirsutism, is it because you haven't done enough tests to eliminate other causes? If that is the case, ask for them. You deserve to know, and have that peace of mind. I feel that everything that needs to be checked has been checked. I am satisfied with my endocrinologist's conclusion. She did a great job.

Read a little more about idiopathic hirsutism here.

Vacation

No post this week; I'm on holidays! Unfortunately, it hasn't been much warmer down south than in the frozen north, but hey, it's still nice to get away!


I did just hear a bit of news, though. My family doctor moved her practice to another end of the city without telling us. So the question is, do we stay with her, or stay within our geographic locale? Why is it so hard to keep a GP these days?

Take Four

This time, going to the endocrinologist made me as nervous as my very first visit to her, a little over a year ago. I didn't get as lost on the medical floor as I usually do, and I had an idea of what would happen next, but my hands shook as I tried to read my book in the waiting room.

After two and a half months on Finasteride, I've noticed a negative change. Since coming off the 200mg of Spiro, my body hair has begun to get darker and more numerous. The dark vellus hair on my collarbone has come back, and I'm even getting more spots and blemishes on my back and chest than I did while on Spiro. To visually compare, my body is currently in a furry state somewhere between 100mg and 200mg of Spiro.

I was also finding that since being on the Finasteride, my stomach was even more unpredictable about how it reacted to food. I know Finasteride is reputed to be easier on your stomach than Spiro, so I tried to deny it, but it's certainly true that the strangest things have upset my stomach in the last few months. Maybe that's just a coincidence, because I found the pill itself quite tolerable.

But I figured the endo would probably want to move on to something else. And she did. She asked if I wanted to go back onto the Spiro, but it didn't seem to be worth it to me, since even at its best, I was still shaving every day. She apologized that there was really going to be no cure for me, and I tried to find the words to express that while I knew that, I was still hoping there might be something else to try. Something besides Cyproterone, the thought of which has made me very uncomfortable. I'd spent the whole morning trying to prepare myself by reading about it, and of course frightening myself with all the side effects. On top of which, there was the required birth control pill to worry about as well.

After some discussion, the endo asked if I would like to try a birth control pill on top of the Spiro. I'd spent the last couple of years with the assumption that most women are prescribed the pill along with androgen blockers because of the dangers of those blockers to a male fetus. Apparently, the pill can also reduce the overall amount of testosterone in the blood, which can improve the overall effectiveness of an androgen blocker.

It wasn't what I'd expected, but it was a drug I knew (and a drug I knew worked somewhat) combined with one new thing, rather than two completely new things to worry about. It was probably the most comfortable way to move forward. I agreed. Even if I never find anything that truly works, I like to imagine that I'll feel better knowing I've tried everything I reasonably could. And the endo said that if this treatment works a little better, I might find that laser hair removal will have a longer lasting effect--but likely not a permanent one.

So she has me on Alesse, because although she wants me on a low dose of hormones, she says Yasmin's active ingredient is too similar to Spiro. I really can't voice my own opinion on this choice, having never been on a BCP before, and from what I've read, every woman reacts so differently to each brand of oral contraceptive (some hate and some love each and every one) so it's hard to guess what would work best for me. I have read that Alesse is one of the pills popularly prescribed for acne, but I have also read that uses an androgenic progestogen, and therefore not the best choice for women with hirsutism. I'm not sure how both those things could be true, but I am willing to try it--I trust she has chosen it for good reasons. If any unpleasant symptoms, such as breakthrough bleeding, persist for over three months, she'll put me on something else.

I always feel strange after an endo visit. It feels like both a step forward and a defeat, all in one. And underlying that strange mix of emotions, each time I go seems to be an admittance that there is something medically wrong with me. I hate thinking that about myself. After the appointment, which took all of ten minutes, I walked through the city in a daze, got on the bus, and instead of going home went to the pharmacy to fill my prescription right away. Bought myself some new make-up, because... y'know. And from there, I rode the bus a little more, got the sudden urge to get off and walk to make the trip home longer, and ruminated a little longer.

