Materiały źródłowe

• #1 Pathophysiology and causes of hirsutism – UpToDate

  https://www.uptodate.com/contents/pathogenesis-and-causes-of-hirsutism

  Hirsutism, defined as excessive terminal hair growth, affects between 5 and 10 percent of females of reproductive age. Hirsutism may be the initial and possibly only sign of androgen excess, the cutaneous manifestations of which may also include acne and male-pattern hair loss (androgenetic alopecia). The pathophysiology and causes of androgen-mediated hair growth are reviewed here. […] The hair growth cycle is comprised of three phases: The growth phase (termed anagen), which varies by body area, is approximately four months for facial hair. Therefore, it takes approximately six months to detect the effects of hormonal therapy for facial hirsutism. […] The number of hair follicles does not change over an individual’s lifetime, but the follicle size and type of hair can change in response to numerous factors, particularly androgens.

• #1 Hirsutism: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/121038-overview

  Hormones and the intrinsic characteristics of the hair follicle determine the quality of hair growth. Vellus hairs are fine, lightly pigmented hairs that cover most of the body before puberty. Pubertal androgens promote the conversion of these vellus hairs to coarser, pigmented terminal hairs. The level and duration of exposure to androgens, the local 5-alpha-reductase activity, and the intrinsic sensitivity of the hair follicle to androgen action determine the extent of conversion from vellus to terminal hair. However, some terminal hair growth is androgen-independent (eg, scalp, eyebrows, lashes). […] Dihydrotestosterone is the androgen that acts on the hair follicle to produce terminal hair. This hormone is derived from both the bloodstream and local conversion of a precursor, testosterone. The local production of dihydrotestosterone is determined by 5-alpha-reductase activity in the skin. Differences in the activity of this enzyme may explain why women with the same plasma levels of testosterone can have different degrees of hirsutism.

• #1 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0215/p373.html

  Androgens, including testosterone, dihydrotestosterone, and their prohormones dehydroepiandrosterone sulfate and androstenedione, are the key factors in the growth and development of sexual hair. Androgens act on sex-specific areas of the body, converting small, straight, fair vellus hairs to larger, curlier, and darker terminal hairs. Hirsutism develops in women when there is excessive growth of terminal hair in these areas, typically due to androgen excess. […] In addition to hirsutism, hyperandrogenemia can manifest as acne, menstrual dysfunction, or alopecia, or could be asymptomatic. The severity of hirsutism is variable at a given level of androgen excess, suggesting that hirsutism is also related to the sensitivity of hair follicles to androgens.

• #1 Hirsutism, its pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2674189/

  Hirsutism can be regarded as a virilizing symptom and may be defined as a male type of body hair distribution in the female. The pathogenesis of hirsutism may be due to an increased androgen production or to an enhanced sensitivity of the hair follicles in sexual areas. […] The androgen production in the female depends upon direct secretion by the ovaries and the adrenals and upon peripheral conversion of androgen precursors and finally on the metabolic clearance rate which may be regarded as a function of androgen production. […] In hirsutism the plasma concentrations are decreased, resulting in elevated levels of free androgens. The intracellular reduction of T to 5 alpha-DHT (dihydrotestosterone) has to be considered as a basic requirement for the androgen-mediated growth of the hair follicle in sexual skin areas.

• #1 Hirsutism and Hypertrichosis – Dermatologic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/dermatologic-disorders/hair-disorders/hirsutism-and-hypertrichosis

  Hirsutism can be due to an […] Increase in circulating androgen levels […] Enhanced end organ response to androgens. Hirsutism typically results from abnormally high androgen levels as a result of increased production of androgens (eg, due to ovarian or adrenal disorders) or increased peripheral conversion of testosterone to DHT by 5-alpha-reductase. Free androgen levels also can increase as a result of decreased production of sex hormonebinding globulin, which can occur in a variety of conditions, including hyperinsulinemia, hyperprolactinemia, and in androgen excess itself. However, the severity of hirsutism does not correlate with the level of circulating androgens because of individual differences in androgen sensitivity of the hair follicle. […] Hirsutism also may be the result of increased end-organ response to normal plasma levels of androgens and manifest as a familial phenomenon in people of Mediterranean, South Asian, or Middle Eastern ancestry. […] When caused by increased androgen levels, hirsutism is often accompanied by virilization, which may manifest as loss of menses, increased muscle mass, voice deepening, acne, androgenetic alopecia, and clitoromegaly.

• #1 Hirsutism 2021 | PPT

  https://www.slideshare.net/elnashar/hirsutism-2021

  3. PATHOGENESIS Hirsutism An increase in 4 1. Androgen production 2. Sensitivity of the androgen receptors at the level of the hair follicle. 3. Activity of 5-reductase. 4. Transformation of the vellus to terminal hair. {Androgens will convert lanugo vellus hair to terminal hair}. Not an increase in Number of hair follicles but an alteration in their character. […] The majority of hirsutism is due to androgen excess (80%), and the majority of women with hirsutism (70% to 80%) have PCOS […] It is unclear whether idiopathic hirsutism is due to Altered androgen mechanism of action within the hair follicle (referred to as cutaneous hyperandrogenism) or to other alterations in hair biology.

• #1 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  Hirsutism reflects the interaction between circulating androgen concentrations, local androgen concentrations, and the sensitivity of the hair follicle to androgens. […] The causes of hirsutism may be divided into androgenic factors, non-androgenic factors, and idiophatic hirsutism. Non-androgenic factors are relatively rare, while androgenic causes account for more than 80% of patients, and include polycystic ovary syndrome (PCOS), which affects about 70-80% of hirsute women. […] Hirsutism must be distinguished from hypertrichosis, which is characterized by increased hair growth in a generalized nonsexual distribution and is independent of androgens. […] Despite this, androgens may aggravate the problem. […] Hirsutism reflects the interaction between circulating androgen concentrations, local androgen concentrations, and the sensitivity of the hair follicle to androgens.

