I'm Still Here

My Dear Beautiful Readers,

I apologize for being absent for almost four years.  I am doing just fine, and I hope you are, too. 

It was actually quite incidental that I logged into my "Allerleirah" account after such a long time.  My overflowing inbox surprised me.  I did not expect that emails would continue to flow in from women and girls who were just starting their body hair journey, or from others interested in supporting hirsute women by sharing our stories on websites, in magazines, and on TV.  I did not expect that there would still be questions.

You are still finding my dormant blog and sending me messages, which tells me that there is still not enough support out there.  And because you are looking for someone to answer your questions and have the courage to reach out to a stranger like me, I really ought to be there for you.

So, if you never got a reply from me, I am sorry.  I hope you found your answers somewhere else.  I had to muddle through a lot of this on my own, too, and I still made it.  You're probably doing even better than I did.

And if you want to, please write me again.  I will make myself available again. Just because I feel like I have nothing new to say about hirsutism doesn't mean I shouldn't be around to say the same things as many times as is needed for others.  I can look back on my struggle from a privileged place where hirsutism is now livable, but others aren't there yet.

I will help you.

*    *    *    *    *

About half the emails I received simply wanted an update on my own hairy situation, so here it is:

Medications:  Unchanged since the last post.  I’m still on 100 mg of Spironolactone a day, Diane-35, and Vaniqa.

Any new hair observations?:  Unchanged since the last post.  It has been stable for a long time thanks to the medications.  Taking the same med dose won't have increasing effectiveness over time, it will only keep things the same.

Any new side effects?:  Nothing I've noticed.  Spiro hasn't given me noticeable constipation since I started pursuing digestive health with fermented foods like kefir.  I think over time the Diane has made my eyes dry, so wearing contacts has grown more difficult.  I just use more expensive eye gel drops and wear glasses more.  My boyfriend likes me in glasses anyway, he's got a thing for librarians.  ;-)

Morning routine:  Tweezing hairs on my chin every day or so.  Sometimes I will bleach the sides of my face when I feel like I have a lot of darker blond hairs there--though they only seem to be darker in certain lights at certain angles.  It helps me feel more confident, though, so I do it.  \

Further laser treatments?:  I went in once since the videos to have a touch-up laser session, which reduced the amount of time I have to pluck back to almost nil.  My chin is the most sensitive to the hair-growing hormone, so even though the meds help, it'll never stay bare forever.  Just gotta keep going back.  Now that I'm in my thirties with a steady job, it doesn't hurt the wallet as much to shell out $120 or so to get zapped once every year or so.  Totally worth it.

*    *    *    *    *

Emotionally, I don’t have as many days where I don’t want to leave the house because my face makes me feel self-conscious.  Now and then it still happens, but you just have to accept those times and remember that tomorrow will be a better day.

I've found that my anxiety has not lessened about travel.  My heart will still freeze in my chest at the prospect of camping and I'll grasp for every excuse in the book, even though I know my hair growth is not such a factor in my reality anymore.  And I still cringe when someone tries to touch my face.

It is possible that it is still affecting my relationships, as well.  I have been dating someone for two years now, but I hold back from any kind of intimacy.  There are a few possible reasons for that, but one of them may be self-consciousness about my body.  I have begun therapy this year to investigate my romantic hang-ups.  (And because this is something that I would want to know: I told him about my hirsutism fairly early in the dating process.  He was curious but not repulsed, and impressed by how well I hid it to the point where I don't think he quite believes I'm hirsute at all.  He has only my face to go by, of course.)

Part of the reason I am not so focused on hirsutism anymore is because I have a new problem: migraines.  I used to get a couple per year, but in the past few years I have begun getting one to three each month that last a few days each, not including the postdome.  I lose a lot of work time and a lot of family time, which gives me a lot of stress.  My new focus is finding a migraine remedy that works for me.  One of the things I’m trying right now is massage, something that as a hirsute person I never thought I would do.  It helps to approach it as a medical treatment and not as a decadent treat.  And if you got the kind of massages I get, you wouldn't think of it as relaxing at all.



So, that's how I'm doing. If I failed to answer something you've been wondering, please leave it in the comments, and email me with any questions, concerns, requests... I'm here for you again.