I've only been on the pill for two days now, and so far so good. I'm actually a little excited I might become regular again. That would be pretty nifty. But there is a slight hang-up; my pharmacy anticipates no Spironolactone shipments for some time. They're not exactly sure when it will get here, but likely not until the new year. They had three pharmacists clicking away at their computers checking it, two of which were girls younger than me, but strangely I didn't feel that embarrassed. I just wanted my pills. I suppose in a way this is a good thing, though--I'll be able to try the BCP by itself for a month and then add the Spiro to it, so I'll be able to compare how I feel with or without it.

So here we go again. Always working away at it, trying to find a way to make life easier.

And now, I must go sleep off this wonderful winter cold. Hope everyone is feeling better than I am right this second! Blech.

More Health News

The endocrinologist tried to call me not long after my last post as it turned out, but I missed it. That's Al for you. When I tried to call her back, she was with a patient, and the receptionist asked the best time and number for her to call me back, making it clear the endo wanted to speak to me herself. So immediately I thought, "Uh oh." She was able to reach me today, however when you're waiting for what you expect to be bad news, any amount of time is very long to wait.

In follow up to this post about severe, intermittent pain and the ultrasound to investigate, I share the results. I do have a benign cyst on my right ovary, 3.5 cm wide at its largest point. The radiologist reports that it is not a tumor and there is no need for further action. The cyst has nothing to do with polycystic ovaries, and in fact my ovaries are clear of such indications. It doesn't have anything to do with the hirsutism at all. It's recommended I just be aware of its existence, in case the pain gets worse.

I was kind of hoping they'd find something in the ultrasound, so at least I might have an answer. So I wasn't shocked, and only somewhat nervous, when she told me. It wasn't until I actually looked at 3.5 cm on a ruler--about the width of my three middle fingers--that it really hit me. Holy crap, I thought. These are my ovaries. As a woman, I have rather a particular attachment for them. And ovarian cancer is the One Big Thing runs in my family. And stupid me, I've misplaced the old records I used to keep about the pain, because it seems to me it has appeared not only on the right side of my abdomen. So perhaps it's not the cyst at all that hurts me now and then.

As this isn't really the endo's area, I'm going to see about being referred to an OBGYN by my family doctor to see where to go from here. I really don't know much about benign cysts. I'm fine with living with it, but I've got a few more questions. And yes, the pain might not be from the cyst at all, so there's that to consider as well.

Oh, and my liver's fine, so I can keep taking the Finasteride. I think--I think--I'm feeling all right about this. I have a possible answer for one problem, and am working towards finding a way to make another problem easier to live with. I'm still digesting the news.

Endo Visit No. 3

Hello and welcome to the new, more sexy blog! New look, and a new drug.

That's right, I'm done with Spironolactone. It helped with the acne and lightened up the male pattern hair growth on my body somewhat, but not my face. It still required daily shaving to hide. Not enough of an effect to want to stay on the medication. I'm ready to move on.

I always get so nervous when I go to the endocrinologist, more than any other doctor. And I know it's only going to be a chat to revise our strategy, so to speak, with some lab requisitions, which I'm getting used to now. As a bonus, I really like my endo, and I'm never worried about leaving with concerns unaddressed. Yet waiting in that room had me so wound up I could barely hold the book steady to read. Realized I've been reading the same book for a year now. In my defense, it's an enormous book.

And once again I was in that little room with the poster of the thyroid, and I told the endo how I was finding the doubled dose of Spiro, and again she seemed surprised and disappointed that I was not seeing a worthwhile effect. She gave me a req for an ultrasound for that pain I mentioned, and offered a stronger painkiller for it, but I really am not comfortable going on more medications than I have to. Then she mentioned a couple of other medications I could try (Cyproterone was a new one mentioned, I'll have to read about it a little as she said I would have to go on birth control with it), but recommended Finasteride again as it is so well tolerated, if less commonly prescribed to women, so I decided to give it a try. I'll do a post soon about what it is and what it does, for those who are curious. And from there we'll see what it really does.

Also of interest, I inquired about the possible increased effectiveness in laser therapy while on an androgen blocker, as I contemplated staying on Spiro a bit longer. She said my problem really doesn't seem to be high testosterone as much as increased sensitivity to it. She thinks I have idiopathic hirsutism, and I think it fits my situation best as well. I wasn't the least bit shocked. In any case, the answer to my question was just what I had experienced with laser in the past; though it might kill off the current hair follicles, even the most normal levels of testosterone will keep stimulating my skin to produce dark, terminal hair.

