Medical Treatment of Hirsutism

Most of the women with hirsutism seek health care advice for a cosmetic purpose more than any other reason. Though mechanical hair removal methods address their expectations, medical treatment of hirsutism is better, as it cures not only the hirsutism but also affects or even cures the underlying cause.

Treatment of hirsutism consists of three components:
  • Treatment of the underlying cause
  • Treatment of the growth of excess hair
  • Treatment of the complications
Though the growth of excess hair is treated by mechanical methods, the other two are treated by drugs, especially hormones.

Treatment of the underlying cause:

The basic abnormality in hirsutism is excess androgen in the blood. The source of this excess androgen could be a deranged hormonal system or an androgen secreting tumor or excessive sensitivity to normal levels of androgen.

The medical treatment of the underlying cause of hirsutism consists of administration of drugs which oppose the actions of androgen.

This can done by
  • Decreasing the secretion of androgens by the adrenal glands and the ovaries
  • Decreasing the binding of androgens to sex hormone binding globulin
  • Decreasing the conversion in to its active forms
  • Decreasing the sensitivity of the skin to androgens.

Suppression of androgen secretion by adrenals:

This can be done by drugs like glucocorticoid in low doses:
  • Dexamethasone
  • Prednisolone
These drugs are taken at bed time for maximum efficacy. These drugs help in the treatment of adrenal causes of hirsutism like congenital adrenal hyperplasia.

Suppression of androgen secretion by ovaries:

This can be done by drugs like oral contraceptives (OC). These are the commonly used drugs. Oral contraceptives are drugs with a combination of estrogen and progesterone. They have variable effects in the treatment of hirsutism. These drugs should be avoided in conditions like migraine, blood clotting diseases, and breast and uterine cancer.

Moreover the progesterone itself sometimes has mild androgenic activity. Norgestimate is newer progesterone with virtually nil androgenic effects.

The OC therapy is effective in curing acne in 60-70% of the patients with hirsutism, whereas it is effective in only 20% in curing hirsutism. Additionally, the effect on hair growth may take up to 6 months.

Other anti androgenic drugs:

Other drugs which have anti androgenic properties and which can be used in the medical treatment of hirsutism are
  • Cyproterone acetate - the side effects include uterine bleeding head ache and decreased libido. This drug is not available in the United States.
  • Spironolactone - It is mainly used to increase urination though its mild anti-androgenic effect helps in the treatment of hirsutism.
  • Flutamide - It is a newer drug with selective anti-androgenic effects. But it can cause fatal liver disease.
  • Finasteride - It blocks the enzyme 5 alpha reductase and prevents the conversion of testosterone in to its active form dihydrotestosterone.

Treatment of growth of excess hair:

The excess hair growth of hirsutism is mostly treated by mechanical means, though products like hydrogen peroxide may be used to bleach hair.

Treatment of complications:

One of the most important complications of hirsutism is the development of insulin resistance resulting in Type II diabetes. This is treated with
  • Metformin
  • Rosiglitazone
Other drugs used are
  • Sibutrarmine - for obesity in PCOS
  • Clomiphene citrate  - for PCOS

There are no well developed treatment protocols for the medical treatment of hirsutism. But based on the investigation results and the underlying cause, if detected, the medical treatment of hirsutism is often a must, to cure an underlying pathology which may sometimes be potentially dangerous.


This page was last updated on June 20, 2006

 


 


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