Vlog #2

Here it is already: the second installment of the video blog!  This time I'm talking about my first laser treatment.  No puppies though.



And if you don't wish to watch it, the topical anesthetic I am using is EMLA this time rather than Maxilene.  Maxilene was 5% lidocaine, EMLA is 2.5% lidocaine and 2.5% prilocaine.  I discovered that although EMLA is inconvenient in that you must cover the cream with an air tight bandage (ie, plastic wrap) and leave it on for 1-2 hours, the numbness lasts much longer, even increasing after you wash it off. 

The treatment itself didn't hurt as much, possibly both because of the EMLA and because I have less of that really coarse dark hair on my face now.  Additionally, the new laser machine they use ("Alex") does not require the tip to be pushed into the skin like the LightSheer diode laser they had eight years ago, so it can easily skim over your skin and treat a larger area with smaller pauses in between.  The Alex also blows cold air during the process, which almost instantly calms the pain you feel after the laser hits.

The worst of the pain was around my chin, where the worst of the hair still lives.  There, I really felt the pain surging down into each hair follicle, and smelled the burning hair, both of which are good signs, apparently.  I also heard a weird popping or crackling sound at those points, which I wasn't sure was from the laser or my hair.  When it was over, the technician wiped my chin and said some of the hairs had "popped" right out on the cloth, which was another sign of good results.  It certainly made me feel good.

My laser technician has spent ten years in aesthetic work, including laser, once owning her own clinic, so she is pretty awesome to me.  She had me out of that chair in less than half an hour.  But she seemed to fixate on the irritation of my skin when I came in, like she'd never seen razor burn before, which made me wonder if I have been doing something really wrong all this time.  Still, it didn't interfere with the treatment, and she just told me to apply Polysporin every night for the next little while to keep any infections at bay. 

That was how the topic of redheads came up; she asked if my beard was red because she couldn't tell with all the redness from the EMLA and the razor burn.  And she told me that they had found some redheaded women have less success with laser hair removal because the laser is also in the red spectrum, making it less effective against red pigments.  I don't think I've ever checked to see if there is red in my beard.  It was interesting, though.

The only new thing about the actual treatment process was that I had to sign a waiver acknowledging, among other things, that laser hair removal would not bring 100% results.  I wish I'd had that eight years ago, so I would have had the possibility of disappointment firmly in my mind.  I think they may have had some upset clients in the past?

One thing I forgot to mention in my vlog was that the technician looked me over, and said the treatment would be closer to $100 because there was more hair than the consultant had quoted.  I had wondered about that--the consultant didn't look at my hair at all.  So I wasn't surprised.  It's not a huge price difference.

So now I've got a really red chin with singed stubble sticking out in places, and the smell of burning hair is stuck in my nose.  I've engineered it so that tomorrow is a day off from work so I can give my skin a good holiday.  My next appointment is in five weeks, only because we couldn't make four weeks work for our schedules.  So look for the blog to update in the meantime! 

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!

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.

What?What?

One of the ladies I work with brought in a No!No! last week. I see the commercials and infomercials on TV here in Canada often, and thanks to my browsing history regarding body hair, I see the ads on the web when I surf, too. It claims to remove hair painlessly and discourage it from growing back by “crystalizing” the hair beneath the skin using “thermocon technology.” I’m not sure what that means, though apparently it uses heat and not light, but it so closely resembled home-laser-hair-removal kits (which I universally read as being disappointments and downright dangerous) that I resolved to stay well clear. Besides, a 60-day risk-free trial barely gets you through two hair cycles. You’d hit very few of your total active follicles in two months.

So anyway. She brought it in, took it out, and I knew immediately what it was. I tried not to be too excited as I drifted toward the conversation she was having with some of the other gals, explaining to them what it was. It sounded like she had brought it in for someone in particular, but I couldn’t insert myself into their circle to see who'd wanted to see it, or hear how it worked on the lady who owned it. But clearly at least two people I work with have concerns about body hair, but I haven’t been able to ascertain whether it’s simply normal hair they’re tired of shaving, a few stray chin hairs from menopause, or something else entirely.

