Laser Consult Next Week!

How long have I been saying I am seriously considering trying laser hair removal again?  Last January, when I went to see the endocrinologist and decided to stay with the medication I am on right now, I knew it was probably the next step in reducing the hair I have to live with.  In August I think I was more seriously resolved, because my ovarian cysts had finally been explained to me and I could move on from that.  I seem to focus on the health concerns that worry me most, and then go down the list.  That indicates to me that hirsutism is no longer my highest concern.  That's pretty exciting on its own.

But I'd love to push it even further down the list, even if the results of laser hair removal are as temporary as last time (3-4 months, if you remember). And it will always be a lingering question in my life if I don't try again--what if the results are better on the medication?  I'll always wonder.

Funnily enough, it wasn't so much the inspiration of others' New Years Resolutions that finally urged me to make the calls, though it is that sensation of January being a "fresh start."  It's hearing about friends taking charge of their own lives and doing the things they always meant to do for themselves that is spurring me on to tackle the questions in my life.  It's getting me beyond the fear of being disappointed, the fear of pain, and the fear of cost.

So I called the same clinic I went to before.  The technician I used to see no longer works there, but they still have my life from 2004-2005, and I feel more confident using this place than trying another clinic elsewhere.  This one is connected with a team of dermatologists (even if one of them is the one who sent me right to laser instead of trying to figure out the cause of my hirsutism), and not one of the many salons that have popped up all over the place in the last several years.  You might be able to get good treatment from a salon, but I can be fairly sure a clinic like this with the backing of doctors will have the most state-of-the-art equipment and most highly trained staff.  I'll know for sure by the kind of questions they ask at my consultation.

I like to think I'm going into this with more realistic expectations.  I know what laser hair removal feels like, and I know the worst-case scenario results.  What I don't know is how much it costs now, and how well it will do this time.  So there's plenty to still be nervous about, but I also feel excited that I am finally trying it again.  I am brainstorming how to document the journey this time, so if anyone has any suggestions, or anything they would really like to see, please leave it in the comments!

What Happened to August?

Wow, I can't believe I haven't updated the blog for a month!  I really apologize for that.  After my trip I experienced a vague need to hold on to that state of mind, and let a lot of things slide in my life for a week after I returned.  And then my computer needed a complete hard-drive wipe and restoration. And then I had a week full of appointments, mostly doctors, and then I got sick.  Aaaand that, in a nutshell, was August.

Camping was great.  We got stuck in such bad traffic on the way out that we had to overnight in a highway-side motel, but that was just a part of the adventure.  The campsite facilities have been seriously upgraded since the last time I was there, greatly reducing a part of my fear--that of having spiders drop on my head arachnophobia style.  Our site happened to be nice and close to the showers, too, so that I felt like I had more opportunities to shower than I needed.  It took a huge load off my shoulders.

I was really hoping to have some photos to prove to you guys that for about a week, I, the hairiest woman of my personal acquaintance, lived in a bathing suit.  I had an awesome bathing suit, very modest, with a low rise at the legs so I didn't have to fiddle with the bikini line all the time.  I didn't shave my body every day, and sometimes I did my face in the tent with a stainless steel bowl of boiled water.  I never did try the sink in the washroom, mostly because they were more popular with the teenage contingent of our party--a contingent I had not realized would be present on this trip.  (And a contingent that flipped out when they thought a waitress at a restaurant one night was in M-to-F transition... so... didn't think they were ready to have their minds blown with the knowledge that sometimes, women just have beards.)  But overall, although I wasn't terribly close to most of the people I was camping with, they were much, much more down-to-earth than previous camping companions.  For the most part, I would not have had a problem telling them, "Excuse me while I go shave my face."

Also I tried highway driving and wake-boarding for the first time, got some great new shoes, discovered a wonderful bookstore, and made some new friends.  I read several books and was so relaxed not having to do anything else.  And I have to say, working through some of my fears really heightened that feeling.  It may be the only time I'll get away this year, but it was excellent.



The appointments went well, too.  I got back my old GP, the one who sent me to the endocrinologist in the first place, and she will continue to fill my prescriptions for Spiro and Diane so I don't need to keep seeing the endo.  The cyst on my ovary is stable--not shrinking but not growing--and the OBGYN didn't recommend any surgical intervention.  So now I know why I'm hirsute and I know why I get pain, and I'm tolerating my treatments.  What next?

