May 18, 2012

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 meIf 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.


Anonymous said...

You were on spiro and diane-35 since last year, what are the results nw.. Please post..

Allerleirah said...

I would say it's cut the hair in half on my face, and even more than half on my chest, stomach and thighs.

Here's a post with before and after photos of my chin and neck:

And here's a post with photos of the progression of the hair on my stomach over various medications:

I hope that helps! :)