Characteristics
No, there are broadly two types of body hair:
- Vellus hair which is thin, slow growing and light colored. Before adolescence, most of the body in both males and females is covered by vellus hair. After adolescence, females generally continue to have vellus hair into terminal hair in typical areas of the body (male pattern). When excessive growth of terminal hair of male pattern occurs in women, it is called hirsutism.
- Terminal hair which is coarse, fast growing and dark colored. Eyebrows, eyelashes, scalp hair are examples of terminal hair. After adolescence, males show conversion of vellus hair into terminal hair in typical areas of the body (male pattern). When excessive growth of terminal hair of male pattern occurs in women, it is called hirsutism.
Hair grows in a cyclical pattern. It erupts from the hair root (follicle) situated in a deep layer of skin. After a period of active growth, the hair root enters a resting phase. Once growth restarts, a new hair erupts and the old hair is pushed out. The life–span of each hair is approximately 9–12 months, whether vellus or terminal hair develops in a given area depends broadly upon two factors:
- Hormones (Secretions of ductless glands which are released in extremely minute quantities directly into the blood): A group of hormones called androgens promote the conversion of vellus hair rate of androgen production and the duration of exposure to androgens. Some hair follicles, such as those on the eyebrows, eyelashes and scalp do not require androgens to produce terminal hairs. As the blood level of androgens is several times higher in males (after adolescence) compared to females, males develop terminal hair in typical areas of the body. If the blood levels of androgens rise in females, they too can develop terminal hair in such areas or in short, develop hirsutism.
- Response of the hair roots to blood levels of androgens: If the response of hair roots to androgens is excessive in a female, she can develop hirsutism even though blood level of androgens is normal.
In a male, androgens are secreted by the testicles and adrenal glands situated above the kidneys. In a female, androgens are secreted by the ovaries (which give out the egg) and adrenal glands situated above the kidneys, lip (moustache), chin and sideburns (beard), chest, upper and lower abdomen, upper and lower back, arms and things.
Acne (pimples), irregular menstrual cycles, “Male” voice, male–pattern baldness, loss of typical female body shape, enlargement of clitoris are other features of androgen excess, is frequently an associated feature in some females.
Causes of Hirsutism
Hirsutism is not, by itself, a disease. Most commonly, it results from a combination of mildly increased androgen production (compared to non–hirsute women) and increased sensitivity of hair follicles to androgens. Certain drugs can lead to Hirsutism. It is therefore important to inform details of all drugs (‘Allopathic’, ayurvedic etc.) you are taking presently or have taken in the past. Disorders of the thyroid gland present in the neck can lead to hirsutism. Sometimes, hirsutism may indicate an underlying disorder of androgen production involving the ovaries or adrenal glands. In such cases, hirsutism may be associated with one or more other features of androgen excess (see below). Rapidly developing hirsutism raises suspicion of cancer.
Treatment of Hirsutism
Most certainly. The first step is to find cause, if any, of hirsutism, Estimating blood levels of relevant hormones is essential to find out serious causes and to decide and monitor treatment. Mechanical methods of hair removal like shaving, plucking, waxing and creams remove existing hair but cannot prevent new hair from appearing. Electrolysis permanently destroys a particular hair root, so new hair does not erupt from that root. However, electrolysis again cannot prevent new hair from erupting from other hair roots. Medical treatment does not get rid of existing hair but very importantly, prevents new hair from appearing. Thus, over a period of time, it is no longer necessary to use mechanical methods of hair removal. In overweight females, weight loss is an important part of treatment.
As already explained, medical treatment does not affect existing hair and the lifespan of each hair is around 9–12 months. Hence, 3–6 months may pass before improvement is seen. The maximum effect is seen after 12–18 months. After that, treatment may be discontinued and in some patients, may need to be restarted if significant degree of new hair reappears. The best indication that treatment is working is decrease in rate of hair growth (decrease in frequency of hair removal) as well as thinning and lightening of hair. Till effects of medical treatment are seen, mechanical methods or electrolysis may be used. It is a misconception that hair grows faster if it is plucked or shaved.
Medical treatment is by and large safe and side–effects are rare (see drug information provided to you before starting treatment). These drugs should not be used if pregnancy is being planned, during pregnancy and breast–feeding. The drugs are preferably started within ten days from the last menstrual cycle. These drugs do not hamper fertility (If oral contraceptives are used as part of treatment, conception will obviously not occur so long as they are used.) Once oral contraceptives are discontinued, there is no hindrance to conception.