Materiały źródłowe

• #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.

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

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

  Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women, which grows in a typical male distribution pattern. […] 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 idiopathic 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 reflects the interaction between circulating androgen concentrations, local androgen concentrations, and the sensitivity of the hair follicle to androgens.

• #3 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.

• #4 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. Androgens may also be derived (not secreted) from the conversion of other steroids by the liver and some peripheral tissues (e.g. adipose tissue, muscle, skin). 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.

• #5 Hirsutism | GLOWM

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

  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. DHA, DHEAS, and A4 exhibit a circadian rhythm similar to that of cortisol, with peak serum concentrations in early morning and the nadir in late evening. DHA and A4 are much weaker androgens than are T and DHT, and under normal circumstances they have a very limited androgenic effect. […] 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 (and, to a limited extent, T, A4, and DHA) 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. Androgens also transform vellus-producing follicles to terminal hair-producing follicle, an irreversible process.

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

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

  Hirsutism is the excessive growth of thick or dark hair in women in locations that are more typical of male hair growth patterns (eg, mustache, beard, central chest, shoulders, lower abdomen, back, inner thigh). […] Hair growth depends on the balance between androgens (eg, testosterone, dehydroepiandrosterone sulfate [DHEAS], dihydrotestosterone [DHT]) and estrogens. Androgens promote thick, dark hair growth. […] 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. […] 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.

• #7 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.

• #8

  https://www.medscape.org/viewarticle/572621_3

  Before puberty, hair is vellus (small, straight, fair and non-pigmented), and the sebaceous glands in androgen-sensitive follicles are small. Sex steroids and a number of local and systemic factors can act directly and indirectly on the dermal papilla to regulate hair growth. In response to the increased levels of androgens at puberty, vellus follicles in specific areas develop into terminal hairs (larger, curlier and darker, hence more visible). Androgens increase hair follicle size, hair fibre diameter, the proportion of time terminal hairs spend in the anagen (growth) phase and sebum secretion. Therefore, not only do androgens alter the type of hair present, they will increase the oiliness of skin and hair. Androgen excess in women leads to increased hair growth in most androgen-sensitive sites, but will manifest with loss of hair in the scalp region, in part by reducing the time scalp hairs spend in anagen phase.

• #9 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. […] 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 is converted to dihydrotestosterone (DHT), an even more potent androgen affecting hair growth, within the hair follicle by 5-alpha reductase. DHT directly binds to androgen receptors, acts as a transcription factor, and promotes hair growth at androgen-sensitive sites. […] An increase in 5-alpha-reductase activitiy has been demonstrated in women with a diagnosis of idiopathic hirsutism who have normal circulating androgen levels.

• #10 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.

• #11 Hirsutism | GLOWM

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

  Androgens can be converted to estrogens in peripheral and hepatic tissue, and the excessive levels of both androgens and estrogens may alter the hypothalamic-pituitary production of gonadotropins. Furthermore, excessive androgen levels directly inhibit follicular development, which may result in the accumulation of multiple small cysts within the ovarian cortex (the so-called polycystic ovary). […] If androgen levels become extremely elevated for a substantial period, the patient’s body habitus may become masculinized, with a reduction in breast size, an increase in muscle mass and upper body fat deposition, and features of virilization. In turn, virilization includes the appearance of sagittal and frontal balding, clitoromegaly, and severe hirsutism. […] The differential diagnoses of hirsutism can be divided into those causes that are independent of excessive androgen action (i.e. nonandrogenic causes), those that are related to excessive production or ingestion of androgens (androgen causes), and idiopathic hirsutism (IH), which is presumed to occur in response to the excessive peripheral utilization of androgens.

• #12 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. Although many conditions can lead to hirsutism, polycystic ovary syndrome and idiopathic hyperandrogenism account for more than 85% of cases. […] Hirsutism is excessive growth of terminal hair in a typical male pattern in a female. It is typically a sign of excessive androgen levels. […] Hair type and distribution are dependent on androgens that cause transformation of vellus hairs to terminal hairs. Androgens affect hair growth broadly, and there are only a limited number of androgen-independent areas (e.g., eyelashes, eyebrows, some scalp follicles). […] Polycystic ovary syndrome (PCOS) is the most common cause of hirsutism, accounting for more than 70% of cases.

• #13 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/

  Hirsutism is the excessive growth of facial or body hair on women. Hirsutism is a symptom of medical disorders associated with the hormones called androgens. Polycystic ovary syndrome (PCOS), in which the ovaries produce excessive amounts of androgens, is the most common cause of hirsutism and may affect up to 10% of women. […] Excess facial and body hair is usually the result of excess androgens in your body. Androgens are present in both men and women, but men have much higher levels of biologically active androgens. In women, androgens are produced by the ovaries and the adrenal glands. […] Polycystic ovary syndrome is a condition associated with hormonal imbalances that cause the ovaries to overproduce androgens. It is a common cause of hirsutism. […] The most common cause of hirsutism is PCOS. PCOS is a term used to describe a common hormonal disorder that causes the ovaries to produce excessive amounts of androgens.

