HIRSUTISM CAUSES

Hirsutism is a condition with excess hair growth in women in male pattern – on face, chest, areola, lower abdomen, upper back, lower back, buttocks, inner thighs and external genitalia. In most cases the main cause of hirsutism is hyperandrogenemia (high concentration of male hormones – androgens, tested in blood). In some cases hirsutism could be developed without increased levels of androgens.

Hirsutism Causes

Main causes of hirsutism can be classified in 4 groups:

• Hormonal causes,
• Tumor related,
• Drug related,
• Idiopathic/genetic/constitutional.

Hormonal causes of hirsutism (75-85% cases)

In normal healthy women androgens are normally secreted by the adrenals and the ovaries. During some hormonal diseases the production of androgens can be increased and it could develop different diseases with very typical symptoms:

	Polycystic ovarian disease (70–80% cases) Ovarian disease with multiple cysts and increased blood androgen levels. Typical symptoms include irregular periods, infertility, dysmenorrhea, occasional glucose intolerance and hyperinsulinemia and obesity.
	Congenital adrenal hyperplasia (CAH) An enzyme deficiency leading to excess production of androgen. Children with CAH may be born with ambiguous genitalia, symptoms of salt wasting, and failure to thrive. Additionally, they may develop masculine features.
	Cushing's syndrome (0,1% cases) Excess secretion of steroids including androgens. Cushing syndrome is a non-congenital form of adrenal hyperplasia characterized by an excess of adrenal cortisol production.
	Acromegaly Excess growth hormone and insulin resistance. Acromegaly most commonly affects adults in middle age and can result in severe disfigurement, serious complicating conditions and premature death if unchecked.
	Hyperprolactinemia (0.3% cases) Increased levels of hormone prolactin. It can also be caused by diseases affecting the hypothalamus and pituitary gland. Typical symptoms include amenorrhea, galactorrhea, osteoporosis and decreased libido.
	Hypothyroidism (0.7% cases) Deficit of the thyroid hormones. Some early symptoms include poor muscle tone, fatigue, increased sensitivity to cold, depression, muscle cramps, and joint pain, decreased sweating, osteoporosis, dry and itchy skin, bradycardia (low heart rate – less than sixty beats per minute), constipation and some more.
	Obesity Up to 8 percent of all women suffer from hirsutism, which also is common in many overweight or obese teenage girls. Because of the link between obesity and hirsutism, this condition also can be found in Type 2 diabetics.
	Syndromes of excessive insulin resistance Insulin resistance is the condition in which normal amounts of insulin are inadequate to produce a normal insulin response from fat, muscle and liver cells. Typical symptoms include fatigue, inability to focus, high blood sugar, intestinal bloating, sleepiness, weight gain, increased blood pressure, depression.
	Hyperreactio luteinalis of pregnancy Transient increase of androgens during pregnancy. Hyperreactio luteinalis is a condition associated with bilateral and, in rare cases, unilateral ovarian enlargement due to theca lutein cysts. Hyperreactio luteinalis is a benign condition

Hirsutism tumor related

In most cases ovarian and adrenal tumors are able to produce high levels of hormones which include excessive production of androgens. List of these tumors include ovarian tumors, arrhenoblastoma, gonadoblastomas, adrenal tumors, adrenal adenoma, adrenal carcinoma, lipoid cell tumors, dysgerminoma, brenner's tumor, granulosa-theca cell tumors and thecoma of pregnancy.

Hirsutism drug related

Unfortunately most drugs produced by pharmacological industry always have different kinds of side effects. Some drugs could increase body hair in normal places as well as in places never expected by clients. Drug related hirsutism can be limited to androgen sensitive areas or both androgen and non androgen responsible areas.
Drugs that can induce hirsutism by their inherent androgenic effects include dehydroepiandrosterone sulfate (DHEA-S), testosterone, danazol, and anabolic steroids. Currently used low-dose oral contraceptives are less likely to cause hirsutism than were previous formulations. The exact mode of action of these drugs on hair follicles is not known.

	Minoxidil It is a vasodilator medication known for its ability to slow or stop hair loss and promote hair re-growth. It is available over the counter for treatment of androgenic alopecia, among other baldness treatments, but measurable changes disappear within months after discontinuation of treatment.
	Phenytoin It is an anticonvulsant drug which can be useful in the treatment of epilepsy.
	Cyclosporine It is an immunosuppressant drug widely used in post-allogeneic organ transplant to reduce the activity of the patient's immune system and, so, the risk of organ rejection. It has been studied in transplants of skin, heart, kidney, liver, lung, pancreas, bone marrow, and small intestine.
	Diazoxide It is a potassium channel activator, which causes local relaxation in smooth muscle by increasing membrane permeability to potassium ions.
	Androgens They are steroid hormones that stimulate or control the development and maintenance of male characteristics in vertebrates by binding to androgen receptors. This includes the activity of the accessory male sex organs and development of male secondary sex characteristics. Androgens are also the original anabolic steroids and the precursor of all estrogens, the female sex hormones. The primary and most well-known androgen is testosterone.
	Oral contraceptives with progesterone component Progesterone-only oral pills are hormonal oral contraceptives, containing only the progesterone hormone. They have been created for women who want to use oral contraceptives but have allergic reactions to estrogens. The main progesterone-only pills benefits are that they do not affect cardio-vascular system and do not decrease the milk flow in breastfeeding women.
	Penicillamine It is a pharmaceutical of the chelator class. It is sold under the trade names of Cuprimine and Depen.  It is a metabolite of penicillin, although it has no antibiotic properties. Penicillamine is used as a form of immunosuppression to treat rheumatoid arthritis.
	Acetazolamide Acetazolamide, sold under the trade name Diamox, is a carbonic anhydrase inhibitor that is used to treat glaucoma, epileptic seizures, benign intracranial hypertension (pseudotumor cerebri), altitude sickness, cystinuria, and dural ectasia. Acetazolamide is available as a generic drug and is also used as a diuretic.
	Heavy metals Heavy metal poisoning has become an increasingly major health problem. Heavy metal toxicity can cause our mental functions, energy, nervous system, kidneys, skin, lungs and other organ functions to decline. When heavy metal toxicity is suspected, a good screening test is a hair analysis. List of heavy metals include Aluminum, Arsenic, Beryllium, Cadmium, Copper, Iron, Lead, Mercury, Nickel, Tin.

Idiopathic hirsutism (4.7% cases)

In most cases of idiopathic hirsutism the affected person is healthy till puberty and during puberty the excessive hair grow (hypertrichosis and/or hirsutism) could be noted.  In this category the hirsutism is usually genetic (family related). In most cases clients have normal regular menstrual cycles with ovulation. Sometimes these clients could have associated obesity and/or insulin resistance. Most clients with idiopathic hirsutism have normal blood androgen levels. In these cases the main cause of hypertrichosis and/or hirsutism is explained by increased sensitivity of the skin to normal androgens. Scientists discovered increased 5 alpha-reductase action in skin and hair follicles.
Familial hirsutism is both typical and natural in certain populations, such as in some women of Mediterranean or Middle Eastern ancestry.

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