I really tried to get in there. I asked questions, like how effective she found it on what type of hair, but the circle ignored me, closed tight. I don’t think they were trying to exclude me, but I sure felt like they didn’t think what they were talking about was relevant to my interests. So once again, I was kind of saddened at work.  But there’s still lots of opportunity to talk to my workmates one-on-one, and maybe someone’s hair woes will come out, because obviously they’re not secretive about it. I really want to know what their concerns are, and what has worked for them. This mystery is bugging me!

And now I’m curious about the No!No! again. It’s different when you actually know someone who’s used it. My expectations still wouldn’t be high, but what if it doesn’t totally suck?

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."

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).

What's Happening to My Beard?

I've come down with a flu (again!) so I haven't been at work.  In fact, I haven't been out at all, except into the yard to soak up a little sunshine and supervise the dog as he explores.  So that means that I haven't been shaving my face.

Well, I say I haven't been shaving, but what I mean is that usually around dinnertime when the family gets together, I'll quickly scrape in the direction of the hair growth with my razor.  This basically only "trims" my stubble, but it causes less stress on the skin.  You can still see the dark shadow, and if you came close enough you'd be able to see those pesky individual prickles.  However, it makes it a little less obvious than having one or two day's growth of beard.  I still haven't talked about my hirsutism with my step-family, and am still not really comfortable having that conversation.  Even if they have already figured it out, I'd still prefer to keep it out of sight and therefore out of their minds, lest it appears in their own conversations with others one day.  (I know I ought to get over this.  Getting people to talk about it would be a good thing.  Even if it's ignorant and judgmental speech, at least it would make people more aware that it's not something unique to a few Victorian-era unfortunates and Hollywood.)

Anyway, before my not-shave yesterday I was stretching my skin and looking for any ingrown hairs, which I'll usually nip in the bud by plucking and then dotting on a bit of Polysporin.  And I turned my face to examine my left cheek and jaw, I thought I noticed something, and leaned in close to the mirror, nearly squashing my nose against the glass.  No, I wasn't going crazy, there really was less dark stubble there.  In fact, there was a spot about an inch to an inch-and-a-half across that had very few dark hairs at all.

When did that happen?  I ran my finger up my cheek, against the direction of the hair growth.  It still felt like the same amount of hair there, but very little of it was dark in that spot.  Had the coarse hairs just lost some of their pigment?  Was this a sign of things to come?  Now don't get excited, I thought, and turned to my right cheek and found everything was still the same as ever.  Am I going nuts?  Was the left side of my face always like that and I've forgotten?  Or are androgens affecting my face less and less?  I have read that the face is usually the last to be affected.

Maybe things are about to get better.  We can only wait and see.



And hey, I've seen a few people have already seen and voted on the 4th Anniversary poll.  Thank you!  I'm really going to be taking to heart your opinions.

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.

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.

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.

About Finasteride

A week on Finasteride, and no unpleasant side effects. The nice thing about Finasteride is that it's not a diuretic, nor meant for blood pressure, so the extra peeing and the possibility of dizziness are no longer there. Neither is the risk of potassium build-up.

So, I wanted to do a post about the drug, and as always, this is for general information purposes only. Never try to self medicate; always speak to your doctor and get a prescription.

Finsteride (aka Proscar, Propecia, Finast, Fincar, etc.) was first designed for men with benign prostatic hyperplasia (enlarged prostate), and a few years later was approved for male pattern baldness. Like Spironolactone, it affects the male hormones in the body which cause these concerns. But it does it in a different way.

Spiro in the body competes with androgens for spots on the androgen receptors in the body. When Spiro attaches itself to the receptors on the skin and hair follicles, the androgens can't get in there to stimulate the cells to produce dark, terminal hair.

Finasteride in the body inhibits an enzyme called 5-alpha reductase which hangs out in places like the skin and turns testosterone into the much stronger dihydrotestosterone (or DHT) which really goes to work on the androgen receptors, causing hair growth on the body (and hair loss on the scalp). So rather than block the hormones themselves, it works to prevent their conversion. But like Spiro, this is not a cure. About the same amount of women find it works as they do with Spiro, and men who have stopped taking it usually find their symptoms return.

