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.