• #1 Hirsutism – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hirsutism/symptoms-causes/syc-20354935

  Hirsutism is excess hair most often noticeable around the mouth and chin. […] With hirsutism, extra hair growth often arises from excess male hormones (androgens), primarily testosterone. […] Hirsutism may be caused by: Polycystic ovary syndrome (PCOS). This condition, which often begins with puberty, causes an imbalance of sex hormones. Over years, polycystic ovary syndrome (PCOS) may slowly result in excess hair growth, irregular periods, obesity, infertility and sometimes multiple cysts on the ovaries. […] Cushing syndrome. This occurs when your body is exposed to high levels of the hormone cortisol. It can develop from your adrenal glands making too much cortisol or from taking medications such as prednisone over a long period. […] Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.

• #1 Hirsutism – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK470417/

  Hirsutism is an androgen-dependent disorder resulting from the interaction between circulating androgen levels and the sensitivity of the hair follicle to androgens. […] After exclusion of an exogenous intake of androgens, hirsutism results either from hypersecretion of androgens, from the ovary or the adrenal gland, or the increased cutaneous sensitivity of the skin to normal circulating levels of androgens. This last case is „idiopathic hirsutism.” […] The diagnosis of idiopathic hirsutism is a diagnosis of exclusion. Approximately 15% to 50% of women suffering from hirsutism belong to this category. Its pathogenesis is then parallel to that of primary androgenetic alopecia.

• #1 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  Hirsutism, which is characterized by excessive growth of terminal hair in a male pattern, may result from various causes including polycystic ovary syndrome (PCOS), non-classic congenital adrenal hyperplasia, adrenal or ovarian tumors or it may be idiopathic. […] The pathogenesis of idiopathic hirsutism is not clear. The androgens are the main hormones to stimulate growth of body hair, therefore, there should be any form of increased androgen effect irrespective of normal serum androgen levels in any patient with hirsutism. […] In accordance to this scientific truth, we have previously shown that, although within normal limits, patients with idiopathic hirsutism have relatively higher serum androgen levels (relative hyperandrogenemia) in comparison to healthy subjects which let as to think that is idiopathic hirsutism really idiopathic?

• #1 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  The severity of hirsutism correlates poorly with the severity of androgen excess. […] It happens, as previously mentioned, because hirsutism not only reflects circulating androgen levels, but it is also influenced by the peripheral metabolism of androgens, by the sensitivity of the target tissues to androgens, and by other hormonal variables, such as insulin resistance. […] Idiopatic hirsutism is defined as hirsutism in patients with regular ovulation and normal androgen levels. […] Some authors try to explain idiopatic hirsutism by an increased peripheral conversion of testosterone to dihydrotestosterone by 5-alpha-reductase and/or a change in the androgen receptor function. […] PCOS is the most common cause of hirsutism, accounting for 72 to 82 percent of all cases and affecting 4 to 12 percent of reproductive-age women. […] CAH accounts for 2 to 4 percent of the cases of hirsutism. […] Androgen-secreting tumors account for only 0.2 per cent of hirsutism cases. […] Other endocrinopathies are less common causes of hirsutism.

• #1 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  In addition to relative hyperandrogenemia, we have previously shown that, in comparison to healthy subjects, women with idiopathic hirsutism demonstrated higher expression of steroid sulphatase and 17-beta hydroxysteroid dehydrogenase mRNA both in the subumbilical region and arm skin, which contributes to local androgen metabolism. […] Those results support the idea that, in some patients, although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia, pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction. […] Upon the demonstration of relative hyperandrogenemia and possible increase in local androgen synthesis in patients with idiopathic hirsutism, we think that idiopathic hirsutism is not idiopathic and it may be named as normoandrogenic hirsutism.

• #1 Polycystic Ovarian Syndrome: Insights Into Pathogenesis, Diagnosi

  https://www.openaccessjournals.com/articles/polycystic-ovarian-syndrome-insights-into-pathogenesis-diagnosis-prognosis-pharmacological-and-nonpharmacological-treatment.html

  Polycystic ovaries develop when the ovaries are stimulated to produce excessive amounts of male hormones (androgens), particularly testosterone, by either the release of excessive luteinizing hormone by the anterior pituitary gland, high levels of insulin in the blood (hyperinsulinaemia) in women whose ovaries are sensitive to this stimulus or reduced levels of sexhormone binding globulin (SHBG) resulting in increased free androgens. […] Hyperinsulinemia increases GnRH pulse frequency, LH over FSH dominance, increased ovarian androgen production, decreased follicular maturation and decreased SHBG binding. All these factors contribute to the development of PCOS. […] Adipose tissue possesses aromatase, an enzyme that converts androstenedione to estrone and testosterone to estradiol. The excess of adipose tissue in obese patients causes them to have both excess androgens (which are responsible for hirsutism and virilization) and estrogens (which inhibit FSH via negative feedback). […] PCOS is characterized by a complex positive feedback of insulin resistance and hyperandrogenism. In most cases, it can not be determined which of those two should be regarded to be the causative agent.

• #1 Hirsutism pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hirsutism_pathophysiology

  DHT is a hormone that acts on the hair follicle to produce terminal hair. […] Differences in the activity of DHT explains why women with the same plasma level testosterone, have different degrees of hirsutism. […] It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. […] There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells resulting in increased androgen production.

• #1 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  By definition, although idiopathic hirsutism is characterized by normal serum androgen levels, those patients exhibit hirsutism and in the presence of scientific data/evidences on relative hyperandrogenemia, increased local androgen production, insulin resistance (although not universal), AR polymorphism and increased DHT production we think that idiopathic hirsutism is misnomer and it is not actually idiopathic.