As with most things to do with hormones, it takes months to see results. Most of the reported side effects are for men, regarding reduced sexual desire and performance. Some drug sites report that this effect is the opposite in women. However, this drug is definitely not recommended for women who are pregnant, breastfeeding, or who may become pregnant, as it can harm a male fetus. I'd heard that with Spiro, too, but they even go so far as to tell pregnant women not to handle broken or crushed Finasteride pills. People on Finasteride cannot donate blood, and as with many drugs, there is a slight chance of liver toxicity. I'm going in for a blood test to monitor that at the end of the month.

Your doctor may prescribe you 1 to 5 mg of Finasteride. I'm on 5 mg a day, and the pill is very little. And blue. Which I joke about a lot. Being on a generic brand of the medication, I only noticed a price increase of a few dollars--my insurance covers 80% of the cost of prescriptions. I was paying about $45 for a month's supply of 2 pills a day of Spiro, so a month of Finasteride would have probably been around $55 without insurance.

The endocrinologist warned me I might get a few odd looks at the pharmacy for picking up a drug well-known for "male problems," but when I dropped off the prescription order, a male pharmacist assisted me, and I didn't notice him do a double take. When I returned to pick it up, he asked if I was warned about this drug, and I assured him I had, thinking about the liver toxicity. He didn't look convinced, and said, "Pregnancy? Absolute no-no while on this." When pregnancy is that far from your mind, it kind of takes you aback. I must have looked blankly at him for several seconds before it clicked that yes, I'd been told that, too. Felt a little foolish after that.

Rescources:

• Wikipedia - for explaining what the drug actually does
• Medicine Plus - Info similar to the handout from the pharmacy
• Rxlist.com - For much more detailed information
• Finasteride.com - The drug has its own site, y'all!

It's not easy to find sites that discuss its use in women with hirsutism. Usually, any reference to women is in the category of female hair loss, which sometimes does go hand-in-hand with hirsutism, but isn't well discussed. Some sites say Finasteride doesn't work at all for women. That seems to be because the studies in hair loss were with post menopausal women, so their hormonal make-up would be a little different from a young woman with male pattern hair growth.

Finasteride is mentioned for women with hirsutism on the Hormone Help Center site which I've had on my sidebar for ages. I've actually just bought the doctor's book to see if it can provide anything else enlightening on my situation. (I'll be sure to post a book review.) It's also mentioned on Hirsutism.com. And a study comparing Finasteride and Flutamide in women with PCOS and idiopathic hirsutism is discussed in a paragraph on the European Journal of Endocrinology site.

But in the end, it's never going to help every woman. Let's just see what it does for me. Worth a try, isn't it?

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.

Four Months on Spiro

I've refilled my Spiro prescription (man, I keep wanting to call it a "subscription") for the fifth time. I'm less than two months away from my follow-up with the endocrinologist. I know the slightly elevated levels of testosterone in my blood are not coming from my adrenals, so it must be coming from my ovaries. Does that mean PCOS? Or are my hair follicles just hypersensitive to the hormone? Either way, what's to be done about it? Because I don't know if the Spiro is working, or working well enough to continue with.

It's diuretic properties can still be pretty inconvenient. Whether I take the pill with breakfast or lunch, if I've drank anything too close to bedtime, I'm stumbling blearily into the bathroom at three in the morning because my teeth are floating--and then have to get back up two hours later to get to work. I'm not a fan of that bloated, close-to bursting feeling when I wake up.

My cycle can be unpredictable about half the time. The only way I can tell it's coming around is that my right breast starts to hurt. I'm making doubly sure to do my monthly breast exam; thanks to the Internet I'll never be able to forget seeing a link between Spiro (in huge amounts) and breast cancer, though I wouldn't expect anything to happen that quickly with such a small dosage. But at least my period is about half as long as it used to be.

And who can forget how it prevents me from eating a lot of potatoes--one of my favorite things.

And, as far as the hair goes, I don't think I see much change. I get the sense that it's growing a little slower, because shaving every 24 hours feels like I'm getting more skin than hair. If I pluck the hair, it seems to take longer to come back. However if the hair breaks as I'm plucking it, it doesn't clear the follicle nearly as fast, either. It just sits under the skin, cheekily visible yet untouchable.