So on my to-do list in the next month or so are an ultrasound and a blood test to see if the new pills cause any liver toxicity. And in three months, a follow-up to see if the new direction is beginning to take effect. Finasteride apparently has a similar success rate to Spiro, so, no outlandish hopes. Let's just see what happens.

Can you believe it's been six months?

Whoa, sorry for skipping a week. After I came back from my follow-up with the endocrinologist I felt incredibly discouraged--though not totally because of the visit. I had to go by myself, and while I managed, it was emotionally very difficult. Dentist, fine. Even my family doctor I can go to by myself. But to go downtown, ricocheting off all the harried businesspeople, trying to kill time before and after my appointment and negotiate that maze of a building to sit alone in a waiting room was very intimidating. And it bothered me that I felt so intimidated. I just didn't want to bring that kind of negativity here. I'll complain to readers about the challenges of feeling beautiful and making living with hair as painless as possible. But when I feel that down on myself for other reasons, I'd rather keep that to myself.

I'm feeling much better now.

So, what happened? Well, soon after I found myself back in that same little room with the picture of the thyroid gland, the endo came in and after greeting me asked how taking the Spiro was going. I noncommittally said it was fine in the sense that I was tolerating it, and she seemed excited until I added that I noticed no difference in the hair.

"Really?" she asked, looking quite surprised. And it surprised me that she was surprised. And though I'd known already that it wasn't working, I felt a sudden rush of fresh disappointment. She did say that the levels of testosterone in my blood were in the normal range now, and my potassium levels were good, but if I wasn't seeing a slowing of the hair growth it was time to look at the next step.

The next step was going up to 200mg a day of Spiro (about the maximum she'd prescribe someone), or trying another drug, Finasteride. I knew right away I was going to pick the drug I knew, the drug my body was familiar with, but I wanted to know about the other option.

Finasteride is prescribed to men with prostate issues or who are losing their hair--the high levels of testosterone that cause humans to grow hair on the bodies can make them lose the hair on their heads. It sounds like it is pretty similar to Spiro as an androgen blocker, and the endo said about the same amount of women find it as effective as the Spiro (approximately 70%). She also said it's more expensive than the Spiro.

In any case, I agreed to double the dose of Spiro. She recommended taking the two pills at different times of day to avoid any possible stomach upset, and to be careful about decreasing blood pressure and dizziness. She took my blood pressure again for her reference, and I made conversation by complaining about not eating as much potato as I used to. She laughed and reminded me she had not told me to stay away from potatoes. But I'm okay with erring on the side of caution. But, after a week on the new dose I have to take another blood test just to make sure my potassium is okay. Think this time I should ask to lie down for it? Heh.

So far, I'm noticing no difference on the new dose, which I started May 18th. I usually take the first pill with breakfast, and the second one around 4:00 when I take a break from work. The first time I took the second pill I felt nauseated, but I think that may have been nerves because since then, I've had no problems. The extra diuretic hasn't made a notable difference either, thankfully. I'm busy enough at work as it is.

I guess since I've been gearing up to leave oral medications in the past, starting a new dose is like accepting a new hope. Maybe this time... but if not, that will be okay, too. The more important thing is accepting that this is a part of who I am. It's also the harder thing. But it's coming along, and it's thanks to being able to "talk" about it here.

Cursing My Cell Phone

I'm certain when I checked my cell phone on my lunch break there were no calls. Yet when I left the office tonight, there was a voice mail on my phone. The endo had called me personally this morning to say the results of my latest blood work have made another test necessary--no whats or whys, she just left her cell phone number to call her back. (A doctor's cell phone number. She's awesome.)

The thing is, I discovered the message long after she would be available and have the test results with her. So now I must wait until Monday. I have no idea if she means I have to go for that specific adrenal test at the hospital or if I just need to retake another blood test. But I'm going to try to worry about that eventuality when it comes. Whatever needs to be done will get done, and there are worse things than a test or two. And at least I have an idea of the results anyway.

For now, there's nothing I can do. I am determined to have a great weekend--have lots of fun things planned!

I'll update on the results when I have them.

First Visit to an Endocrinologist

Summary: No diagnosis yet. More tests, and I'm going on an androgen blocker.