I've got to call the laser clinic I used to visit, and see if the laser technician who helped me before still works there.  She was lovely and I'd want to give her the business.  Also apparently my GP is concerned about some moles on my stomach and wants a dermatologist to look at them.  Just have to wait for the referral on that one.  So that's what I'm working toward now.

Ultrasound Today and What's Up Next Week

I was meant to be having my ultrasound yesterday, but a migraine made me throw up all my water forty-five minutes before my appointment.  (Side note: throwing up only water is a very bizarre experience.)  I managed to nab a cancellation spot today, which was very fortunate considering that clinic was booking into the end of August already.  I really wanted to get the thing over with before I went camping--one less thing to worry about. 

Thankfully the migraine had all but departed by this morning and I could hold and process the water okay.  I think I’m starting to get the hang of how much water I personally need to drink, because this was probably the most comfortable ultrasound yet.  It probably helped tremendously that the technician was super-fast.  Almost before I knew it, I was done. Now I just have to wait until my OBGYN comes back from holidays to hear the results, but I’m not worried.

My reward for “being good” at my ultrasound (i.e., "going, as if I had any other choice") was taking a little detour and picking up my favorite ingredients for croissant sandwiches--namely, croissants.  It’s totally irrelevant to this blog, really, but I’m trying to get a bit more personal so you guys can get to know me as a person.  So now you know that I love croissants, and that I will use any excuse to spoil myself.

Ultrasounds really aren’t so big a deal, but they always make me emotional.  I really, really hate leaving the house with a full bladder (you guys know my worst recurring nightmare involves having to pee and finding no suitable place to do it), and having my lady parts laid bare on a screen is a very vulnerable feeling.  Couple that with helplessly puking my guts out less than 48 hours ago (something else I am a huge wimp about is vomiting) and I feel all stretched thin and fragile, like tissue paper.

What’s weirder, though, is I feel most vividly happy when I feel wrung-out like that.  I get happy about all the simple things, like sunshine, puppy kisses, and croissants.   I’m strangely fearless, as though throwing up and having an ultrasound were the worst possible things that could happen to me and there’s nothing else to be scared of.  I go out in public without make-up, I ask for help from strangers even though I find it scary, I sing to the radio.  What do you suppose that means?





So next week, ladies, I’ll be encamped by a beautiful lake with a lot of people who don't know me that well.  A lot of my energy has been directed towards gearing up for that and trying not to be too scared of it, and now that the ultrasound is over with, I feel more relaxed and free to look forward to the holiday.  Part of this “gearing up” has included forcing myself to buy some new bathing suits--ones that I simply like, not ones that I feel will hide most of my flaws.  I intend to really face my fears next week.

See you all soon, and take care of yourselves!

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.

Beardiful

Girls, I am sick again.  Unexpected downside to working with kids, I guess.  Viruses come and go through that place like its a hotel.  So, as a combined break for my throbbing head and the granting of a request, I'm going to use this week's post to share some beardy pictures.  Of my beard.

The only successful photos I have are from before I started treatment and after I finally decided what treatment to go with, so I really don't think they're the best example of how the various meds have worked on me.  But if they're at all helpful to you, Anonymous, or any other readers who haven't asked, I will be happy. 

These are from November 2009, before my first visit to the endocrinologist.  I believe I had just been sick in bed for a week or so, so the hair on my face is quite a bit longer (and much of the acne and irritation caused by shaving is absent).  You may have seen the first one on tumblr.  Click for large size:

Below are the only other photos where you can actually see the facial hair, and they're from January 2012, just after my most recent endo appointment.  I'd been on Spiro since the first photos were taken (with a brief break on Finasteride), and on Spiro with Diane-35 for 6 months.  This is about two days growth, which I was able to cultivate thanks to a brief break before starting my new job:

You can see the beard has really thinned out, especially on the sides of the face and under the jaw.  I mean, look, the neck-beard is almost gone!  But there's still plenty on the chin which is why I still complain about shaving every day.  Your results might be different if you try this treatment--they could be disappointing, or they could be even more satisfying.  My endo says its rare for Spiro to completely clear up facial hair, especially if your hirsutism was as severe as mine (or worse), but you won't know for sure until you try, right?

For those of you just joining us, I usually post photos of how the different meds worked on my stomach hair.  If you want to see those, try any of the tags below, like "medical" or "spiro."

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!)

