Hirsutism may be a sign of serious medical condition

Hirsutism or frazonism is the excessive hairiness on women in those parts of the body where terminal hair does not normally occur or is minimal - for example, a beard or chest hair. It refers to a male pattern of body hair (androgenic hair) and it is therefore primarily of cosmetic and psychological concern. Hirsutism is a medical sign rather than a disease and may be a sign of a more serious medical condition, especially if it develops well after puberty.

Hirsutism affects women and sometimes men, since the rising of androgens causes a male pattern of body hair, sometimes excessive, particularly in locations where women normally do not develop terminal hair during puberty (chest, abdomen, back and face). The medical term for excessive hair growth that affect both men and women is hypertrichosis.

Hirsutism can be caused by either an increased level of androgens, the male hormones, or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the growth and pigmentation of hair.

Other symptoms associated with a high level of male hormones include acne, deepening of the voice, and increased muscle mass. Growing evidence implicates high circulating levels of insulin in women for the development of hirsutism. It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens.

Signs that are suggestive of an androgen-secreting tumour in a patient with hirsutism is rapid onset, virilisation and palpable abdominal mass.

The following may be some of the conditions that may increase a woman's normally low level of male hormones: polycystic ovary syndrome, congenital adrenal hyperplasia, Cushing's disease, growth hormone excess, tumours in the ovaries or adrenal gland, insulin resistance, obesity. This is the same mechanism as polycystic ovary syndrome, PCOS, Use of drugs.

Diagnosis of patients with even mild hirsutism should include assessment of ovulation and ovarian ultrasound (because of the high prevalence of polycystic ovary syndrome), as well as 17-hydroxyprogesterone.

The writer is an Endocrinologist working at Shaheed Suhrawardy Medical College Hospital, Dhaka. Email: selimshahjada@gmail.com