Endocrine
evaluation needed for women with even minimal ‘male type’ hair
growth
Researchers at Cedars-Sinai Medical Center and the University
of Alabama, Birmingham recently conducted a study of 188 women
with minimal excess hair growth. They discovered that 102 of the
subjects tested had excessive androgens, “male hormones” that
usually exist in much lower levels in women. Published in the
December 2004 issue of the American Journal of Obstetrics and
Gynecology, the study suggests that even minimal amounts of unwanted
hair in male-type patterns (hirsutism) may be a sign of serious
hormonal imbalances.
Among the 188 women in the study who experienced hirsutism, 102
were found to have an underlying androgen excess disorder. 94
of those 102 women were diagnosed with polycystic ovary syndrome
(PCOS), a serious disorder characterized by the presence of multiple
small cysts on the ovaries. PCOS sufferers often experience menstrual
irregularities, skin problems, and excess weight, and have an
increased risk of developing Type II diabetes, hypertension, and
heart disease.
Four study participants were diagnosed with a multi-system disorder
resulting from an excess of insulin in the blood that up-regulates
the ovarian secretion of androgens. This disorder, hyperandrogenic
insulin resistant acanthosis nigricans syndrome (HAIRAN), increases
the possibility of hirsutism and masculinization. Women suffering
from HAIRAN may exhibit symptoms such as thick dark patches of
skin (acanthosis nigricans).
Another four of the 188 women were found to suffer from non-classic
adrenal hyperplasia (NCAH), an adrenal gland dysfunction that
can lead to premature development of pubic hair, severe acne,
hirsutism, and irregular periods.
The patient evaluations in the study were completed between January
1995 and June 2002 at the University of Alabama, Birmingham. During
physical exams, patients were assessed for the presence of coarse
hairs on the upper lip, chin and neck, upper abdomen, lower abdomen,
thighs, upper arms, upper back, and lower back. There were no
external indicators of androgen excess disorders, other than the
excess hair. Results showed that patients ultimately found to
have androgren excess disorders were younger and more likely to
complain of infertility than were other patients.
Fully one-fourth of the study participants suffered from acne,
and half of the women with acne and excess hair growth had elevated
androgen levels and infrequent, irregular periods. As earlier
studies have shown that 55 to 86 percent of women with acne have
elevated androgen levels, the authors of this study recommend
that women with acne and excess hair growth pursue in-depth hormonal
evaluation.
The study found that the best predictor of androgen excess disorder
for patients with minimal excess hair growth was the presence
of infrequent, irregular menstrual periods (oligomenorrhea). Despite
this finding, some women who claimed to have regular periods were
found to have irregular ovulatory cycles and androgen excess disorder.
Doctors involved in the study highlighted the need for women
with hirsutism to seek medical attention for the problem, because
it is often an indicator of deeper medical issues. Most women
with hirsutism only seek medical treatment on the advice of their
electrologists, who often realize the excess hair is a symptom
of a larger problem. Even so, the underlying hormonal imbalance
often goes completely undetected.
Researchers agree that better education of both the public and
physicians is needed to increase recognition of androgen excess
disorders. One of the first such programs in the United States,
the Cedars-Sinai’s Center for Androgen- Related Disorders,
specializes in diagnosing and treating androgen excess disorders.
The Cedars-Sinai Center offers in-depth endocrine testing, comprehensive
support and treatments, and research into the disorders and possible
future therapies.
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