|
|
|
|
Keywords: increased hair hirsuitism acne endocrine endocrinology
hormones testosterone androgen skin disease adrenal ovary treatment diagnosis complication
electrolysis male
In the past decade, research conducted by the staff of the Institute for Endocrinology and Reproductive Medicine, as well as by other medical experts, has clearly established a connection between increased levels of male hormones and the development of excessive facial and body hair. This condition is known as hirsuitism. The availability of precise and sensitive methods for measuring male hormone levels in the blood enables the physician to effectively diagnose, treat and monitor patients with hirsuitism. In the female, excessive hair growth (hirsuitism) on the face, chest or abdomen is usually a manifestation of excessive male hormone production or due to the increased sensitivity of the hair follicle to normal male hormone levels. This increased sensitivity is typically ethnic in origin. Women of mediterrean descent (Greek, Italian, Spanish), for example, commonly have far more body hair than oriental women. In rare instances, the abnormal hair growth is a genetic disorder not related to male hormones. Certain medications, such as Minoxidil, may also cause excess hair growth. The management of hirsuitism requires
The therapy works to either cure the underlying disease or reduce the effects of the male hormones. During therapy, hormone levels must be closely monitored to ensure effective treatment. It should be remembered that when treatment is successful, it will result in prevention of the progression of hirsuitism, not in the elimination of existing excessive hair. Troublesome existing hair will typically fall out at the end of the two year hair cycle. Significant improvement is usually seen at six months. Existing excessive hair can be removed by electrolysis, or various forms of high energy light therapy,such as laser, or after the underlying hormonal disturbance has been corrected. However, electrolysis alone will be less than satisfactory if hormonal regulation has not been achieved. Since increased production of male sex hormones can result in hirsuitism, acne, and menstrual irregularities, the presence of unwanted hair growth in females may be an important sign of an underlying endocrine (hormonal) problem. An underlying disease of the ovarian or adrenal gland, if left undiagnosed and untreated, can lead to disorders of the menstrual cycle, PMS, and infertility. Therefore identification of and underlying disease state is key to the management of this health care problem. Regular monitoring of the hormone levels is necessary to determine the type of medication and dosage and to evaluate its effectiveness during therapy. Thus, an accurate diagnosis and treatment schedule can control excess hair growth, acne, and disorders of the menstrual cycle such as PMS, infertility and menstrual irregularity. The underlying cause of hirsuitism and acne is often a deficiency of certain enzymes in the adrenal gland or ovary. Increased adrenal male hormone production can cause an imbalance in the pituitary gland and cause increases in ovarian male hormone secretion, further compounding the problem. TREATMENT OF HIRSUITISM In about 40% of cases, elevated male hormone levels are caused by an enzyme deficiency in the adrenal gland. In these instances, the abnormal adrenal production can be effectively suppressed with low doses of cortisone. This therapy also has the added benefit of prohibiting any interaction between the adrenal male hormones and the pituitary gland or ovaries. This type of cortisone therapy can restore normal ovarian function and is used as an adjunct to infertility therapy. When the ovary is the primary source of the male hormones, therapy with birth control pills has proven successful. The hormones in the birth control pill suppress the ovary and therefore the production of male hormones. At the same time the birth control pill therapy increases estrogen levels. Choosing the appropriate pill is important, because some pills use an androgenic progesterone that can make symptoms worse in some patients. There is a birth control pill is avilable in Europe called Diane or Dianette which contains ethinyl estradiol and cyproterone acetate. It is very effective for excess hair growth and perhaps acne. It probably will never be approved by the US FDA because of the theoretical risk of cyproterone acetate caused birth defects (feminization of male fetuses). Obviously, used in combination as a birth control pill markedly cuts that risk. For patients who do not tolerate the pill, cyclic estrogen and progesterone can be an effective alternative. Anti-androgen drugs such as Spironolactone or Aldactone are useful additions to therapy, and a new drug, Proscar, which stops testosterone from being converted to its active form, is showing promise. All treatments should be followed by both clinical evaluations and blood tests to monitor benefits of therapy and prevent side effects. Recently, physicians have become aware that there is a disorder called insulin resistance which underlies dysfunctions of many endocrine systems including the ovaries, adrenals, and pancreas. Certain people with insulin resistance can have polycystic ovaries which result in inappropriate secretion of male directed hormones resulting in irregular cycles, obesity, increase body hair, acne, and infertility. This may need to be investigated in women with adult onset hirsuitism, particularly if they have other components of this syndrome. A simple glucose challenge test measuring insulin and glucose levels can make the diagnosis. Preliminary data suggests that medications such as Glucophage (metiformin) may help with these conditions in certain women even if they do not have diabetes.
|