So I'm trying to prepare myself for giving up the pills. It will become another one of those things that I can say with certainty was not for me and my beard. And that shouldn't be a defeat, it should be an accomplishment.

I wonder, if I get to the end of possibilities to try, I'll finally be able to totally accept this part of myself... because I'll have to.

Yeah, a part of my mind is still hoping for a miracle. What can I say? It's my fantasy to be able to wake up, and just... go somewhere without having to shave my face. How many women fantasize about Johnny Depp even though they know it'll never happen? ;P

Where's the Potassium?

Refilled my prescription for spiro today. I honestly thought I'd have had my blood test by now to measure my adrenals (to eliminate them as a cause of the hair) and potassium levels (just in case). But thanks to the pills entering my body and going, "This'll be fun; let's invent an entirely new cycle for her!" I have to play the waiting game.

I got an odd cramp behind my right knee the other night. It felt different from any leg cramps I've had in the past. It could have been from an old injury I sustained when getting up awkwardly from a kneel with my college book bag--that knee has been weak ever since. Or it could have been from keeping my leg nervous and tense trying to drive in the piled up snow. But I remembered reading that muscle cramps were a sign of too much potassium in the body, and whether that is accurate or not, it was all I could think about. Such a drama queen.

But I had to put my mind at rest, so I applied myself to research. We all know bananas and potatoes are high in potassium. But what about other foods might we not even think about? All that yogurt I was having for breakfast, the skim milk I've been using to take my vitamin D, the bran I try to keep in my diet, the raw spinach salads I love... You might be surprised.

So here's a few links for the gals out there taking potassium-sparing diuretics. Many of the lists are a little conflicting, so when reading this information, temper it with smarts.

• http://www.healthtouch.com/bin/EContent_HT/cnoteShowLfts.asp?fname=02023&title=POTASSIUM+CONTENT+OF+FOODS+LIST+&cid=HTHLTH
• http://www.weightlossforall.com/potassium-rich-food.htm
• http://www.dermatologyseattle.com/forms/forms/form15.html
• http://www.fatfreekitchen.com/nutrition/potassium.html
• http://www.drugs.com/cg/potassium-content-of-foods-list.html
• http://members.tripod.com/~charles_W/table2.html

According to some sources, an adult needs to take in at least 2,000 - 4,000 mg of potassium a day. A person trying to keep their potassium intake lower should, apparently, be aiming at less than 2,000. That's still about four baked potatoes, so while it's good not to go overboard, there's no need to be obsessively avoiding it. After all, we still need some potassium for our hearts, muscles, and even our digestive systems.

As well, exercising and drinking lots of water can only help keep things moving so that the potassium the spiro is leaving behind finds its way out eventually.

So tired. Will look at comments soon...

Week Two on Spiro

I'm coming up on the second week. Still having moments of panic at imagined side effects. But my period finally came last night. I was worried it would come at work and I'd be so excited that I'd tell the first person I saw. I don't think I've been this glad to see it since it first appeared and I could count myself among the ranks of my "grown up" friends. I finished an ambitious personal challenge that same night, but I was more thrilled about this. I'm in pain that ibuprofen can only take the edge from, and I feel drained and unfocused, but that's normal for me when it comes, and I'm stupidly relieved. It bothered me this much when I was warned it would mess up my cycle, so I can't imagine how women feel when they don't know why they're late.

Thing is, who knows when my next one will come? Three weeks? Three months? I'll have to be on a constant watch, lest I be caught off-guard. That is one of my worst fears, up there with public bathrooms with no doors on the stalls. Except it's a fear I've survived: imagine an inexperienced teenager, a 10+ hour flight to Indonesia, and white jeans. Yeah, I've been there. Doesn't stop me from agonizing over it. It's going to be a fun few months.

I haven't noticed anything else. I had a dream last night that it was making me grow more hair, not less, and it was making a thick, healthy rug of my ribs. No sign of change either way.

I was introduced to a blog this week that totally blew me away. It's not about hirsutism or polycystic ovaries for once. 65RedRoses is written by a young woman with cystic fibrosis. I'm still reading through it, and it makes me feel incredibly grateful for what I have, and so humbled and inspired by her courage and determination. Please take a look; it's worth your attention. I'm hoping to be back later in the week to update again and talk about something other than medication.