Hirsutism
Alerts and Notices
Synopsis
Hirsutism may be idiopathic, or it may be linked to other conditions. Familial hirsutism is generally facial with a prolonged preauricular hair line. Other etiologies can be considered on the basis of the organ causing the abnormality. Adrenal hirsutism may be due to congenital adrenal hyperplasia or hypercorticism. Causes of increased cortisol include primary nodular hyperplasia, adrenal adenoma, and adrenal carcinoma.
Ovarian hirsutism can be due to polycystic ovary syndrome (PCOS) or ovarian tumors. Pituitary hirsutism is associated with Cushing disease, a prolactin-secreting adenoma, and psychotropic medications that increase prolactin (ie, antipsychotics). Ectopic hormone production, such as the production of ACTH by small cell lung cancer or HCG by choriocarcinoma, also leads to hirsutism. Anabolic steroids lead to the condition as well.
Hirsutism may be associated with seborrhea, acne, and androgenetic alopecia (termed SAHA syndrome). These findings can also be seen in PCOS; however, in SAHA, menstrual cycles are not anovulatory and ovarian ultrasound is unremarkable. HAIR-AN syndrome has also been characterized, which is marked by hyperandrogenemia, insulin resistance, and acanthosis nigricans.
Codes
ICD10CM:L68.0 – Hirsutism
SNOMEDCT:
399939002 – Hirsutism
Look For
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
Differential diagnosis of causes of hirsutism:- Familial hirsutism – mostly facial in the preauricular area
- Cushing disease
- Acromegaly
- Polycystic ovarian syndrome (PCOS)
- Anorexia nervosa
- Hypothyroidism
- Porphyria cutanea tarda
- Idiopathic hirsutism
- Virilizing neoplasm
- Ovarian hyperthecosis
- Congenital adrenal hyperplasia
- Prolactinoma
- SAHA syndrome
- HAIR-AN syndrome
- Persistent adrenarche syndrome
- Excess ovarian androgen release syndrome
Best Tests
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:06/25/2018
Last Updated:08/10/2021
Last Updated:08/10/2021
Patient Information for Hirsutism
Overview
Hirsutism describes excessive hair growth in females caused by androgen hormones (male hormones) in the body as well as other masculine changes. Hirsutism is a common condition and is different from hypertrichosis, or excessive hairiness. Hirsutism is a "male" hair growth pattern found in such places as the chest, chin, upper lip, and stomach. Other such changes might include deepening of the voice, acne, and increased muscle growth. There are family and ethnic factors that affect hair growth, but hirsutism is usually caused by a disease or the use of certain medications.Since there are a number of causes of hirsutism, you should see a doctor for medical care to determine the underlying cause and appropriate treatment.
Who’s At Risk
Women in their 20s and 30s are typically at risk for this male pattern excess hair growth. Women may also have female relatives with the same condition.Signs & Symptoms
Look for excessive hair growth in areas such as the sideburns, upper lip, chin, chest, stomach, and groin. Deepening voice, acne, reduction in breast size, increased sex drive, and increased muscle growth are other signs.There are many other symptoms that can be found with hirsutism, including sudden weight gain, irregular menstrual periods, and an inability to become pregnant.
You may also have high blood pressure, easy bruising, muscle weakness, and purple-colored stretch marks on the stomach.
Self-Care Guidelines
You can remove the unsightly hair on your own using tweezers, by shaving, or with hair removal creams; however, the hair might return, and removing large amounts of unwanted hair with these techniques may be frustrating.When to Seek Medical Care
Hirsutism is mainly a cosmetic problem but can also mean something is going on within the body. Your doctor can determine if the excessive hair is normal or because of an underlying disease, such as polycystic ovarian syndrome (PCOS), Cushing syndrome, or congenital adrenal hyperplasia.Your doctor may run tests to check testosterone levels and other androgens, such as androstenedione and dehydroepiandrosterone (DHEA), found in the blood that might be increased in hirsutism. Your doctor may refer you to a specialist.
Treatments
If your doctor suspects an underlying cause, you will likely need to see a specialist for treatment.If no underlying problem is determined, your doctor may prescribe oral medications to block the action of androgens such as an oral contraceptive or spironolactone (not FDA approved for treating hirsutism).
Hair removal may be achieved by different methods.
Remove the hair mechanically:
- Depilatory (removing hair from the surface of the skin) – Includes shaving and chemical treatments. Contrary to popular belief, shaving hair does not make it grow back thicker or grow in faster.
- Epilatory (removing hair along with the root) – Includes tweezing, waxing, laser therapy, and electrolysis. Electrolysis can help with mild hirsutism for permanent hair removal, especially if performed by an experienced electrologist. Laser therapy is another option for permanent hair removal for moderate to severe hirsutism but may be expensive and time consuming.
References
Suurmond D. Disorders of hair follicles and related disorders. In: Suurmond D, ed. Fitzpatrick's Color Atlas & Synopsis of Clinical Dermatology. 6th ed. New York, NY: McGraw-Hill; 2009:section 32. http://www.accessmedicine.com/content.aspx?aID=5198818. Accessed May 03, 2013
Ehrmann DA. Hirsutism and virilization. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, eds. Harrison's Principles of Internal Medicine. 18th ed. New York, NY: McGraw-Hill; 2012:chap 49. http://www.accessmedicine.com/content.aspx?aID=9093260. Accessed May 03, 2013.
Hirsutism