Talk About Love

After the preliminary interview with Carly from the Pink Razor Project, my mind was abuzz with all sorts of fuzzy things.  She asked me some things I really had to think about--things which I am still thinking about.

I ended up not updating the blog last week because of a combination of stress and writer’s block.  Among the things I had to take care of was a last-minute appointment for an ultrasound in order to get some new snapshots of the cyst on my ovary for the OBGYN, which is coming up at the beginning of next month.  They asked me again if they could do the trans-vaginal ultrasound, and I again said I would be fine with it, but that I am under the impression they can’t perform one if I’ve never been sexually active.  I got a really nice, chatty technician this time (who let me empty my bladder a bit before the scan), so I finally managed to ask why that is, and she said that I wouldn’t be used to it so they don’t want to hurt me, and that in some cases women will refuse the procedure anyway.  Me, I’d actually like to see the back of my backyard.  But I guess it’s not to be.

Anyway, the point is, I’ve been thinking about relationships.  Talking to the ultrasound technician  about being a virgin, telling the endo that family planning is not even on the horizon, and then Carly’s questions about how being hirsute affects my dating life, it’s all reminding me that I’m 26 and haven’t been on an “official” out-to-dinner date for nine years.

I think a part of my own shock at that timeline is thanks to societal pressures to be married and start a family, same as they are to be a flawless hairless female.  But a part of it is also... I really thought I’d be married by now.  As a little girl I was always so in love with love.  Disney princess love.  Gone with the Wind love.  Sleepless in Seattle love.  I always imagine how, in just a little while longer, I’d be “old enough” to be swept off my feet.  But I got to high school, then college, then out into the working world, and very few people who I wanted to be in love with wanted to be in love with me.  And those that did, I was not interested in.  As time went by, I got more and more involved in my studies and my hobbies and I realized that it was not a matter of being “old enough.”  I had to be ready, in so many ways.  The things that I wanted in Prince Charming completely transformed between seventeen and twenty-one.  Life began to teach me what I valued in others (and not just as far as being able to see past visible flaws was concerned).  I had to have accomplished the things I wanted to accomplish on my own, like traveling and taking occupational risks and being creative.   I had to learn to love myself.

I think of the practicalities of a relationship, too, particularly an intimate one.  Prince Charming’d have to be okay with some chin stubble from time to time.  But more importantly, I’d have to be okay with it, too.  In order to be strong enough to let him see me, day after day, sudsing up my face and applying the razor, I’d have to become so used to it that it would be like brushing my teeth.

Taking that time has been very valuable to me.  I tried to get rid of the hair with laser hair removal partially out of a mistaken need to “prepare” myself for the grande passione that was surely on the horizon.  All I really needed to do was find out why the hair was there and how very small a part of my identity it was.  There are so many other things about me someone could love.  I’d rather Mr. Knight in Shining Armor didn’t love me because of the hair, or in spite of it.  I want it not to even register as a factor.

Above and beyond any perspective significant other’s acceptance of this strange aspect of me has to be my acceptance.  It will never be enough if I just find a man who doesn’t care about the hair.  I still have to learn to be content with myself and that’s a big work in progress.  To be “enough” without the man and with the hair.  More and more often, I feel like I am.  And that takes some of the pressure off.

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).

We Interrupt Our Regularly Scheduled Programming...

...for an important breast cancer PSA... along with some eye candy and a good ol' giggle.

Outed by a Curriculum?

Readers who have been around for a while may remember that I came to live in a blended family in my very late teens.  By then, I was reaching my peak of hirsute awesomeness, and not about to let these virtual strangers in on my secret.  I didn't know if I could trust them, and thank goodness, because one of them could certainly not be trusted.  After she moved out, however, there was still some concern about what would happen if I let people in on this oh-so-embarrassing part of me.

And it hasn't been easy to hide it.  The odd places I keep razors outside of the shower, the plethora of shaving mediums under the sink, the doctors visits, the very obvious prescription refill runs...  Maybe that only seems obvious to those of us who know what the clues add up to, but I still worry and keep things to myself.

My step-sister started her accelerated course in pharmacy tech, and the stuff she tells me she's learning is so fascinating.  There's a lot of memorization, and she's working hard using many different techniques to make all the drug names stick in her head.  The other day,  I walked past the whiteboard she's using, and my eyes were drawn to something written there.  The very familiar word "spironolactone."  I am so used to seeing that word now that I almost didn't stop to think about it.

