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WOMEN’S BODIES: HIRSUTISM: TYPES AND CAUSE
There are two types: ’simple’ hirsutism and hirsutism with virilisation (obvious evidence of masculinisation).
‘Simple’ hirsutism
This is growth of varying amounts of terminal hair on ‘male’ sites in women who] have no other signs of masculinisation. One or many sites may be affected, beginning around puberty.
Why does simple hirsutism occur in some women and not in others if all women produce some male hormones after puberty? Many factors may be responsible, including how much male hormone is produced, how it is circulated and used in the body, and increased sensitivity to androgens of the hair follicles id the sites affected. All of these factors ten to be controlled by our genes, which explains why the tendency to simple hirsutism runs in some families and races. It is
common in southern Mediterranean and Middle Eastern women, variable in Caucasians and rare in Asian women.
Hirsutism with virilisation
This is always associated with an excess of male hormones. The onset may be before (rarely), during or after puberty. Male-pattern hair growth is usually much more pronounced than in simple hirsutism (but a diamond-shaped or ‘male’ pattern of pubic hair growth is normal for many women and is not regarded as a sign of virilisation). Other symptoms and signs of virilisation include missed or scanty periods, subfertility, acne, deepening of the voice, altered body shape and increased masculinity, shrinkage of the breasts, male-type baldness and an enlarged clitoris. The excess hormone may come from overactivity or hormone-producing tumours of the ovaries, adrenal glands or pituitary gland, or from drugs (mainly anabolic steroids and the anticonvulsant phenytoin; less commonly synthetic progestogens with masculinising properties; rarely corticosteroids).
After the menopause some women gradually develop hirsutism with features of virilisation. This happens because the body continues to make androgens but these are no longer counteracted by oestrogens from the ovary. The unopposed Meet of even small amounts of androgens may have a masculinising effect.
Finding the cause
It’s important for any woman worried by hirsutism to see a doctor, first, to rule out the possibility of excess androgen production or drug-induced hirsutism and, second, because medical treatment can also help simple hirsutism.
Your doctor will want to know when the condition was first noticed, how rapidly it developed, your family history, if you are on medication, your menstrual history, and of any other health disorders. The physical examination will include looking for signs of virilisation, a general examination, and a pelvic examination to look for abnormalities of the ovaries. A blood sample for measuring hormone levels is usually taken. A common cause of hirsutism with or without virilisation is polycystic ovaries; therefore pelvic ultrasound examination may be suggested at this stage. If there is any evidence of increased androgens, you’ll probably be referred to an endocrinologist (specialist in hormone disorders) or gynaecologist for further investigations and treatment.
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