• #1

  https://link.springer.com/article/10.1007/s10787-025-01691-4

  Excessively high levels of androgens may cause hirsutism in women. […] The multifactorial etiology of hormonal causes underlines the importance of a full hormonal work-up and individualized treatment based on patient response. […] Genetic constitution also tends to play an important role in determining susceptibility to both hirsutism and hypertrichosis. […] Insulin resistance plays a very critical role in the pathogenesis of hirsutism and hypertrichosis, mostly in PCOS sufferers. […] The changes in sensitivity of hair follicles to androgens are the most important modifications for understanding the pathogenesis of hirsutism and hypertrichosis. […] Variations in their number and activity account for wide differences in the hair growth patterns among individuals. […] The interaction between hormonal, genetic, environmental, and lifestyle factors must be understood in order to achieve a proper diagnosis and management of hirsutism and hypertrichosis.

• #1 Hirsutism – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/hirsutism/

  Hirsutism arising from elevated androgens as a result of a tumor or functional endocrinologic disorder of the ovaries or adrenals have their own specific comorbidities that need to be taken into consideration. […] The medical treatments are directed at decreasing the androgen availability to exert negative effects on the hair follicle. These include suppression of ovarian androgen production with oral contraceptives, androgen receptor blockade with spironolactone, flutamide, or cyproterone acetate, and inhibition of 5-alpha reductase activity with finasteride. […] Patients with FOH are underdiagnosed when screening is limited to a total testosterone. These women often have subtle laboratory abnormalities demonstrating a normal total testosterone (usually high end of normal), but an elevated free testosterone and low sex-hormone-binding globulin.

• #1 Hirsutism | Endocrine Society

  https://www.endocrine.org/patient-engagement/endocrine-library/hirsutism

  Hirsutism is common and is usually a sign of an underlying endocrine disorder, most commonly polycystic ovary syndrome (PCOS). […] Elevated levels of androgens can cause fine, vellous hair follicles to produce larger, darker terminal hair, which leads to hirsutism. […] Sometimes women who appear to have PCOS actually have an adrenal gland problem called non-classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency, or NCCAH. […] Hirsutism may be caused by other disorders of male hormone overproduction, but these are not common. […] The diagnosis of idiopathic hirsutism is sometimes given to women with hirsutism, but normal menstrual cycles, normal levels of androgens, and no obvious cause for the hirsutism. […] Some experts think that these women most likely have PCOS without all of the usual signs and symptoms. […] Most women start with an oral contraceptive (birth control pill) and if they are not pleased with the improvement after six months, a second medication called an antiandrogen can be added. […] Some studies have found weight loss is associated with slight improvement in unwanted hair growth.

• #1 Hirsutism – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/hirsutism/

  Hirsutism should be suspected when there is an excessive amount of terminal hair growth on a womans body. This hair growth occurs in androgen-sensitive sites, the most common of which are the chin sideburns, above the upper lip, and chest. […] The diagnosis is generally made clinically. A detailed history and physical examination often provide sufficient information to exclude pathologic causes of hirsutism. […] In most cases laboratory studies are unremarkable, and the diagnosis is one of exclusion, so-called idiopathic hirsutism. But in a subset of women the hirsutism may be a marker of underlying pathology including an androgen-producing tumor of the ovary or adrenal glands, functional ovarian hyperandrogenism (FOH) formerly called polycystic ovarian syndrome or late-onset congenital adrenal hyperplasia (LOCAH).

• #1 Hirsutism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hirsutism/diagnosis-treatment/drc-20354941

  Tests that measure the amount of certain hormones in your blood, including testosterone or testosterone-like hormones, might help determine whether elevated androgen levels are causing your hirsutism. […] The most commonly used anti-androgen for treating hirsutism is spironolactone (Aldactone, CaroSpir). The results are modest and take at least six months to be noticeable. […] Oral contraceptives are a common treatment for hirsutism in women who don’t want to become pregnant. Possible side effects include nausea and headache. […] These types of drugs block androgens from attaching to their receptors in your body. They’re sometimes prescribed after six months on oral contraceptives if the oral contraceptives aren’t effective enough.

• #1 Hirsutism

  https://www.medscape.org/viewarticle/572621

  Hirsutism is defined as the excessive growth of terminal hair on the face and body of a female in a typical male pattern distribution. […] Hyperandrogenemia is the key trigger for excess hair growth. Polycystic ovary syndrome and idiopathic hirsutism are the most common cause of hirsutism. […] A raised serum testosterone level of 150 ng/dl (5.2 nmol/l) should prompt further investigations to exclude an underlying androgen-secreting tumour. […] The current review discusses definition, pathogenesis, differential diagnosis, diagnostic strategies, management, guidelines and the authors recommendations about hirsutism.

• #1 Hirsutism | GLOWM

  https://www.glowm.com/section-view/heading/Hirsutism/item/301

  Hirsutism is the presence of terminal (coarse) hairs in females in a male-like pattern; it affects between 5% and 15% of women surveyed. This chapter outlines the normal metabolism of androgens; the physiology and pathophysiology of hair growth; and the differential diagnosis, workup, and treatment of the hirsute patient. Androgens are C19 steroids that are derived from cholesterol and secreted by the adrenal cortex and ovaries. Principal circulating androgens include testosterone (T) and its 5-reduced metabolite dihydrotestosterone (DHT), androstenedione (A4), and dehydroepiandrosterone (DHA) and its metabolite dehydroepiandrosterone sulfate (DHEAS). Androgens act through a specific cytoplasmic/nuclear intracellular receptor. In adult women, T originates approximately 25% from the ovary, 25% from the adrenal, and 50% from the peripheral conversion of A4. T and A4 are also metabolized to DHT, a potent androgen, through the action of 5-reductase in the liver and skin. The increased clearance is caused, in part, by an obesity-related decrease in SHBG, which leads to higher levels of rapidly metabolizable free T and DHT. Androgens are the most important determinant of the type and distribution of hairs throughout the body. Circulating androgens, particularly T and A4, are converted in the hair follicle to DHT through the action of 5-reductase. DHT then acts on the dermal papilla of androgen-sensitive hair follicles and sebaceous glands to increase the growth rate and thickness of terminal hairs and sebum production, respectively. The effect of androgens on the hair follicle depends on whether the hair follicle is sensitive to these hormones. Terminal hair growth in these areas is characteristically masculine and, if present in women, is considered hirsutism. Hirsutism is the presence of terminal (coarse) hairs in females in a male-like pattern. Excessive growth of coarse hairs of the lower forearms and lower legs alone does not constitute hirsutism. Although hirsutism usually is obvious, it is important to standardize the examination for future reference by use of a scoring system. Not all hyperandrogenic women demonstrate hirsutism, such as Asian women. The differential diagnoses of hirsutism can be divided into those causes that are independent of excessive androgen action, those that are related to excessive production or ingestion of androgens, and idiopathic hirsutism (IH), which is presumed to occur in response to the excessive peripheral utilization of androgens. The primary goal of hormonal therapy is to stop the progression of hirsutism. Hormonal therapy may also decrease the growth rate, diameter, and pigmentation of terminal hairs that are already present.