But I glanced up and down the whiteboard, trying to get the context around this unprecedented appearance of my magic-pill-for-hairiness.  She was listing diuretics.  Of course.  The on-label use for the medication.  Not likely she'd be studying the non-FDA-approved uses just yet... right?

Also of interest was last, when the two of us were chatting with some friends, and everyone was coming up with humorous ways to help her study.  And she gestured at me and said, completely casually, "Maybe it'd help if she told me what medications she was taking..."

Over the years, I've worried less and less about what my cohabitants know about me.  But I'm so used to hiding it I do it now by reflex.  I'm still scared of what might happen if they know.  But that's another entry.  For now, I just thought it was pretty comical that she might clue in through such a totally independent means.

Now, I know I've got some comments and emails and notifications waiting for me, but I'm trying to stave off a migraine so I'll have to get to those later.  Thanks for your patience!

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!  :)

Ultrasound; the Sequel

It is against human instinct to leave the house without going to the bathroom first.  I dislike ultrasounds. 

I always drink as much as they ask, which is always way more than I have capacity for.  And then I end up being unable to keep it for the two hours before the appointment, and have to start all over again half an hour before leaving, which means my bladder continues to fill up in the waiting room, even though I’m no longer drinking.

This time when I went, the technician didn’t even ask me to empty my bladder partway, and I know I was as full last time.  I had to lie there in agony, toes cricked and ankles twisting, as she did the sonogram.  And because of that cyst on my ovary, or whatever it is that causes that random severe pain in my lower abdomen, holding it for that long is actually a little painful, especially at the time of the month where I’m somewhat bloated anyway.

Interestingly, she asked me if I would be all right with a trans-vaginal exam.  (Last time, this wasn’t even offered, though I had gone in expecting one.  Obviously they’d found what they were looking for without one.)  I said this would be all right; after all, I'd carefully groomed myself for close quarters.  But when the technician found out I was not and had never been sexually active she said she couldn’t do it.  I was both puzzled and relieved--I mean, if she needed to look at the back sides of the ovaries to ensure I had no other cysts developing, what would it matter what else had been there?

She was, of course, puzzled that I was on birth control although not sexually active, and I surprised myself by saying quite matter-of-factly, “Well, I’m hirsute, so it’s part of my treatment for controlling the hair.  I also take aldactone.”  Maybe I was tired, after being wrung-out about the appointment for so long.  When I get emotional and stressed, I become very frank with people.  She just hmmed like this was a perfectly normal answer, which I actually found vastly reassuring.

When the technician had enough pictures and said I could go to the washroom, I bolted out of there, not even bothering to wipe off the gel.  Then she got me to lie back and began really squishing my abdomen with the transducer.  It wasn’t causing me any pain, but here’s the thing: the monitor on the wall was on, so I could see what she was seeing.  And I’d been having twinges, mere ghosts of that severe pain, all week, radiating from the same spot she kept going over and over, a couple inches under my navel and slightly to the right.  And I could see cross-sections of this dark spot, almost like a hole, as she passed over it again and again, pressing and pushing and trying to get good shots of it.  I was too afraid to ask what it was, because it looked big enough to be an ovary, but... it just didn’t seem to look like one to me.  Was it the cyst?  Did I want to know?

She took the pictures to the radiologist, and then came back saying she needed more.  In the midst of this, my bladder was filling up again from the water I’d downed half an hour ago.  So I had to go take care of that, come back and let her literally dig around some more.  And I just gazed at this mysterious oblong hole on the sonogram on the wall, horrified but intrigued, and oddly pleased that whatever pain I had been experiencing for years, we were looking at the right spot.

But now I have to wait until the endocrinologist calls me with the results, to find out just what that black spot was.

But you think ultrasounds are awkward?  My pharmacy is not too far from the clinic, so I went over to pick up my prescription refills, and as we got into line I was explaining to my mother (who drove me, I would speed like a bat outta hell if I drove myself to an ultrasound on a full bladder) what had happened.  Little did I realize, one of my old friends from high school who I hadn’t seen in eight years was standing right behind me!  She was on her phone, and though she stopped to exchange pleasantries I got no hint that she heard me say “trans-vaginal.”

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.

6 Months on Spiro with Alesse

So here we are, 6 months on Alesse and 5 more uninterrupted months on 200 mg of Spironolactone. I've been trying various medications with my endocrinologist for over a year and a half now.