And now for the long, detailed version, which I'm sure everybody loves. For those who haven't read my entire story, an endocrinologist is the farthest I have come in the nigh-decade since the hair began to grow. I was so excited and worried for this appointment. I was afraid to know what the cause was, and afraid there would be no answer. I was afraid the endo was going to be curt, disinterested, and rush me out of there. (By the way, don't believe everything you read on sites like RateMyMD.) I was afraid to get a prescription, and afraid there wouldn't be one. Needless to say, I was all over the place.

The closer I got to this appointment, the more emotional I became. I felt more strongly than ever that I wanted to tell everybody about this secret I keep, even though I figured this wouldn't benefit anyone. And as I ran through outcomes in my head, I started to cry. Often. The day before my appointment I was unsteady and flustered and could think of nothing else. I don't even remember what I did at work. After dinner I wrote down questions, previous tests, and anything else I wanted to remember for the appointment tomorrow. I didn't refer to them once in the consultation, but the act of writing them down cemented them in my head.

From the moment I put my boots on, to wandering through the maze of rooms on the medical floor of the building, to sitting in the waiting room of the clinic, my chest was tight, my heart hammering, and my hands and feet restless and damp like I was about to give a speech. One of the office staff measured my height and weight as soon as I checked in, and then I sat and read. I was there early--that's the only reason I waited. I watched the few women who came in and out in my periphery, wondering if anyone was here for the same reason. I couldn't tell. When they called me into an examining room, and I had barely the time to sit down and squint at a poster of the thyroid gland before the endo came in and shook my hand. She knew what I was there for, had my blood tests in her hand, and took notes as we went over my symptoms, my medical and family history. Then she did a brief physical exam, and we discussed where she wanted to go from here and let me ask some questions. She took the time to address every concern I had, and was happy to explain everything. And considering how often she must have to--she says hirsutism is one of the most common things she sees as an endocrinologist--I was extra impressed.

We talked about the likelihood of PCOS. She explained it was a diagnosis of elimination, and supported what I've read about not all the symptoms needing to be present. In my case, since I only have the hair as a symptom, an ultrasound won't be necessary. All I am needing to manage is the hormones. The endo still wants to eliminate the adrenal glands as the producers of the testosterone. So that means another blood test, which has to be done during the first two weeks of my cycle. I'll also have to get tested for potassium levels, since she wants to start me on the androgen blocker Spironolactone, which is a potassium-sparing diuretic. But assuming those tests come back normal, I shan't be hearing from the endo until our six month follow-up.

I went right to a pharmacy to fill the prescription. The pharmacist, a man, peered at it and said, "It's some kind of water pill?" It is, so I nodded, though that's not what I'm taking it for. The instructions advised me not to take it after 6 pm so I'm not getting up in the night to pee. So tomorrow will be the day I start. The medication will take a few months to start to work, if it works at all. But I will be sure to report on any changes that I notice. It's not a cure, but it should reduce the amount of hair and rapidity of its growth. I often expect the people who might read this to have already done some research on hirsutism's causes and treatments. Perhaps I should spend some time making entries on that sort of thing?

I'm feeling good, overall. Taking medication of any kind always frightens me, but after so many years, I think I owe it to myself to try it. It's all about making progress for me, and finding the best way to live with my hair. So here we go...

Possible Mislabel

I woke this morning--9:00 on my day off--to the sound of my cellphone vibrating. By the time I had untangled myself from the duvet and pulled it out of my bag pocket, I had missed the call, but the display stilled show it as the name of my GP's clinic--the same clinic I had been calling all day to get an appointment with, and had no luck. Still groggy, I redialed. The woman told me my doctor wanted me to come in to discuss the results of my latest blood work, and could I come in today?

I agreed, and of course as the stupor wore off, all sorts of dubious thought started running through my head. Why did they want to see me today? Had they seen something urgent in the results? What had they found that was so different from the one I'd taken almost four months ago? (For those of you who are just joining us or have the memory of a normal human being, this details my last follow-up. She wanted to monitor my thyroid which showed hyperactive before, and testosterone and free androgen on the side.) I figured it was the thyroid. All morning I agonized. Trying to prepare yourself for the worst and yet calm yourself down is no easy task.

