In the previous week, various cases of Hirsutism, Facial hair in adolescent women, that is how causes a social stigma, were discussed.
The latest treatments for hirsutism, which is excessive hair growth in women, focus on a combination of pharmacologic therapies and direct hair removal methods. Pharmacological treatments aim to reduce androgen production or block their effects, while hair removal techniques offer immediate cosmetic improvement and are dealt in the following strokes.
General Management
Hirsutism is generally a treatable condition, with various options available, including medications like oral contraceptives and anti-androgen drugs can help regulate hormone levels and reduce hair growth. Also, topical treatments creams containing eflornithine can slow hair growth. Further hair removal methods such as laser therapy, electrolysis, and plucking, shaving, waxing, and chemical creams are also in practice. Treatment approaches should be tailored to the individual’s specific needs and the underlying cause of hirsutism. The perception of hirsutism and its severity can vary across different ethnicities and social groups in India. Further research is needed to understand the prevalence of hirsutism in diverse Indian populations and its impact on quality of life. Improved awareness and education about hirsutism can help reduce social stigma and encourage individuals to seek appropriate medical care.
Specific Management
Pharmacologic therapy is directed at interrupting one or more of the steps in the pathway of androgen synthesis and action. Androgen synthesis is a complex process that involves the transport of cholesterol into the mitochondria. This first rate-limiting step is under the regulation of the steroidogenic acute regulatory protein (1). Suppression of adrenal and/or ovarian androgen production, (2) enhancement of androgen-binding to plasma binding proteins, particularly SHBG, that is Sex hormone-binding globulin (SHBG) or sex steroid-binding globulin (SSBG) is a glycoprotein that binds to androgens and estrogens (3) Impairment of the peripheral conversion of androgen precursors to active androgen, and (4) inhibition of androgen action at the target tissue level. Lessening of hair growth is typically not evident until 4-6 months after initiation of medical treatment, and in most cases, leads to only a modest reduction in hair growth.
Endocrinology consultation
To initiate hormonal therapy to control hirsutism, it is always advised to consult an endocrinologist so that the proper use of hormones, the correct dosage, the period of treatment, the evaluation of the case, and early recognition of side effects and complications due to certain hormones can be controlled scientifically.
Combination estrogen-progestin therapy in the form of an oral contraceptive is usually the first-line endocrine treatment for hirsutism and acne, after the cosmetic component of most oral contraceptives currently in use is either ethinyl estradiol or mestranol. The suppression of LH leads to reduced production of ovarian androgens. Suppression of luteinizing hormone (LH) refers to a decrease in the levels or activity of this hormone, which plays a crucial role in reproductive function. LH is a gonadotropin, meaning it stimulates the gonads (testes or ovaries). LH suppression can occur due to various factors, including stress, hyperprolactinemia, and the use of certain medications.
LH suppression is a complex phenomenon with various potential causes and consequences, particularly impacting reproductive health and fertility. Understanding the underlying mechanisms and factors influencing LH levels is crucial for managing reproductive health and optimizing treatment strategies in cases of infertility or during assisted reproductive technologies. The reduced androgen levels also result in a dose-related increase in SHBG, thus lowering the fraction of unbound plasma testosterone.
Combination therapy also has been demonstrated to decrease DHEAS, or dehydroepiandrosterone sulfate, is a hormone produced by the adrenal glands that serves as a precursor to both male (androgen) and female (estrogen) sex hormones. A precursor of a disease is a definable pathologic state that progresses directly to disease without a known intermediate step, and whose presence substantially increases the likelihood of disease.
It plays a role in the development of male and female sexual characteristics, particularly during puberty, perhaps by reducing ACTH levels. ACTH is Adrenocorticotropic Hormone. It is a hormone produced by the anterior pituitary gland that stimulates the adrenal glands to release cortisol and androgens. ACTH plays a key role in regulating the body’s response to stress, metabolism, and immune function. Estrogens also have a direct, dose-dependent suppressive effect on sebaceous cell function.
The choice of a specific oral contraceptive should be predicated on the progestational component, as progestins vary in their suppressive effect on SHBC levels and in their androgenic potential. Ethynodiol diacetate has relatively low androgenic potential. Whereas progestins such as norgestrel and levonorgestrel are particularly androgenic, as judged from their attenuation of the estrogen-induced increase in SHBC. Norgestimate exemplifies the newer generation of progestins that are virtually nonandrogenic. Drospirenone, an analogue of spironolactone that has both antimineralocorticoid and antiandrogenic activities, has been approved for use as a progestational agent in combination with ethinyl estradiol.
A word of caution
Oral contraceptives are contraindicated in women with a history of thromboembolic disease and women with increased risk of breast or other estrogen-dependent cancers. There is a relative contraindication to the use of oral contraceptives in smokers and those with hypertension or a history of migraine headaches. In most trials, estrogen-progestin therapy alone improves the extent of acne by a maximum of 50-70%. The effect on hair growth may not be evident for 6 months, and the maximum effect may require 9-12 months owing to the length of the hair growth cycle. Improvements in hirsutism are typically in the range of 20%, but there may be an arrest of further progression of hair growth.
Hirsutism, characterized by excessive hair growth in women, is a relatively common condition in India, with prevalence varying across different regions. Idiopathic hirsutism (IH) and Polycystic Ovary Syndrome (PCOS) are frequently identified as underlying causes. While the condition is treatable, social stigma surrounding hirsutism can significantly impact individuals, particularly adolescents.