• #1 Hirsutism and Polycystic Ovary Syndrome (PCOS) patient education booklet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/hirsutism-and-polycystic-ovary-syndrome-pcos/

  Hormonal treatment frequently is successful in temporarily correcting the problems associated with PCOS. If treatment is stopped, however, symptoms usually reappear. […] If you are diagnosed with PCOS, treatment will depend upon your goals. Some patients may be concerned primarily with fertility, while others are more concerned about menstrual cycle regulation, hirsutism, or acne.

• #2 Hirsutism | Treatment & Management | Point of Care

  https://www.statpearls.com/point-of-care/22904

  Hirsutism is an androgen-dependent disorder resulting from the interaction between circulating androgen levels and the sensitivity of the hair follicle to androgens. […] After exclusion of an exogenous intake of androgens, hirsutism results either from hypersecretion of androgens, from the ovary or the adrenal gland, or the increased cutaneous sensitivity of the skin to normal circulating levels of androgens. […] The pathogenesis is then parallel to that of primary androgenetic alopecia.

• #2 Hirsutism | PPT

  https://www.slideshare.net/slideshow/hirsutism-231290101/231290101

  1. Hirsutism; Excessive growth of androjen dependent sexual hair. (face, arms, legs, or chest) Virilism; Severe state ( clitoromegaly, deepening of the voice, temporal alopesi, changes in body habitus) […] […] 2. Hair growth is cyclic; 1. Anagen ( growth) 2. Catagen (rapid involution) 3. Telogen (inactivity) each hair follicle has it own growth cycle […] […] 3. Physiology of Androgens -Limiting step p450c17 gene expression -depending on LH / ACTH Production: ovary / adrenal / peripheral * Ovary: LH theca cell androstenedion DHEA testosterone FSH granulosa cell aromatize estogens […] […] 4. Etiology A- OVARIAN DISORDERS Nonneoplastic – PCO syndrome – Stromal hyperplasia – Stromal hyperthecosis – HAIR-AN […] […] 5. Etiology B- ADRENAL DSORDERS Enzyme deficiencies – Congenital adrenal hyperplasia – Neoplastic – Cushing syndrome: * adrenal tm * nonpituitar ACTH * pituitar ACTH – Hyperprolactinemia: PRL binds to its receptors on adrenal gland result with adrenal stimulation […]

• #2 Hirsutism: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/121038-overview

  Hormones and the intrinsic characteristics of the hair follicle determine the quality of hair growth. Vellus hairs are fine, lightly pigmented hairs that cover most of the body before puberty. Pubertal androgens promote the conversion of these vellus hairs to coarser, pigmented terminal hairs. The level and duration of exposure to androgens, the local 5-alpha-reductase activity, and the intrinsic sensitivity of the hair follicle to androgen action determine the extent of conversion from vellus to terminal hair. However, some terminal hair growth is androgen-independent (eg, scalp, eyebrows, lashes). […] Dihydrotestosterone is the androgen that acts on the hair follicle to produce terminal hair. This hormone is derived from both the bloodstream and local conversion of a precursor, testosterone. The local production of dihydrotestosterone is determined by 5-alpha-reductase activity in the skin. Differences in the activity of this enzyme may explain why women with the same plasma levels of testosterone can have different degrees of hirsutism.

• #2 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html

  Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. […] Hair growth is influenced by several local and systemic factors, including cytokines, growth factors, and sex steroids. […] Androgens affect hair growth broadly, and there are only a limited number of androgen-independent areas (e.g., eyelashes, eyebrows, some scalp follicles). […] Androgens have a paradoxical response on the face and scalp: stimulating beard growth and inhibiting scalp hair growth lead to androgenic alopecia (male pattern baldness). […] Polycystic ovary syndrome (PCOS) is the most common cause of hirsutism, accounting for more than 70% of cases. […] Hyperinsulinemia affects more than one-half of women with PCOS, triggering an increase in gonadotropin-releasing hormone pulse frequency. The subsequent increase in gonadotropin-releasing hormones triggers increased production of ovarian and adrenal androgens while the production of sex hormone-binding globulin in the liver decreases, resulting in an increased amount of biologically active free testosterone in the serum.

• #2 Hirsutism, its pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2674189/

  Hirsutism can be regarded as a virilizing symptom and may be defined as a male type of body hair distribution in the female. The pathogenesis of hirsutism may be due to an increased androgen production or to an enhanced sensitivity of the hair follicles in sexual areas. […] The androgen production in the female depends upon direct secretion by the ovaries and the adrenals and upon peripheral conversion of androgen precursors and finally on the metabolic clearance rate which may be regarded as a function of androgen production. […] In hirsutism the plasma concentrations are decreased, resulting in elevated levels of free androgens. The intracellular reduction of T to 5 alpha-DHT (dihydrotestosterone) has to be considered as a basic requirement for the androgen-mediated growth of the hair follicle in sexual skin areas.