To ease the drama of this post, I'll let you know now that my thyroid is back within normal levels and it seems they just had an opening and wanted to fit me into it. This time, I got in right away and only sat for a minute in that small room with the examination table and the biohazard box. Then my doctor came in and asked, "Remind me, what are we doing about the PCOS?"

I'm sure I must have gaped idiotically at her for a second or two. Since when did I have PCOS? My only symptom had been hirsutism for the past eight years. Wasn't I being sent to the endocrinologist so they could determine the cause? When I regained control over my vocal chords, I said that she had referred me to said endocrinologist. She asked me about my previous treatments, which were only for the hair, and then I finally managed to stammer out that no one had ever tried to figure out the cause before now, and I had never had someone call it PCOS.

My blood work, she said, was consistent with it. I think I asked her what was off except for the androgens--such as the glucose. But she said the androgens were enough of an indication, and took me back into the little closet computer room to show me. The results were consistent with the last test, and not shockingly high. She printed off a copy to take to the endrocinologist, and started telling me about what I might be prescribed, and that although she could be communicating with the specialist that I should keep her abreast of how I tolerate the medication and any concerns I might have. She was very sweet again, touching my arm in that way she has, but I only noticed her manner on the surface, because I was still thinking, "PCOS... PCOS... PCOS..."

I just have never had any symptom but the excess hair. My periods are painful but regular, I am not overweight, have no serious problems with acne or insulin--but I know not everyone will have all the symptoms, or present them at the same time. I've considered the possibility of having polycystic ovaries, but I wasn't prepared to hear that when I did. It's possible my GP was just calling it that, and the endocrinologist may find something different, but she's the doctor, not me.

To kill time while I waited for my ride, I went to the drugstore and looked at overpriced makeup. I couldn't wait until we got in the car before I started to tell her what had happened. I haven't told her much about PCOS because I haven't focused a lot of my energy on that eventuality, so I tried to explain what I knew. As I was trying to say that fertility can be an issue, I turned and saw I was standing next to the wedding and baby cards. I don't know if I want kids, or even if that will be a problem I will have to face, but hearing those words come out of my mouth, I just couldn't believe I was saying them. Living with the hair is one thing, but having this name with all these other meanings and possible dangers is something else. For a few moments, I couldn't control my tears.

But after that, I got a handle on myself, came home, had some tea and fresh bread with my family around me. Received some kind and generous words from a friend who had no idea what exactly I was worried about, but never for a moment allows me to demean myself. And I thought of all the strong women I know, or know of, who live successfully with their health problems. And I knew that I could work through this, whatever the results happen to be.

Only a month away, now, and I'll be even closer to knowing for sure. It will be better to know. It can't be treated properly until I know.

Four months!

I have some good news and some bad news.

The good news is that I got a call from my doctor's office yesterday. They left a message on my cell while I was at work. Luckily I remembered to check for messages at the end of my lunch hour, because it seemed that every male coworker under the age of thirty was having lunch at the same time, and I wouldn't have suffered them to see how teary-eyed I got when I heard that my GP had decided on a referral at last.

I could barely understand the name of the clinic in the message, but what I could make out sounded very generic. No clues as to whether it was a dermatologist or an endocrinologist. I tried to surreptitiously Google it at work, but as I feared, there were a ton of clinics in the city under that name. For all I could tell, it was a chiropractor.

But I was determined not to have to call the doctor's office back, or wait for the clinic to send me their mail-out to find out just what kind of clinic it was. So when I got home, I rolled up my sleeves and gave it another go, this time cross-referencing the clinic's phone number. Among the links that popped up was one for a paper on PCOS, and my eyes stung anew. Bless my GP! Not only was it a clinic for endocrinology, but it was possible they treated quite a few women with unwanted hair. I felt so grateful. I hadn't realized how much I did not want to see a dermatologist again.

So what's the bad news? My appointment is not until mid-November.

Yup. Another reason to be assertive about your health from the start: appointments are like a rare treasure. You have to quest for them and then guard them with your life.

We have a possible answer!

A quick recap: I met a candidate for our new family doctor at the beginning of the new year, liked her, and went back for a long-awaited physical in April. At that time, I told her about my hirsutism and that I was eager to find out what was causing it. (I've read a lot of trepidation and embarrassment ladies have about seeing their doctor for this kind of matter, so I detailed that discussion in this entry.) My new doctor sent me for blood tests, some to measure routine things with a few additions to investigate my hormone levels. After some shuffling around with my appointment, we finally settled on June 11 to discuss the results.