• #14 Hirsutism in Women | AAFP

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

  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. […] Idiopathic hyperandrogenism accounts for approximately 15% of hirsutism cases. It is characterized by normal menses, normal ovaries on ultrasonography, elevated androgen levels, and no secondary causes. […] 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.

• #15 EXCESSIVE HAIR GROWTH (HIRSUTISM)

  https://laivfclinic.com/excessivehairgrowth/

  Polycystic ovary syndrome (PCOS) is the most common ovarian cause of hirsutism. The syndrome presents with irregular ovulation and thus irregular menstrual cycles, increased hair growth or presence of acne, and in some cases polycystic appearing ovaries (small growing follicles not true cysts). Most cases of PCOS women are either overweight or obese and therefore have increased insulin levels, insulin resistance or diabetes. Insulin has a close association with androgenic hormone production in PCOS patients. Elevated levels of insulin are generally co-existent with elevated levels or activity of androgenic hormones, which result in increased hair growth. […] Congenital adrenal hyperplasia is the most common adrenal cause of hirsutism, although this is a rare clinical entity in an adult. The deficiency of the enzyme called 21-hydroxylase results in shifting of hormone production from 17-hydroxyprogesterone to the androgenic pathway. In severe cases, hirsutism is apparent at puberty and diagnosis is based on exclusion of other causes. It can also present in mild form in later reproductive years as well.

• #16 Hirsutism | GLOWM

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

  Nonclassic adrenal hyperplasia (NCAH) is an autosomal recessive disorder that causes symptomatic hyperandrogenemia (e.g. hirsutism, acne, oligomenorrhea) peripubertally or postpubertally, in the presence of normal female external genitalia. A defect in 21-hydroxylase (21-OH) accounts for more than 95% of all cases of NCAH. […] The hyperandrogenic-insulin resistant-acanthosis nigricans (HAIRAN) syndrome is characterized by extreme insulin resistance with secondary hyperinsulinemia and hyperandrogenism. The elevated circulating insulin concentrations act synergistically with luteinizing hormone (LH) to augment ovarian androgen production. […] Hirsutism is present in 60% to 70% of women with Cushing’s syndrome. Excessive ACTH-dependent adrenocortical function can lead to excessive adrenal androgen secretion and hyperandrogenemia.

• #17 Hirsutism in Women | AAFP

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

  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. […] Combined oral contraceptives should be used as initial therapy for hirsutism in women who are not trying to conceive. These drugs suppress luteinizing hormone secretion, which decreases ovarian androgen production. They also stimulate production of sex hormone-binding globulin, thereby lowering serum free androgen levels. […] If combined oral contraceptives are contraindicated or ineffective, the antiandrogens spironolactone, finasteride (Propecia), or dutasteride (Avodart) may be considered. […] The ornithine decarboxylase inhibitor eflornithine (Vaniqa) can be used as topical therapy for excessive facial hair.

• #18 Hirsutism: Symptoms, causes, diagnosis, and treatment

  https://www.medicalnewstoday.com/articles/182659

  Excessive hair growth in women with normal androgen levels, regular menstrual periods, and no other underlying conditions is called idiopathic hirsutism. This means that the disorder has no identifiable cause. […] Tumors of the adrenal glands, pituitary glands, and ovaries can sometimes lead to hirsutism. However, hirsutism that occurs for this reason will generally be more severe and onset more quickly than with hormonal causes.

• #19 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. […] Idiopathic hirsutism is currently defined as hirsutism associated with normal ovulatory function, normal serum androgen levels and normal ovarian morphology, however, 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?

• #20 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.

• #21 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. […] Clinically, this can be find out by following-up patients with idiopathic hirsutism prospectively. […] The pathogenesis of idiopathic hirsutism is not well known and in this review we will discuss the potential mechanisms underlying idiopathic hirsutism. […] Currently, idiopathic hirsutism is diagnosed in hirsute women who have regular ovulatory cycles, normal ovarian morphology and normal serum androgen levels. […] Since the pathogenesis of idiopathic hirsutism is not well known, in contrast to other androgen excess disorders, no clear molecular or biochemical markers exist in patients with idiopathic hirsutism. […] A brief summary regarding the pathogenesis of idiopathic hirsutism is given in Table 1.

• #22 Hirsutism | Endocrine Society

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

  Hirsutism is excessive growth of „male” pattern hair that appears on the face, back, chest, abdomen, and thighs in women. 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. When a woman has more male hormones than normal, it is most often due to PCOS. […] Hirsutism may be caused by other disorders of male hormone overproduction, but these are not common. Medications such as anabolic steroids that contain male hormones can cause hirsutism. […] Some experts think that these women most likely have PCOS without all of the usual signs and symptoms.

