Five to 10 percent of North American women have hirsutism, a condition that causes women to have excess hair on their faces and bodies. Women have the same number of hairs on their bodies and faces as men do, but the male hormone, testosterone, makes hairs thicker, darker and longer, making them more noticeable. Some women with noticeable body hair have normal amounts of testosterone and inherit this tendency. Others have a tumor or medical condition that causes their bodies to produce larger amounts of testosterone.
Women with noticeable body and facial hair should get blood tests for testosterone to measure male hormones made by the ovaries and DHEAS to measure male hormones produced by the adrenal glands. They should also get a sonogram of their ovaries to test for polycystic ovary syndrome (PCO syndrome) in which the ovaries do not release eggs each month. PCO syndrome is treated like diabetes with drugs such as metformin to lower blood insulin levels, and severe restriction of foods made with flour or added sugars.
Doctors have treated hirsutism with birth control pills and spironolactone, a drug to block male hormones. Now they also have leuprolide (brand name Leupron) which stops the brain from stimulating the ovaries to produce testosterone (1) and Proscar, the drug to shrink a man's enlarged prostate.(2,3,4) The most effective treatment may be the anti-male hormone, flutamide (brand name Eulexin) to stop the body from responding to testosterone (5,6,7,8,9,10,12). Doctors can measure the benefit of these drugs by drawing PSA blood tests in women (11)
1) The vast majority of women with hirsutism are overweight and have acne. The most effective available regimen to for them to take birth control pills and injections of Leuprolide acetate.Patricia Farris Dermatologist at Tulane presented to the American Academy of Dermatology update 11/15/94 New York.
2) P Moghetti, R Castello, CM Magnani, F Tosi, C Negri, D Armanini, G Bellotti, M Muggeo. Clinical and hormonal effects of the 5 alpha a-reductase inhibitor finasteride in idiopathic hirsutism. Journal of Clinical Endocrinology and Metabolism. 79: 4 (OCT 1994):1115-1121.
3)L Rhodes, J Harper, H Uno, G Gaito, J Audettearruda, S Kurata, C Berman, R Primka, B Pikounis. The effects of finasteride (Proscar) on hair growth, hair cycle stage, and serum testosterone and dihydrotestosterone in adult male and female stumptail macaques (Macaca arctoides). Journal of Clinical Endocrinology and Metabolism 79: 4 (OCT 1994) Page(s) 991-996.
4) A Tolino, A Petrone, F Sarnacchiaro, D Cirillo, S Ronsini, G Lombardi, C Nappi. Finasteride in the treatment of hirsutism: New therapeutic perspectives. Fertility and Sterility 66: 1 (JUL 1996):61-65.
5) E Pucci, AD Genazzani, F Monzani, F Lippi, F Angelini, M Gargani, D Barletta, M Luisi, AR Genazzani. Prolonged treatment of hirsutism with flutamide alone in patients affected by polycystic ovary syndrome. (125 mg twice a day) Gynecological Endocrinology 9: 3 (SEP 1995):221-228.
6) S Dodin, N Faure, I Cedrin, C Mechain, L Turcotlemay, J Guy, A Lemay. Clinical efficacy and safety of low-dose flutamide alone and combined with an oral contraceptive for the treatment of idiopathic hirsutism. Clinical Endocrinology 43: 5 (NOV 1995):575-582.
7) F Fruzzetti, D Delorenzo, C Ricci, P Fioretti. Clinical and Endocrine Effects of Flutamide in Hyperandrogenic Women. Fertility and Sterility 60: 5 (NOV 1993):806-813.
8) L Cusan, A Dupont, JL Gomez, RR Tremblay, F Labrie. Comparison of Flutamide and Spironolactone in the Treatment of Hirsutism - A Randomized Controlled Trial. Fertility and Sterility 61: 2 (FEB 1994):281-287 Conclusion: The present data obtained in a randomized prospective study clearly demonstrate that the pure antiandrogen flutamide is superior to spironolactone in the treatment of female hirsutism and its related androgen-dependent symptoms and signs in women.
9) M Erenus, O Gurbuz, F Durmusoglu, Z Demircay, S Pekin. Comparison of the Efficacy of Spiranolactone Versus Flutamide in the Treatment of Hirsutism. Fertility and Sterility APR 1994;61(4):613-616.
10) RS Howe, RP Chow, CL Stevens. Use of flutamide for self-induced androgen excess - A case report. Journal of Reproductive Medicine 39: 10 (OCT 1994) Page(s) 838-840.
11) Negri, F Tosi, R Dorizzi, A Fortunato, GG Spiazzi, M Muggeo, R Castello, P Moghetti. Antiandrogen drugs lower serum prostate-specific antigen (PSA) levels in hirsute subjects: Evidence that serum PSA is a marker of androgen action in women. Journal of Clinical Endocrinology and Metabolism, 2000, Vol 85, Iss 1, pp 81-84.
12) P Moghetti, F Tosi, A Tosti, C Negri, C Misciali, F Perrone, M Caputo, M Muggeo, R Castello. Comparison of spironolactone, flutamide, and finasteride efficacy in the treatment of hirsutism: A randomized, double blind, placebo-controlled trial. Journal of Clinical Endocrinology and Metabolism, 2000, Vol 85, Iss 1, pp 89-94 (spironolactone (100 mg/day), flutamide (250 mg/day), and finasteride (5 mg/day).
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