I wasn't too nervous before I left for the appointment. Usually I get really jittery when I'm expecting something big in the afternoon, and can't focus on anything. I was doing okay until I got there. The clinic waiting area was abnormally quiet and I had forgotten my book, so I sat there clasping and unclasping my hands, tucking them under my elbows, and listening to the office staff rescheduling appointments and booking referrals. Even then, I couldn't focus on my worry. After twenty minutes, they called my name and put me in an examination room, where I waited for fifteen more. In that silent space, facing the bio hazard box of syringes on the wall above the little sink, I managed to tackle what was bothering me.

I wanted something to be wrong. Twisted, but true. It had to be better than hearing, "There's no reason for your excess hair." And since I have hardly had a thing wrong with me my whole life, this seemed the most likely answer. But on the other hand, I didn't want anything to be too wrong with me. What if, despite my regular cycles and other lack of symptoms, the tests indicated a possibility of Polycystic Ovarian Syndrome? I do have a family history of ovarian problems. Something that affects your fertility, your weight, your insulin as well as the hair--if that was the answer, so be it, I would work through it, but it was not news I wanted to hear either.

Basically, some kind of answer had to be better than no answer at all. But maybe there had been no telling results from that blood test years ago, and that's why no one was bothered about helping me find it and telling me what was on it. Maybe my dermatologist at the time really had known what he was doing when he sent me off for laser hair removal without investigating whether or not I was a good candidate. Maybe there was no other answer than, "It just is." And I tried for those fifteen minutes of silence to prepare myself for that.

My doctor came in and took me to another room, almost like a closet, where her computer was tucked away. We went through the results together. I had never seen the results of a blood test with my own eyes before. The things that were too high or too low in my blood were bolded and in red, and next to them were the normal ranges. There were some things unrelated to the hirsutism that needed to be addressed with a daily supplement; nothing serious. My thyroid is slightly overactive, explaining my revved up metabolism, so I have to go for another blood test in a few months so she can monitor what it's doing. I noticed she wrote down another androgen test on the requisition form.

What was most relevant was my androgen levels. Both testosterone and other androgens were elevated--not overly so, but noticeably enough to show up big and bold and red on the screen. I was so flustered that this might actually be the answer that I didn't retain the exact numbers she showed me. She says this is a possible explanation for the hirsutism, and when she decides which specialist to refer me to, she will let me know. She touched my arm, looking truly sympathetic as she made sure this was okay with me.

I don't mind waiting. Seeing a possible answer makes me feel so much better. I was a little stunned, and wandered through the next door drug store in a haze. I couldn't remember enough of my reading and research to recall exactly what was done for high levels of androgens, or a sensitivity of hair to those androgens, both of which can cause the excess dark hair. So I just floated through the store, picking up the recommended vitamins and few beauty tidbits I needed. I vaguely recall nearly breaking down into tears in front of the lotions. This sales clerk asked me if she could help me and I felt so self conscious that I probably acted very guilty--like she wanted me out of the store.

In the mean time, I have another blood test (ugh) on my horizon. Then goodness knows what the specialist might want to do to me. I may find myself becoming good at being poked by needles to the point where I won't have to lie down anymore. Knowing that it is all to find an answer certainly helps. I also have a lot of reading up on anti-androgens to do, so I have good questions to ask in the future. The Hairtell forum has been quite interesting in that regard.

I want to encourage whoever may read this to be assertive in finding out why they have excess hair, especially before investing in expensive treatments. Doctors have one of the toughest jobs out there and they went through years of research and training to get where they are, so of course you should respect their expertise. But they are also human. They are busy and stressed, so you might happen to slip through the cracks. Your condition may not seem as important to them as someone with a life endangering health issue. People often say "Be your own advocate" but I never would have thought much about it until I found myself at a loose end, personally. Perhaps I was too young, not ready (I left it for years, for goodness sake), or hadn't done enough of my own research to be aware of what the dermatologist was doing and not doing when referring me to a laser clinic before doing any tests. I could have been better equipped to ask him questions or insist on tests, instead of nodding meekly and shelling out college money on a procedure that did not work well for me and taught me very little.