• #23 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.

• #24

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

  The hormonal imbalance, especially of the more important androgens like testosterone and DHEA, forms the very basic influences in the evolution of hirsutism and hypertrichosis. […] Excessively high levels of androgens may cause hirsutism in women. […] Key conditions contributing to androgen excess include PCOS, a very common endocrine disorder among women of reproductive age, generally characterized by chronic anovulation, hyperandrogenism, and polycystic ovaries. […] 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. […] The changes in sensitivity of hair follicles to androgens are the most important modifications for understanding the pathogenesis of hirsutism and hypertrichosis.

• #25 Hirsutism (Excessive Hair Growth in Women): Causes, Treatment

  https://www.healthline.com/health/excessive-or-unwanted-hair-in-women

  Hirsutism, which causes excessive facial hair growth in cisgender females, is typically caused by an increase in hormones called androgens. […] Women can develop excessive body or facial hair due to higher-than-normal levels of androgen hormones. These hormones include testosterone and androstenedione. […] If a women’s skin suddenly becomes sensitive to androgens, or her body begins to produce these hormones in excess, she can develop hirsutism. […] Polycystic ovarian syndrome (PCOS) is one common cause of hirsutism. It accounts for 85 percent of cases. […] Other forms of hormonal imbalance that can cause hirsutism include certain adrenal gland disorders. […] Excessive body or facial hair growth can also result from taking any of the following medications: anabolic steroids, which are synthetic variations of testosterone.

• #26 Hirsutism | Beacon Health System

  https://www.beaconhealthsystem.org/library/diseases-and-conditions/hirsutism?content_id=CON-20212573

  Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands. […] 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. […] 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.

• #27 Hirsutism, Normal Androgens and Diagnosis of PCOS

  https://www.mdpi.com/2075-4418/12/8/1922

  The conversion of vellus to terminal hairs is mainly stimulated by androgens, through the prolongation of the anagen stage. […] The occurrence and severity of hirsutism are also associated with the sensitivity of hair follicles to androgens. […] Previous studies have shown that the expression of the type 2 17β-HSD gene is lower in scalp hair follicles of women with hirsutism than of women without it but similar to that of men, and higher in the subumbilical region and arm skin. […] Different molecular signaling pathways are involved in the control of hair follicle growth and cycling. […] Although hirsutism reflects androgen action in the hair follicle, local factors, sensitivity to androgen, duration of exposure and local conversion of testosterone to a more potent androgen, DHT, by 5α-reductase may be more important than plasma androgen levels.

• #28 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. […] Androgens are the most significant hormones associated with hair growth modulation. […] They are necessary for terminal hair and sebaceous gland development, and cause differentiation of pilosebaceous units into either a terminal hair follicle or a sebaceous gland. […] Gene transcription is responsible for important heterogeneity in hair growth in different areas of the body that are affected by the same hormones. […] There are a lot of molecular mechanisms involved in hair growth, such as insulin growth factor-I, transforming growth factor, fibroblast growth factor, keratinocyte growth factor, bone morphogenic proteins, and wingless-type proteins.

• #29 Pathophysiology and causes of hirsutism – UpToDate

  https://www.uptodate.com/contents/pathophysiology-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.

• #30 Hirsutism | PPT

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

  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) […] Hair growth is cyclic; 1. Anagen ( growth) 2. Catagen (rapid involution) 3. Telogen (inactivity) each hair follicle has it own growth cycle […] 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 […] Etiology A- OVARIAN DISORDERS Nonneoplastic – PCO syndrome – Stromal hyperplasia – Stromal hyperthecosis – HAIR-AN […] 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

• #31 Hirsutism, Normal Androgens and Diagnosis of PCOS

  https://www.mdpi.com/2075-4418/12/8/1922

  Most women with androgen levels more than twice the upper limit of the reference range have some degree of hirsutism, but it has been demonstrated that androgen levels, measured by conventional techniques, correlate poorly with the severity of hirsutism. […] Hirsutism has a multifactorial pathogenesis that is mainly affected by androgen levels, with the sensitivity of hair follicles to androgens also playing a role in this process. […] In fact, the correlation of biochemical hyperandrogenism with hirsutism severity was found not to be as significant as expected, suggesting that there may be other factors contributing to the mechanism described above.

• #32

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

  Variations in their number and activity account for wide differences in the hair growth patterns among individuals. […] It is very important to understand these mechanisms, which will help in targeting the specific management of hormonal imbalance and the sensitivity of hair follicles for better outcomes in treatment. […] Chronic inflammation accompanying dysbiosis may have an important impact on hormonal balance and hair growth. […] 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.

