And It's About Time There Was Some Support For Cushing's!
By Laurie Green, MD
Ask the Experts
Hormonal changes in a woman's body through her life will cause changes in the time and production of her hair. Before puberty, facial hair is a fine, thin type known as "vellus." With the onset of puberty, hormones transform some hair to a coarse pigmented variety called "terminal." The appearance of terminal hair in the pubic and axillary (under the arm) regions is caused by male hormones that are produced in puberty. For some women, terminal hair begins to replace vellus hair on the face.
When they compare their facial hair at age 40 with what it was at age 20, many women note subtle increases that they may deem abnormal or cosmetically disturbing. These increases may be bothersome, but they're generally part of the normal skin changes associated with aging, and aren't connected with an increase in male hormone levels.
At menopause, the ratio of male hormones -- androgens -- to estrogen may change, and this can produce mild increases in facial hair.
Finally, if a woman's mother or father has a good amount of facial hair, chances are that she will, too. Heredity dictates how thickly hair follicles are distributed through the skin, and this is fixed at birth. Certain ethnic groups are more likely to develop facial hair than others, so heavy facial hair is quite normal in some families.
The disorder in which excessive hair growth is stimulated by androgens is called hirsutism. Hirsutism can be accompanied by other changes, such as balding, deepening of the voice, and cessation of menstruation. In other words, excessive hair growth is usually not the only symptom of a true medical disorder.
Most hirsutism is caused by overproduction of androgens from one of the two natural sources of androgens in women: the ovary or the adrenal gland. The predominant androgen from the ovary is testosterone, while DHEA -- currently marketed as a dietary supplement -- comes from the adrenals. Simple blood tests that measure DHEA and testosterone can pinpoint the source of the trouble.
The most common condition associated with excessive androgen production is called polycystic ovarian disease, or PCO. Women with PCO often experience infertility and irregular menstrual cycles in addition to hair growth. Some develop diabetes as well. PCO can be treated with medication.
The adrenal glands, located above the kidneys, are less common sources of excess androgen. A condition called adult onset congenital adrenal hyperplasia is difficult to diagnose but can cause hirsutism. This disorder is characterized by large adrenal glands, and while it is present from birth, the symptoms may not show up until adulthood.
Tumors of the adrenal glands or the ovaries can also produce androgens. Tumors are rare and typically cause extremely high levels of male hormone with striking physical changes, such as more severe hair growth and enlargement of muscles.
Some medications can also cause hirsutism: Oral contraceptives containing norgestrel may cause mild hair growth. Over-the-counter supplements such as DHEA, which claim to increase libido or build muscle, can also be a culprit. These products should be avoided.
Diagnosing the Problem
You should undergo a complete medical evaluation before you begin any treatment for excess hair growth. In addition to measuring testosterone and DHEA sulfate levels, taking a thorough history is crucial. Be sure to tell your doctor all of the supplements and vitamins you are taking and report any breast discharge. If possible, bring photographs to your doctor visit to demonstrate changes in hair growth. (Researchers have developed a "scorecard" to help physicians visually determine what is normal in terms of hair type and quantity.)
If simple tests and medical history do not identify the source of excess androgen, further testing is available through a specialist.
With PCO, or when the cause is elusive, birth control pills can be used to limit hair growth. The birth control pill works by rendering some of the circulating androgen inactive. Adrenal hyperplasia is treated with a different hormonal antidote.
A number of other medications have proven helpful. Spironolactone, a diuretic, inhibits androgen production. Ketoconazole, an antifungal drug, also blocks the creation of male hormones.
For women with minimal facial hair, there are a number of options, but all have drawbacks. Temporary solutions such as shaving and depilatories can provoke skin irritation. Electrolysis is costly and uncomfortable, but it does yield results. Laser therapy is similarly costly, and it should be used with caution by women with dark skin, since permanent skin blotching can occur.
The most encouraging development is a cream called Vaniqa*, that was submitted to the U.S. Food and Drug Administration for approval in October 1999. Vaniqa, which is manufactured by Bristol-Meyers Squibb and Gillette, is said to prevent hair growth with frequent use. Approval is expected sometime within the year 2000.
Copyright 1999 WebMD. All rights reserved.