• #2 Hirsutism pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hirsutism_pathophysiology

  DHT is a hormone that acts on the hair follicle to produce terminal hair. […] Differences in the activity of DHT explains why women with the same plasma level testosterone, have different degrees of hirsutism. […] It is speculated that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens. […] There may also be an effect of high levels of insulin to activate the insulin-like growth factor-I (IGF-1) receptor in those same cells resulting in increased androgen production.

• #2 Hirsutism, its pathogenesis – PubMed

  https://pubmed.ncbi.nlm.nih.gov/2674189/

  In patients suffering from hirsutism, the conversion rate of T to 5 alpha-DHT is significantly increased, almost reaching male levels. […] The elucidation of its complex pathogenesis is still incomplete; however, the information available so far provides a reasonable basis for further diagnostic and therapeutic approaches.

• #2 Idiopathic Hirsutism | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-642-81571-3_11

  Based on the androgen action mechanism (Fig. 23), hirsutism may result from two factors: (1) an oversecretion of virilizing androgens either from the ovaries or the adrenal glands, or (2) a hypersensitivity of the target cells in the skin to circulating androgens, that is, idiopathic hirsutism.

• #2 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2012/0215/p373.html

  Androgens, including testosterone, dihydrotestosterone, and their prohormones dehydroepiandrosterone sulfate and androstenedione, are the key factors in the growth and development of sexual hair. Androgens act on sex-specific areas of the body, converting small, straight, fair vellus hairs to larger, curlier, and darker terminal hairs. Hirsutism develops in women when there is excessive growth of terminal hair in these areas, typically due to androgen excess. […] In addition to hirsutism, hyperandrogenemia can manifest as acne, menstrual dysfunction, or alopecia, or could be asymptomatic. The severity of hirsutism is variable at a given level of androgen excess, suggesting that hirsutism is also related to the sensitivity of hair follicles to androgens.

• #2 Hirsutism – Symptoms & causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hirsutism/symptoms-causes/syc-20354935

  Tumors. Rarely, an androgen-secreting tumor in the ovaries or adrenal glands can cause hirsutism. […] Medications. Some medications can cause hirsutism. These include minoxidil (Minoxidil, Rogaine); danazol, which is used to treat women with endometriosis; testosterone (Androgel, Testim); and dehydroepiandrosterone (DHEA). If your partner uses topical products containing androgens, you can be affected as well, through skin-to-skin contact. […] Often hirsutism occurs with no identifiable cause.

• #2 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  The severity of hirsutism correlates poorly with the severity of androgen excess. […] It happens, as previously mentioned, because hirsutism not only reflects circulating androgen levels, but it is also influenced by the peripheral metabolism of androgens, by the sensitivity of the target tissues to androgens, and by other hormonal variables, such as insulin resistance. […] Idiopatic hirsutism is defined as hirsutism in patients with regular ovulation and normal androgen levels. […] Some authors try to explain idiopatic hirsutism by an increased peripheral conversion of testosterone to dihydrotestosterone by 5-alpha-reductase and/or a change in the androgen receptor function. […] PCOS is the most common cause of hirsutism, accounting for 72 to 82 percent of all cases and affecting 4 to 12 percent of reproductive-age women. […] CAH accounts for 2 to 4 percent of the cases of hirsutism. […] Androgen-secreting tumors account for only 0.2 per cent of hirsutism cases. […] Other endocrinopathies are less common causes of hirsutism.

• #2 Hair manifestations of endocrine diseases: A brief review – Indian Journal of Dermatology, Venereology and Leprology

  https://ijdvl.com/hair-manifestations-of-endocrine-diseases-a-brief-review/

  Hirsutism, a clinical sign for hyperandrogenemia, is a frequent reason of cosmetic embarrassment, poor self-esteem, and psychological distress for women world over. […] Hirsutism is a manifestation of increased action of androgens at the hair follicle. Hirsutism is observed in 70-80% of patients with hyperandrogenemia and in turn, 70-80% of hirsute patients have hyperandrogenemia. The most common cause of hirsutism is polycystic ovarian syndrome, accounting for 70% of cases. […] Increase level of circulating androgens in hyperandrogenemic states stimulates the differentiation of androgen dependent vellus hair into terminal hair. Various other mechanisms postulated in idiopathic hirsutism are exaggerated peripheral 5 reductase activity, androgen receptor polymorphism, altered androgen metabolism, insulin resistance, decreased sex hormone binding globulin levels, and lower aromatase levels.

• #2 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  Furthermore, it may not be a different entity but may be an early stage of hyperandrogenic disorders such as PCOS. […] Although huge number of studies have been performed for the pathogenesis of PCOS, only limited number of investigations exist regarding the pathogenesis of idiopathic hirsutism. […] The current diagnosis of idiopathic hirsutism relies on normal serum androgen levels which are almost determined by immunoassays. […] All those results support the idea that, in some patients, although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia, pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction. […] Thus, patients with idiopathic hirsutism may have an increased androgen synthesis within the skin tissue so, calling those patients as idiopathic is misnomer.

• #2 Hirsutism and Polycystic Ovary Syndrome (PCOS) patient education booklet | ReproductiveFacts.org

  https://www.reproductivefacts.org/news-and-publications/fact-sheets-and-infographics/hirsutism-and-polycystic-ovary-syndrome-pcos/

  Some women are born with insulin resistance, a defect in the ability of insulin to control blood sugar levels. To compensate, the pancreas produces more insulin. Excessively high levels of insulin stimulate the ovaries to dramatically overproduce androgens, leading to hirsutism, acne, and irregular ovulation. […] Cushing syndrome refers to overproduction of cortisol by the adrenal glands. Although hirsutism may be seen in Cushing syndrome patients, it is not the primary feature of the disorder. […] Around the time of menopause, the ovaries stop producing estrogen but continue to produce androgens. The decreased levels of estrogen may allow the androgens to have a greater impact, leading to an increase in the number of dark terminal hairs, especially on the face. […] Drugs with characteristics of androgens may cause hirsutism. Anabolic steroids, used for increasing the muscle mass of chronically ill and debilitated people and by some bodybuilders, are chemically related to androgens. Other medications associated with increased hair growth include danazol, phenytoin, minoxidil, and diazoxide.

