Hirsutism (pronounced HUR-soot-iz-um) is a disorder that affects women and causes an abnormally large amount of hair to grow in a pattern similar to that of men, specifically on the face, chest, and back. Increased hair growth is a common symptom of hirsutism, which is caused by an imbalance in male hormones known as androgens, most notably testosterone.
Women who seek to address hirsutism have access to a variety of treatment alternatives, including self-care measures, which are highly effective. However, in the past ten years, spironolactone, which is sold under the brand name Aldactone, has garnered a great deal of attention as a potential treatment for androgen-excess disorders, in particular hirsutism. Although it was initially developed as an aldosterone antagonist, spironolactone has now found widespread application as a salt-wasting diuretic and antihypertensive. However, it is apparent that the medicine also possesses other properties.
There is a correlation between increased androgen production and bioavailability, as well as increased androgen use by hair follicles, and hirsutism. Although there are some causes of hyperandrogenism that could be fatal, the majority of women who have excessive facial and body hair have an issue that is harmless, minor, and can be remedied by removing the hair physically.
Symptoms of Hirsutism
Hirsutism is characterised by the growth of coarse or dark body hair in areas of the body where women’s natural hair does not grow, most commonly on the face, chest, lower belly, inner thighs, and back. People have quite different ideas on what constitutes an excessive amount of something. When hirsutism is brought on by elevated amounts of testosterone, a process referred to as virilization may take place over the course of time. Some possible signs of virilization include:
- A deeper voice
- Balding and growing of facial hair.
- Acne
- A smaller size for the breasts
- An increase in total body muscle mass
- An increase in the size of the clitoris
Causes of Hirsutism in Women
A number of factors, including the following, have been linked to the development of hirsutism:
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Polycystic ovary syndrome (PCOS)
An imbalance in sex hormones is the result of this illness, which typically starts during puberty for most people. Over the course of years, PCOS may gradually result in increased hair growth, obesity, irregular periods, infertility, and sometimes many cysts on the ovaries. All of these symptoms can take their toll on a person’s quality of life.
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Cushing syndrome
When your body is subjected to excessive levels of the hormone cortisol, this condition will manifest itself. It is possible to develop this condition if your adrenal glands produce an excessive amount of cortisol, or if you use drugs such as prednisone for an extended period of time.
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Congenital adrenal hyperplasia
This genetic disorder is characterised by an abnormal production of steroid hormones by the adrenal glands, including cortisol and androgen.
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Tumors
In extremely rare cases, hirsutism can be caused by a tumour in the adrenal glands or ovaries that produces androgen.
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Medications
There are some drugs that are known to cause hirsutism. These include danazol, which is prescribed to patients suffering from endometriosis, minoxidil (which is sold under the brand name Rogaine), testosterone (which is sold under the brand name Androgel), and dehydroepiandrosterone (DHEA).
Risk Factors of Hirsutism
The risk of having hirsutism can be affected by a number of different factors, including the following:
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Family history
There are a number of genetic diseases that can lead to hirsutism, some of which run in families, such as congenital adrenal hyperplasia and polycystic ovary syndrome.
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Ancestry
When compared to other women, those of Mediterranean, Middle Eastern, and South Asian descent have a higher risk of having an increased amount of body hair that cannot be attributed to a specific source.
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Obesity
Being fat leads to increased androgen production, which can make hirsutism symptoms even worse.
Spironolactone in the Treatment of Hirsutism
The condition known as hirsutism is quite frequent in women of childbearing age and can have a significant impact on a woman’s quality of life. It is characterised by the growth of terminal hairs in places that are sensitive to androgens, such as the chin, the upper lip, and the trunk, in a pattern that is characteristic of males. The polycystic ovary syndrome is the most common cause, followed by unknown or idiopathic factors.
Androgens play a significant part in hirsutism, regardless of the overall levels of androgens in the body, due to the fact that 5-alpha reductase activity is most pronounced in the hair follicle. The Ferriman-Gallwey scale is the instrument that is used to evaluate hirsutism more frequently than any other. It takes into account eleven different body areas and is based on a point system that classifies people as having normal, mild, moderate, or severe hirsutism depending on how high the patient’s score is.
Off-label use of the medication spirolactone as a therapy for hirsutism has been suggested. Its usage in hirsutism, in contrast to that of spironolactone in acne, FPHL, and hidradenitis suppurativa. For the purpose of lowering the Ferriman-Gallwey score, a 100 mg/d dose of spironolactone was found to be more beneficial than a placebo in a study that was conducted by Cochrane in 2015. In addition, the effectiveness of this medication was comparable to that of flutamide and finasteride in the two studies that compared the three medicines. However, it is important to note that the quality of the evidence that is available now is quite poor.
The Response Rate of Hirsutism to Spironolactone
The effects of spironolactone on hirsutism were initially noticed by Ober and Hennessy, who reported an accidental impact in a patient who was receiving treatment for hypertension at the time. It was stated that their subjective impressions of a reduced growth rate of existing hair, decreased hair shaft diameter, and no further progression of coarsening and darkening of the hair were accurate.
Side Effects of Spironolactone on Hirsutism
The following is a pharmacological list of probable side effects that may be caused by spironolactone, many of which only last for a short period of time even if they do occur at all.
- An electrolyte imbalance has not been recorded, even with high dose treatment for hirsutism; however, the patient should avoid consuming an excessive amount of potassium.
- There is a chance that you will experience lethargy and stomach trouble.
- Menstrual irregularity can occur, especially for women who have a history of menstrual irregularity, although in most cases, this condition is only temporary.
- In the vast majority of patients, a cycle that is relatively regular but anovulatory emerges.
- It is feared that spironolactone, like many other gestagens, may stimulate the breast, which may, in turn, raise the chance of developing breast cancer. This is because spironolactone is structurally similar to the hormone prolactin. Patients who were taking spironolactone for reasons other than the treatment of hirsutism have been reported to have developed breast cancer. Despite this, there is no evidence that spironolactone causes breast cancers; however, it cannot be established that it does not contribute to the development of breast cancer either.
Patients who are of reproductive age should only take the medication if they are also using an effective method of birth control. The medication should not be taken during pregnancy.
Treatment recommendations of Spironolactone
At this time, the recommended dosage of spironolactone is between 100 and 200 milligrammes per day, to be taken in two equally divided doses. This dosage may be taken by itself or in combination with either 35 [Xg ethinyl estradiol and 0.5 mg norethindrone, or with 50 mg ethinyl estradiol and 1 mg ethynodiol diacetate. The combination of spironolactone and dexamethasone, at doses ranging from 0.25 to 0.5 milligrammes before night, is an alternative treatment option. This dose range is below the physiologic threshold for immunosuppression.
Although it is not authorised for use in the United States for the treatment of severe hirsutism, the combination of spironolactone with either a birth control pill or dexamethasone is likely the most effective medication that is now available. During treatment, people with mild hirsutism should be discouraged from undergoing medical treatment because physical techniques of hair removal are helpful and should not be disregarded.
When to see a doctor
If you feel as though you have an excessive amount of coarse hair on your face or body, you should discuss potential treatments with your primary care physician. An underlying medical condition is frequently the cause of excessive hair growth on the face or body. Consult your primary care physician for an evaluation if, over the course of a few months, you notice unusually heavy or quick hair growth on your face or body, as well as other indicators of virilization. You could be referred to a dermatologist or an endocrinologist if your primary care physician suspects that you have a hormone imbalance.