So, yes. Be your own advocate. Research is the best tool to have in your arsenal. Temper it with respect for the professionals. Getting answers, even possible ones, feels so good.

A Doctor's Visit

I mentioned back in early February that I was meeting a new doctor. A woman doctor. Our family GP is leaving his practice, and my confidence in him had been rattled after being given the impression on three different occasions that he should have tested for something that he didn't. It's hard to imagine how difficult a doctor's job is, so it's hardly fair for a layman to criticize. However, when your laser technician wonders why you haven't been tested for hormone abnormalities before being referred to a expensive cosmetic procedure that may or may not work, you've got to wonder too.

Last week I had my first physical with her, so I was furiously filling out the forms about my medical history before she came in. Then she reviewed them with me, and noticed the question marks beside some of the other diagnoses I've had over the years. I explained that because my last doctor would often say, "It's probably this," I wasn't sure if that counted as an actual diagnosis. Then I ventured, "There are some other things I wasn't sure if I should put on the list." I named hirsutism last. Despite having this blog where I talk about the condition once a week, it was still much harder than I expected to actually say, out loud, "I have hirsutism."

She looked down at me from the examining table where she put my forms. "Really? It's not prominent at all."

I felt my throat growing thick. My voice came out strained and much too loud. "Well, yeah, that's because I--" I had to swallow here. "I'm very--anal about--about shaving..."

"Shaving? Shaving usually makes it worse."

"It does?" I was agog. I'd always been convinced that the theory that shaving made hair grow in thicker and darker was an old wives' tale. To have a medical professional say it so matter-of-factly took me completely aback, and I didn't even have a chance to ask how on earth it could make things worse. I had never myself observed any worsening in my condition while I was shaving.

"I would say waxing."

I shook my head. "Then I'd have to wait until the hair grew back long enough before I could..."

She nodded, smiling. "I see. Is it just here?" She motioned to her jaw as I had been doing.

"Here, here, and here," I touched the areas of my face and neck, "my chest, and my stomach."

Of course she wanted to know if my cycle was regular, and of course, to add to the mystery, mine always is. She asked if I had considered laser hair removal and I explained in a nutshell what had happened there. (For those of you just joining me, I have two entires about it here and here.) I emphasized the lack of testing beforehand, and she asked what had become of the test I finally did have. I told her I never did find out. So she said she would have me tested for free androgens again, and optimistically mentioned options after we knew what was causing it.

As she was feeling my neck and jaw for the usual lumps and bumps she touched my chin and said, "Ah, I see what you mean." And as she felt along my abdomen for the same, she said again, "I see what you mean. I really think you should try waxing. Maybe not for the face, but for everything else."

I still didn't have it in me to ask her why. Talking about it out loud felt so awkward, and it seemed to me like I really had to restrain myself--or perhaps just my tears. But after I have my tests done (eeyuck), I'm to make another appointment to come in and discuss the results with her. I'll ask her about the evils of shaving then. Considering how long it's been since the last time I was tested for weird hormonal things, this is a big step forward for me.

I just hope I can remember that when I'm facing down the needle. I can't even get my ears pierced without nearly fainting. But then afterward, I'll regain my senses, suck on a candy, and I'll walk out of there none the worse for wear. And know that things have been set in motion that may get me some questions answered.

It's the condition I'm in.

I remember the first time I realized the onset of hirsutism was a "problem." I was in my grade nine math class, probably getting my homework checked off at the beginning of class. I turned around to leave the teacher's desk and the boy behind me nearly collided with me. He flinched back and said, "What are you, growing a beard?"

Back then, I only had a soft vellus halo around my chin, and yeah, I knew it was there. But it hadn't bothered me until that boy said something. I started trimming it with a pair of curved scissors used for cutting nails. By grade eleven, I was plucking darker, terminal hairs from my chin and sideburns every day. Now, I love to travel and I love camping and all the things that go with it. I remember sitting in the jeep that summer while everyone else had breakfast, trying desperately to pluck in the side-view mirror before they finished. I remember driving all night to a friend's graduation in another province and agonizing over my reflection in a truck stop's Ukrainian restaurant bathroom. And I hated going to the beach because the thickness of the hair on my thighs was getting hard to handle. Imagine a good-looking guy trying to hoist you onto his shoulders to play "chicken" and you can think of nothing but: "Oh-crap-cactus-legs-cactus-legs-cactus-legs!"