• #2 The Role of Probiotics and Synbiotics on Hirsutism

  https://www.mdpi.com/2311-5637/7/1/10

  Consequently, both effects of IR are directly linked with hirsutism through excess androgen production. […] This study showed that the exposure of these cells to testosterone led to insulin resistance, suggesting there is a link between hirsutism, androgen presence and insulin resistance development. […] Potential causes of IH include increased sensitivity of hair follicles to androgens, and androgen receptor gene polymorphism. […] Hirsutism treatments are usually combinational treatments, and they include peripheral androgen blockage, androgen suppression and cosmetic intervention. […] Current drug therapies for hirsutism include androgen suppression and peripheral androgen blockage, also known as anti-androgens. […] The effect of probiotics and synbiotics on hirsutism has been studied, with findings suggesting that probiotics can decrease the production of androgens, and specifically total testosterone, and improve m-FG scoring on hirsute women, increasing the levels of SHBG that bind and regulate free testosterone. […] Moreover, synbiotics are shown to have a similar effect with probiotics but more enhanced. […] Therefore, it is suggested that a combination of probiotics and prebiotics can improve and help on the management of hirsutism and other conditions.

• #2 Levels of a novel metabolic marker, spexin in patients with hirsutism: metabolic syndrome risk in idiopathic and polycystic ovarian syndrome (PCOS) hirsutism | Atakul | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/96191

  The positive association of TT in hirsutism patients in our study suggested that spexin could interfere with androgenic hormone synthesis and spexin’s interaction with the central nervous system suggests a possible influence on the hypothalamic-pituitary-adrenal axis and other hormonal axes involved in hair growth regulation. […] An alteration in androgen receptor function most commonly associated with IH but also with possible underlying adrenal/ovarian dysfunction should not be overlooked. […] However, lower spexin levels in IH showed that, as demonstrated by only a few studies, IH also possesses a higher risk of metabolic syndrome. […] The correlation of spexin levels with lipid parameters has resulted in conflicting data. […] Proposed mechanisms may involve spexin-mediated effects on lipid synthesis, storage, and metabolism, as well as interactions with other metabolic pathways implicated in dyslipidemia. […] Both IH and PCOS hirsutism patients have an increased risk of metabolic syndrome; hyperandrogenemia and dyslipidemia contribute to the development of future T2DM and CVD risk.

• #2 Hirsutism – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/hirsutism/

  Androgens are significantly associated with hair growth modulation including the transformation of a vellus hair to a terminal hair resulting in hirsutism. The severity of hirsutism does not correlate with androgen level because the hair follicles sensitivity to androgen stimulus varies considerably within and among women. […] Testosterone, derived from adrenal glands, ovaries, as well as the peripheral conversion of androgen precursors, is a critical circulating hormone impacting hair growth. […] An increase in 5-alpha-reductase activity has been demonstrated in women with a diagnosis of idiopathic hirsutism who have normal circulating androgen levels. […] In some instances, obesity directly contributes to the hirsutism due to increased production of androgens and/or decreased sex-hormone-binding globulin; weight reduction can improve the condition.

• #2 Hirsutism – Dermatology Advisor

  https://www.dermatologyadvisor.com/home/decision-support-in-medicine/dermatology/hirsutism/

  Hirsutism arising from elevated androgens as a result of a tumor or functional endocrinologic disorder of the ovaries or adrenals have their own specific comorbidities that need to be taken into consideration. […] The medical treatments are directed at decreasing the androgen availability to exert negative effects on the hair follicle. These include suppression of ovarian androgen production with oral contraceptives, androgen receptor blockade with spironolactone, flutamide, or cyproterone acetate, and inhibition of 5-alpha reductase activity with finasteride. […] Patients with FOH are underdiagnosed when screening is limited to a total testosterone. These women often have subtle laboratory abnormalities demonstrating a normal total testosterone (usually high end of normal), but an elevated free testosterone and low sex-hormone-binding globulin.

• #2 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Congenital adrenal hyperplasia (CAH). […] Cushing’s syndrome. […] Other causes include severe insulin resistance, anorexia nervosa, prolactinoma, acromegaly, hypothyroidism and porphyria. […] The task is then to establish whether the hirsutism is androgen-mediated and if so, the cause of excess androgen. […] Further investigations for hyperandrogesteronism will depend on the clinical picture and may need to take place in secondary care. […] Testosterone: If the total testosterone is raised, further investigations for androgen excess should be conducted. […] If free testosterone is elevated, further investigations for androgen excess should be conducted. […] Treatment for hirsutism is unnecessary if no abnormal aetiology can be diagnosed and if the patient is not concerned about the cosmetic appearance. Management is mainly directed at any underlying cause if present.

• #2 Hirsutism: diagnosis and treatment – Archives of Endocrinology and Metabolism

  https://www.aem-sbem.com/article/hirsutism-diagnosis-and-treatment/

  Hirsutism reflects the interaction between circulating androgen concentrations, local androgen concentrations, and the sensitivity of the hair follicle to androgens. […] Treatment of hirsutism should be based on the degree of excess hair growth presented by the patient and in the pathophysiology of the disorder. […] The current review discusses denition, pathogenesis, physiopathology, differential diagnosis, diagnostic strategies, and treatment.

• #2 Hirsutism – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/hirsutism/diagnosis-treatment/drc-20354941

  Tests that measure the amount of certain hormones in your blood, including testosterone or testosterone-like hormones, might help determine whether elevated androgen levels are causing your hirsutism. […] The most commonly used anti-androgen for treating hirsutism is spironolactone (Aldactone, CaroSpir). The results are modest and take at least six months to be noticeable. […] Oral contraceptives are a common treatment for hirsutism in women who don’t want to become pregnant. Possible side effects include nausea and headache. […] These types of drugs block androgens from attaching to their receptors in your body. They’re sometimes prescribed after six months on oral contraceptives if the oral contraceptives aren’t effective enough.