A quick recap: 100 mg of Spiro was an improvement. 200 mg was better. 5 mg Finasteride did not work, as the progress I'd made visually began to reverse. Nothing changed the hair on my face enough to improve my quality of life.

So why did the endo recommend adding an oral contraceptive to what was already sorta working? Lowering the amount of androgens in your system in addition to blocking them from reaching the receptors that cause the dark hair to grow (what we've already been doing) might work even better.

And what do I think? It's working just a little better than anything else so far, though the hair on my face still needs to be shaved every day. But I can shave my chest and not have to do it again for two or three days. I can pluck that hair and go a little longer without hair removal (though the hairs in my cleavage are not usually strong enough to seize with tweezers). Acne has once again been visibly reduced on my face, chest and back.

The Alesse has made my cycles more predictable, though I still get mid-cycle spotting. I waited for this to dissipate for longer than three months, thinking that it was because of the Spiro, or because of stress and travel, which usually caused me to forget a pill or two now and then. But after six months, I think it's pretty obvious Alesse is not going to control my spotting when my cycle is under the influence of Spiro. That's probably because I don't think there's a lot of estrogen in this pill.

I should also note that I don't think I had an allergic reaction to the Alesse in the first month after all. The rash has come back twice since then, always at different times of the cycle, including the placebo week.  (EDIT:  It also returned once when I was off the Alesse.)

I have read that the progestin in Alesse is androgenic (and woman with hirsutism probably want a pill with non-androgenic progestins since they don't want more hormones in their body that behave like testosterone). Between that fact and feeling like I'm bleeding for half of every month, I am considering asking for a different birth control pill.

With my next endo visit looming, I'm agonizing over my next step. The other choice the endo might present to me again is switching from Spiro to Cyproterone Acetate. I'm trying to ignore the fact that the name fills me with irrational fear. From my research, it seems to be tolerated well by most women, and has been used to treat androgen sensitivity symptoms for longer than Spiro. But it is reported to work only as well as Spiro, so really I'd only be trying it on the off-chance that it works better in my own body than the Spiro, and I'm at the point where I feel like this is the best it's ever going to get. I'm tired of being frightened new medications. Frankly, I'm kind of tired of medications in general.

I am tempted to just stick with what I'm doing and try laser hair removal again, and see how long the effects last. I know they won't be permanent, but I'm ready to spend a butt-load of money for a few months where I don't have to shave my face, I think.

But enough about what I think. Here again are some pictures of the progress of the various medications. The most dramatic (and easily photographable) difference is, as always, my stomach:


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). The three at the bottom are just close-ups of the hair, which you can kinda see get coarser and darker on the Finasteride again.

Actually, Alesse with 200mg of Spiro looks about the same as 200mg of Spiro on its own. Hm.

Remember, every woman is different and will have different degrees of success. This is just mine.

...Oooh, I don't feel ready to my appointment. I'm going to be as nervous as ever

Three Months on Alesse (2 Months on Spiro)

A couple weeks ago I finished my third pack of Alesse. For two of those packs, I have also been on 200 mg of Spiro.

How's the hair?
I thought I was seeing things at first, but it really is true. Two Sundays ago, I shaved my chest, and didn't have to shave it again for two more days. Albeit the hair that has the audacity to grow in my cleavage is a little thinner than the hair elsewhere, but I won't complain if it's going to grow back more slowly. I've been wearing v-necks and scoop-necks, and all-but-forgotten necklaces, all like they're going out of style.

Other than that, though, I've noticed no differences. My beard, the true bane of this hirsute existence, is unchanged. I'm going to try another before-and-after shot, but I did a hefty deforestation just before I went on vacation, so I have to wait for that to grow back before I can do a fair comparison.


Other good side effects?
I don't know if this is good or not, but I've lost almost 10 lbs. The last time I lost that much weight, I'd been depressed and not eating well, so I don't really associate losing weight with good things. But I know some women go on birth control hoping it will help them lose weight, and it seems like that is never a guarantee. Just because it's happening to me doesn't mean it's going to happen to everyone who goes on Alesse/Spiro.

Maybe it's something else I'm doing. I was not expecting such a thing, so I don't really know what to think, but it really is the only thing different about my habits of late.

That rash from the first month has not returned. As difficult as that was, it's history now, and my body and the pill have come to some kind of accord. So that's a plus.

But a really great thing? My cycle is now always predictable. For the first time since I can remember, I've not had a period coincide with travel or conventions. After the third week, I move onto the placebos, and usually the second day of the placebo I have a brief, light period, and start all over again.


