Hirsutism occurs when hair follicles become unusually sensitive to normal androgen levels in the blood, or when androgen levels rise. The growth of facial hair in many postmenopausal women is due to the drop in levels of the female hormone estrogen that occurs during menopause. This decline alters the estrogen-testosterone balance, causing a relative excess of testosterone.
How Serious is Hirsutism?
Excessive hair-growth in women is neither a disease nor, in most cases, a sign of disease. Sudden or severe hirsutism, however, does require medical attention, especially if accompanied by menstrual irregularities or signs of increased androgen levels, such as baldness or a deepening of the voice.
In these cases, a doctor will look for possible underlying causes, including polycystic ovarian disease, adrenal gland disorders and (rarely) adrenal or ovarian tumors. Hirsutism can also be caused by drugs that have an androgen effect, such as the drug danazol, used to treat endometriosis and fibrocystic breast disease. If a drug cause is suspected, the doctor may prescribe an alternative medication.
Treatment Options for Unwanted Hair
Hirsutism can be treated by physically removing unwanted hair or with drugs that help reduce androgen levels. Oral contraceptives and the diuretic spironolactane are commonly prescribed for hirsutism.
Often taken together, these drugs help suppress androgen production and new hair growth, but do not eliminate existing hair. They also take up to six months to show any effects. Common side effects of spironolactone include menstrual irregularities.
In 2000, a clinical trial showed similar efficacy of other anti-androgen drugs in eliminating unwanted facial hair in women.
The other medications included finasteride and flutamide. Flutamide can cause liver toxicity in high doses. Side effects of finasteride treatment are few and include liver enzyme abnormalities. Use of these drugs should be limited to those effectively preventing pregnancy as they can have a feminizing effect on male fetuses.
In what is particularly good news for the millions of American women with unwanted facial hair, in 2000 the U.S. Food and Drug Administration approved the first topical prescription cream for the suppression of facial hair.