• #2 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  By definition, although idiopathic hirsutism is characterized by normal serum androgen levels, those patients exhibit hirsutism and in the presence of scientific data/evidences on relative hyperandrogenemia, increased local androgen production, insulin resistance (although not universal), AR polymorphism and increased DHT production we think that idiopathic hirsutism is misnomer and it is not actually idiopathic.

• #3 Hirsutism pathophysiology – wikidoc

  https://www.wikidoc.org/index.php/Hirsutism_pathophysiology

  The growth of hair on sex-specific areas of the body occurs due to androgens. Androgens stimulate the growth of vellus follicles in sex-specific areas to develop into terminal hairs, which are larger and have increased pigmentation (darker). […] The growth of sexual hair is dependent on the presence of androgens. […] Hirsutism is caused by increased androgen production and/or an increased sensitivity of the hair follicles to androgens. […] Hyperandrogenism, resulting from any factors, prolongs the anagen(growth) phase of androgen-sensitive hairs, resulting in their conversion from fine, light, vellus hairs to coarse, dark, terminal hairs. […] The response of hair follicle to androgens and other factors such as local 5 alpha-reductase activity determines the level of conversion of hair from the vellus type to terminal hair.

• #3 SciELO Brazil – Hirsutism: diagnosis and treatment Hirsutism: diagnosis and treatment

  https://www.scielo.br/j/abem/a/t5GTrmpRNGJ7nDzYkqwtmpL/

  The severity of hirsutism correlates poorly with the severity of androgen excess. […] It happens, as previously mentioned, because hirsutism not only reflects circulating androgen levels, but it is also influenced by the peripheral metabolism of androgens, by the sensitivity of the target tissues to androgens, and by other hormonal variables, such as insulin resistance. […] Idiopatic hirsutism is defined as hirsutism in patients with regular ovulation and normal androgen levels. […] Some authors try to explain idiopatic hirsutism by an increased peripheral conversion of testosterone to dihydrotestosterone by 5-alpha-reductase and/or a change in the androgen receptor function. […] PCOS is the most common cause of hirsutism, accounting for 72 to 82 percent of all cases and affecting 4 to 12 percent of reproductive-age women. […] CAH accounts for 2 to 4 percent of the cases of hirsutism. […] Androgen-secreting tumors account for only 0.2 per cent of hirsutism cases. […] Other endocrinopathies are less common causes of hirsutism.

• #3 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html

  Hirsutism is the excessive growth of terminal hair in a typical male pattern in a female. It is often a sign of excessive androgen levels. […] Hair growth is influenced by several local and systemic factors, including cytokines, growth factors, and sex steroids. […] Androgens affect hair growth broadly, and there are only a limited number of androgen-independent areas (e.g., eyelashes, eyebrows, some scalp follicles). […] Androgens have a paradoxical response on the face and scalp: stimulating beard growth and inhibiting scalp hair growth lead to androgenic alopecia (male pattern baldness). […] Polycystic ovary syndrome (PCOS) is the most common cause of hirsutism, accounting for more than 70% of cases. […] Hyperinsulinemia affects more than one-half of women with PCOS, triggering an increase in gonadotropin-releasing hormone pulse frequency. The subsequent increase in gonadotropin-releasing hormones triggers increased production of ovarian and adrenal androgens while the production of sex hormone-binding globulin in the liver decreases, resulting in an increased amount of biologically active free testosterone in the serum.

• #3 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  In addition to relative hyperandrogenemia, we have previously shown that, in comparison to healthy subjects, women with idiopathic hirsutism demonstrated higher expression of steroid sulphatase and 17-beta hydroxysteroid dehydrogenase mRNA both in the subumbilical region and arm skin, which contributes to local androgen metabolism. […] Those results support the idea that, in some patients, although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia, pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction. […] Upon the demonstration of relative hyperandrogenemia and possible increase in local androgen synthesis in patients with idiopathic hirsutism, we think that idiopathic hirsutism is not idiopathic and it may be named as normoandrogenic hirsutism.

• #3 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  By definition, although idiopathic hirsutism is characterized by normal serum androgen levels, those patients exhibit hirsutism and in the presence of scientific data/evidences on relative hyperandrogenemia, increased local androgen production, insulin resistance (although not universal), AR polymorphism and increased DHT production we think that idiopathic hirsutism is misnomer and it is not actually idiopathic.

• #3 Levels of a novel metabolic marker, spexin in patients with hirsutism: metabolic syndrome risk in idiopathic and polycystic ovarian syndrome (PCOS) hirsutism | Atakul | Ginekologia Polska

  https://journals.viamedica.pl/ginekologia_polska/article/view/96191

  The positive association of TT in hirsutism patients in our study suggested that spexin could interfere with androgenic hormone synthesis and spexin’s interaction with the central nervous system suggests a possible influence on the hypothalamic-pituitary-adrenal axis and other hormonal axes involved in hair growth regulation. […] An alteration in androgen receptor function most commonly associated with IH but also with possible underlying adrenal/ovarian dysfunction should not be overlooked. […] However, lower spexin levels in IH showed that, as demonstrated by only a few studies, IH also possesses a higher risk of metabolic syndrome. […] The correlation of spexin levels with lipid parameters has resulted in conflicting data. […] Proposed mechanisms may involve spexin-mediated effects on lipid synthesis, storage, and metabolism, as well as interactions with other metabolic pathways implicated in dyslipidemia. […] Both IH and PCOS hirsutism patients have an increased risk of metabolic syndrome; hyperandrogenemia and dyslipidemia contribute to the development of future T2DM and CVD risk.

• #3 Hirsutism: Causes, Symptoms, and Treatment | Doctor

  https://patient.info/doctor/hirsutism

  Weight loss increases steroid hormone-binding globulin levels and decreases insulin resistance and the levels of serum androgens and luteinising hormones. […] Anti-androgens: Flutamide, finasteride and spironolactone have all been used in the management of hirsutism. […] Metformin and other insulin-sensitisers have been shown to improve insulin sensitivity and decrease testosterone levels in patients with PCOS.

