endocrine evaluation needed for women with even minimal ‘male type’ hair growth
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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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