Endocrinology - Hirsutism and Hypertrichosis: By Joshua Lakoff M.D.

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Endocrinology - Hirsutism and Hypertrichosis: What You Need to Know
Whiteboard Animation Transcript
with Joshua Lakoff, MD
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Hirsutism is a common complaint, affecting 5-10% of reproductive age women. It is defined as excess terminal hair growth in androgen dependent areas.
Hirsutism must be distinguished from hypertrichosis, which is excessive hair growth in non-androgen dependent areas and is not caused by excess androgen.
Hypertrichosis is much less common and can be seen with certain genetic conditions, drugs, malnutrition, hypothyroidism, and other diseases, such as porphyria.
Polycystic ovarian syndrome accounts for 3/4 of Hirsutism cases. It can be diagnosed based on 2 or more of the key features:
• One, clinical or biochemical hyperandrogenism
• Two, abnormal menstruation, and
• Three, the presence of ovarian cysts.
But to diagnose PCOS a number of other conditions must be excluded
First, and foremost pregnancy must be excluded in woman with irregular or absent menses.
Adrenal or ovarian tumours may be the cause, if there is signs of viritilization, these include, a rapid increase in hair growth, deepening of the voice, increased muscle mass, male pattern balding, or genital ambiguity.
Congenital adrenal hyperplasia, is caused by a deficiency in a key enzyme in the adrenal steroid pathway, this can lead to hirsutism. Androgenic medications and endocrinopathies such as Cushings syndrome, hypothyroidism, acromegaly, and hyperprolactinemia are other causes to consider. Up to 15% of cases of hirsitism are idiopathic.
The main goal of therapy is to treat the underlying cause. In PCOS, weight loss can help to reverse the underlying pathology.
All causes of Hirsutism respond to cosmetic procedures such as shaving, plucking, and waxing, but these do not affect the hair follicle and hence do not prevent regrowth.
Folliculytic therapy such as electrolysis can reduce hair follicle numbers but can be costly and time consuming. Eflornithine cream is effective for hair in a limited distribution. Hormonal therapy and antiandrogen therapy can help to reestablish the balance of estrogen to androgen, this reduces current hair and preventing further growth.