Other bad side effects?
My period might be reliable, but the mid-cycle spotting certainly is not. It seems like a force as spiteful as my "af" used to be, coming maliciously just in time to get on a plane or for special weekend plans. It can come anytime between the second week of pills and the placebo week, and though the blood is old, the pain is as bad as a regular period. I am not impressed by this.

And now I'm wracking my brain to remember if my endo told me to call her if the spotting never stopped after three months, or if it stopped but came back each time. So I'm waiting another month to see what this cycle will be like. I really don't want to switch birth control and make my body adjust to another type of artificial hormone.

Since switching from Finasteride, my stomach hasn't gotten any better. It still gets quite upset at some of the most innocuous food, so either these meds are not nice for it either, or something else is affecting my IBS. Hard to say.


We'll keep on truckin'. Endo's appointment is in another three months, so I'm hoping to have seen something else by then, otherwise, it might be time for another change. I don't know how much longer I can do this. It amazes me that some hirsute women have been on their medication for years. I'm already getting tired of it. But then, I'm also in a bit of a dip in my mood lately--angry at the hair, hating the way I look... It passes eventually.

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?

One Month on Alesse

Another week is almost over and I have make my excuses again. After two years of fairly regular posting, this is kind of a scary indication of how the pill is messing with my motivation.

I do finally feel better as far as that mysterious "cold" is concerned. But on the fourth last pill of the pack, I started to notice a new reaction. The itchiness on the backs of my thighs that I mistook for razor burn was spreading down my calves and to the insides of my wrists. It wasn't a rash per se, but if I scratched the itchy areas, raised white welts appeared and the itching got worse--which kind of reminded me of being stung by nettles. But it's winter and there are no such plants around. I showered over and over, washed my bedclothes, towels, made sure I was well moisturized with gentle lotions... everything I could think of that might be giving me a reaction. Still the itching spread.

But other than that, and experiencing such intense mood swings that it was like going through puberty all over again, I felt totally fine so I waited to see if it would go away. By the last pill of the pack, I was covered with little scratches and scabs from all my scratching, from neck to ankles, and I called the pharmacist to ask if I should bother refilling my prescription. He didn't sound convinced that it was not an allergic reaction to something I ate, since the hormones present in the pill are also already present in everyone's body. He said it could possibly be a reaction to one of the inactive filler ingredients of the pill, or a very rare side effect, but if it wasn't getting worse to stay on it for another month. Or, if I couldn't live with the itching, call my endo and ask to have the prescription changed.

So with the constant desire to whip off my shirt and rub my upper body against a brick wall, I went to work, not really knowing what else to do. The demands of the job have kept me distracted, mostly, so when I come home I just try to take a shower, cover myself in aloe vera, and go to sleep before I scratch anymore. Sometimes at night I would wake to the feel of my own hands scratching at my skin, aggravating the itch so that I'd be up for another hour trying to fight the desire to keep going. I haven't slept too well this last week.

But as you may know with the pill (I didn't, never having been on any oral contraceptive before) after three weeks of taking it, you have one week where you either take nothing, or take a placebo to help you keep track of when to start the next pack. This allows your body to have a period, which is supposed to be lighter and more comfortable for most women. But sometimes it takes the body a couple of months to adjust to the artificial rhythm. Case in point, I've been spotting all last week complete with cramps before starting my week of no pills. Mind you, I was used to that on the Spiro.

The good news, though, is that 24 hours after my last hormone-filled pill, my skin felt immensely better. The pharmacist's comment about fillers in the pill stuck in my mind, so instead of downing the placebo I've been dropping it in the toilet. I've still got a few itchy places, but it's not that all-consuming desire to roll around on a sandpaper carpet that it used to be. Everyone could tell something was different about me from the first morning I woke up without the pill. My relief was that obvious.

So I'm a little nervous about starting this next pack. Will my body adjust, or will it be an utter spaz? I have a holiday next month, I don't want to be a great big barnacle of misery of my trip. The pharmacy is getting in some Spiro, at last, so I'll be able to start that again and see what they're like combined.

I just want to add here that all women react to different brands of birth control pills in different ways. The more I moan about my woes, the more my friends and acquaintances come forward to say, "That happened to me on such-and-such pill." It sounds like a lot of them have had to try one or two different pills before they found one that worked for them. So I certainly don't want to give up just yet.