In twelfth grade, I began bleaching my face from ear to ear. I had to do it every day because the hair growth was so rapid that you could see the dark roots emerging each morning. When I got my hair done for graduation, I had to ask my hair dresser to leave ample tendrils hanging down the sides of my face, just so I'd feel comfortable. I began to see this development might affect some of the most exciting years of my life A consultation with my family doctor got me referred to a dermatologist, who in turn referred me to a laser hair removal clinic. I was too afraid to even let her do a test zap on my inner arm. I could live with it. Yeah. I could. Maybe it would go away after puberty had run it's course.

That summer, staying in a trailer in a mountain valley with my best friend and her family, I found I could not sit in the closet of a bathroom every morning for half an hour while the bleach on my face and then my stomach below my navel did its job. They were making digs at the amount of time I lurked in there. And so, one morning, in a fit of rage, I mushed shaving gel into a froth on my face and dragged my leg razor over my chin and jaw. I couldn't remember the last time my face felt so smooth. It was faster, felt nicer afterward. I was hooked.

By age eighteen and a freshman in college, I was shaving my face and neck every morning. I couldn't wear shorter shirts for fear that if I reached for something high, the world would get a glimpse of my "treasure trail." A bra, at least, would hide what was sprouting on my breasts. But now my chest was getting in on the fun. I couldn't wear anything that showed more than my collar bones. And even the shaving was starting to get lame. Teenage acne was bad enough, but soon I discovered I was going to become victim to--dun dun dun!--adult acne. Couple that with razor burn and careless nicks and you've got total pizza face for most of the month.

Just before my second year I went back to the dermatologist and got a new referral to the laser clinic. I figured I'd start on my face, and if that worked out, I'd employ the method everywhere else. All the money I'd accumulated from babysitting went towards it, leaving only student loans to pay for college supplies. I'll leave the details of laser treatment for another post, but for now, let me just say that my beard gleefully cycled back each month, until my very lovely but puzzled laser technician ordered a blood test. ("Your doctor never got you to have one? Really?" Yeah. Really.) With pity, she gave me an extra freebie session, and then I spent months waiting for--and calling about--the results of the test. The laser treatment place told me I was calling the wrong place. The dermatologist's office told me my dermatologist was on vacation and I was calling the wrong place. And for unrelated reasons, I was no longer consulting my family doctor.

Meanwhile, the terminal hair cycled out, and nothing grew back. I went house boating and didn't shave my face once--which was good, because even shaving your legs can be a disaster in a tiny loo on a rocking boat. But, by the next year of college, I was having to pluck again. It was like my condition had been "reset" and was starting all over again. Resigned, I was back to bleaching within the year, and have been shaving ever since.

So, four years after that blood test, I still don't know what or if they found anything. Heck, I don't even have a family doctor right now. My biological parents are both of European ancestry with no history of hirsutism that we're aware of. I'm a healthy weight, fair skinned and haired everywhere but aforementioned places, and my cycles are like clockwork. I now hold a degree in the arts and two of the coolest-sounding jobs out there. I'm also single, 50% because I've been absorbed in work and school, and 50% because my standoffish nature is intimidating to others. (I will be discussing romance and relationships at some point.) And I live with my step-family, who I've never told about my unique situation. To this day, I wonder if they ever raised an eyebrow about those months when I'd disappear off to "the doctor" and come home holding an ice pack to my jaw.

So, don't I want to do anything about it? Yes, yes I do. There are days when I cannot make myself get out of bed just to shuffle to the bathroom to shave. And there are other days when I can do it, slap on some make-up, and forget about it for the rest of the day and feel really good about myself. Most days, though, I'm in between. I hit the snooze a few times, make faces at myself in the mirror, go to work, and worry about five o'clock shadow. It would be so amazing to roll out of bed and be able to get up and go. I don't even remember what that used to feel like.

One of these days, I'll audition some new GPs and see if they can't dig around in my records for this phantom blood test. But for now, I work two jobs and am easily distracted by hobbies. I can't decide if its because I'm beginning to accept this as something I'll have to live with, or just some kind of contentedly twisted denial. But that's partly what this is for.