• #3 The Role of Probiotics and Synbiotics on Hirsutism

  https://www.mdpi.com/2311-5637/7/1/10

  Consequently, both effects of IR are directly linked with hirsutism through excess androgen production. […] This study showed that the exposure of these cells to testosterone led to insulin resistance, suggesting there is a link between hirsutism, androgen presence and insulin resistance development. […] Potential causes of IH include increased sensitivity of hair follicles to androgens, and androgen receptor gene polymorphism. […] Hirsutism treatments are usually combinational treatments, and they include peripheral androgen blockage, androgen suppression and cosmetic intervention. […] Current drug therapies for hirsutism include androgen suppression and peripheral androgen blockage, also known as anti-androgens. […] The effect of probiotics and synbiotics on hirsutism has been studied, with findings suggesting that probiotics can decrease the production of androgens, and specifically total testosterone, and improve m-FG scoring on hirsute women, increasing the levels of SHBG that bind and regulate free testosterone. […] Moreover, synbiotics are shown to have a similar effect with probiotics but more enhanced. […] Therefore, it is suggested that a combination of probiotics and prebiotics can improve and help on the management of hirsutism and other conditions.

• #4 Hirsutism in Women | AAFP

  https://www.aafp.org/pubs/afp/issues/2019/0801/p168.html

  Idiopathic hyperandrogenism accounts for approximately 15% of hirsutism cases. […] Adrenal hyperplasia is inherited in an autosomal recessive pattern and is due to deficiency of one of the enzymes involved in adrenal steroid hormone synthesis, causing precursors to be shunted to the androgen pathway. […] Androgen-secreting tumors are a rare cause of hirsutism, can be ovarian or adrenal in origin, and are malignant in more than 50% of cases. […] Other endocrine disorders such as hyperprolactinemia, thyroid disorders, acromegaly, and Cushing syndrome may be associated with hirsutism but rarely present with isolated hirsutism.

• #4 Idiopathic hirsutism: Is it really idiopathic or is it misnomer?

  https://www.wjgnet.com/2307-8960/full/v11/i2/292.htm

  Furthermore, it may not be a different entity but may be an early stage of hyperandrogenic disorders such as PCOS. […] Although huge number of studies have been performed for the pathogenesis of PCOS, only limited number of investigations exist regarding the pathogenesis of idiopathic hirsutism. […] The current diagnosis of idiopathic hirsutism relies on normal serum androgen levels which are almost determined by immunoassays. […] All those results support the idea that, in some patients, although the adrenals or ovaries do not secrete increased amount of androgens leading to hyperandrogenemia, pilocebaceous unit locally produce increased amount of androgens leading to hirsutism without ovulatory dysfunction. […] Thus, patients with idiopathic hirsutism may have an increased androgen synthesis within the skin tissue so, calling those patients as idiopathic is misnomer.

• #5 Hirsutism: What It Is, In Women, Causes, PCOS & Treatment

  https://my.clevelandclinic.org/health/diseases/14523-hirsutism

  Hirsutism is a condition that causes excess hair to grow on certain parts of your body. It mainly affects females. Hirsutism doesn’t have a known cause, but it’s a symptom of other conditions, including polycystic ovary syndrome. […] In many cases, hirsutism doesn’t have a known cause. But several conditions cause hirsutism, including: […] The natural production of androgens. All people have androgens, but males make more of them. If a female has high androgen levels or their hair follicles are more sensitive to androgens, they may develop hirsutism. […] Polycystic ovarian syndrome (PCOS). PCOS is a common hormonal condition that causes females to produce too many androgens. […] Postmenopause. The hormonal changes that take place in your body after menopause may lead to increased facial hair, including a mustache or whiskers.

• #5 The Role of Probiotics and Synbiotics on Hirsutism

  https://www.mdpi.com/2311-5637/7/1/10

  Consequently, both effects of IR are directly linked with hirsutism through excess androgen production. […] This study showed that the exposure of these cells to testosterone led to insulin resistance, suggesting there is a link between hirsutism, androgen presence and insulin resistance development. […] Potential causes of IH include increased sensitivity of hair follicles to androgens, and androgen receptor gene polymorphism. […] Hirsutism treatments are usually combinational treatments, and they include peripheral androgen blockage, androgen suppression and cosmetic intervention. […] Current drug therapies for hirsutism include androgen suppression and peripheral androgen blockage, also known as anti-androgens. […] The effect of probiotics and synbiotics on hirsutism has been studied, with findings suggesting that probiotics can decrease the production of androgens, and specifically total testosterone, and improve m-FG scoring on hirsute women, increasing the levels of SHBG that bind and regulate free testosterone. […] Moreover, synbiotics are shown to have a similar effect with probiotics but more enhanced. […] Therefore, it is suggested that a combination of probiotics and prebiotics can improve and help on the management of hirsutism and other conditions.

• #6 Hirsutism: What It Is, In Women, Causes, PCOS & Treatment

  https://my.clevelandclinic.org/health/diseases/14523-hirsutism

  Cushing’s syndrome. Cushing’s syndrome happens when your body has too much of the hormone cortisol, which can impact the set of organs that affect your hair, skin, nails, glands and nerves (integumentary system). […] Other conditions. If hirsutism occurs suddenly along with symptoms like a deeper voice, acne or increased muscle development, you may have a more serious condition. More serious conditions may include an adrenal gland disorder or an ovary disorder, such as congenital adrenal hyperplasia or a tumor on your adrenal glands or ovaries that produce androgen. […] Medications. Some medications can cause hirsutism, including anabolic steroids, testosterone, cyclosporine (Sandimmune), minoxidil (Rogaine), danazol (Danocrine) and phenytoin (Dilantin). […] PCOS isn’t the only cause of hirsutism. However, 70% to 80% of all people with PCOS develop hirsutism.

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