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

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

  Hirsutism is defined as excessive terminal hair growth in androgen-dependent areas of the body in women, which grows in a typical male distribution pattern. […] 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 definition, pathogenesis, physiopathology, differential diagnosis, diagnostic strategies, and treatment.

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

  https://patient.info/doctor/hirsutism

  Is a diagnosis of exclusion and thought to be related to disorders in peripheral androgen activity. […] Ovarian causes: PCOS: virilisation is minimal and hirsutism is often prominent. This is the most common cause and is present in approximately 70% of cases. […] Adrenal causes: Androgen-producing adrenal tumour. […] Other causes include severe insulin resistance, anorexia nervosa, prolactinoma, acromegaly, hypothyroidism and porphyria. […] Signs of associated virilism (hyperandrogenism) may be present. […] Other abnormalities associated with excessive levels of androgen are cardiovascular disease, dyslipidaemia, glucose intolerance/insulin resistance and hypertension. […] The task is then to establish whether the hirsutism is androgen-mediated and if so, the cause of excess androgen.

• #35 Hirsutism | SpringerLink

  https://link.springer.com/chapter/10.1007/978-3-540-46911-7_17

  Hirsutism is related to hormonal factors, mainly an increase in androgen levels. […] The pituitary, the liver, ectopic hormones, certain drugs, and peripheral failure to convert androgens into estrogens may also be causes of hirsutism. […] As a general rule whenever there is hirsutism that appears abruptly and evolves quickly, one must first suspect that there is an ovarian, adrenal or pituitary tumor. […] When the hirsutism is mainly localized to the areola and the lateral surfaces of the face and neck, the androgens usually have an ovarian origin, whereas if the location is central, with a distribution from the pubic triangle to the upper abdominal area, between the breasts, to the neck and the chin, the origin is usually adrenal. […] A correct biochemical evaluation must request levels of free testosterone, 5–dihydrotestosterone (5–DHT), DHEA-S, 17–hydroxyprogesterone, -4-androstenedione, prolactin, sex hormone binding globulin (SHBG), 3–androstanediol glucuronide, and prostate-specific antigen (PSA), a marker of hyperandrogenism. […] Depending on the origin of the hirsutism, the treatment is based on antiandrogens, glucocorticosteroids, and contraceptives, in association with topical and dermato-cosmetic therapies.

• #36 Patient education: Hirsutism (excess hair growth in females) (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/hirsutism-excess-hair-growth-in-females-beyond-the-basics/print

  Antiandrogens are medications that directly decrease androgen production or block the action of androgens on the hair follicle. […] The most commonly used antiandrogen is spironolactone. Spironolactone may be recommended, in addition to the birth control pill, if excess hair growth does not improve adequately after taking a birth control pill for six months. […] Combination therapy – Over time, many females find that a multipronged approach that includes direct hair removal (such as laser), suppression of androgen production with estrogen-progestin contraceptives and androgen blockade with an antiandrogen (spironolactone) may produce the maximal reduction in bothersome hair growth.

• #37 Hirsutism | GLOWM

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

  PCOS affects approximately 4% of reproductive-aged women in the United States. The disorder is one of the most common causes of oligo-ovulatory infertility and hirsutism, and it is associated with increased risks of cardiovascular disease, type 2 DM, endometrial carcinoma, and psychosocial dysfunction. […] 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. A clinical response may not be apparent before 6 months of therapy.

• #38 Hirsutism – what causes excessive hair growth in women?

  https://www.topdoctors.co.uk/medical-articles/hirsutism-what-causes-excessive-hair-growth-in-women

  A female foetus in utero is at risk of developing feminised external genitalia if his mother is having treatment with an antiandrogen. The use of adequate contraception is therefore essential while on an antiandrogen treatment course. Additionally most antiandrogens have various side effects, some of which are potentially dangerous. […] While on antiandrogen hormonal treatment, it is beneficial to also have hair removal procedures. This provides an immediate effect while you are waiting for the long-term results of the hormone treatment. […] Although electrolysis is advertised as permanent hair removal, in many women regrowth occurs. The combination of medical therapy to remove stimulus for new hair growth with the mechanical removal of established hairs (either conventional electrolysis or laser treatment), offers the best cosmetic results. In recent years laser hair removal has revolutionised the treatment of hirsutism.

• #39 Hirsutism in Women (Excess Body Hair Growth)

  https://myhealth.umassmemorial.org/library/Encyclopedia/85,P00327

  Antiandrogen medicine. This type of medicine can reduce your body’s androgen levels. Or it may stop the effects of androgens on hair follicles. The most common type is spironolactone. The medicines can cause birth defects, so a woman must use birth control while taking them. […] Treating disorders of the pituitary gland, adrenal gland, or thyroid gland can lessen excess hair growth. […] In some women, losing weight can reduce androgen levels and cause hair growth to slow. […] Women age 30 and older have decreasing androgen levels. Hair growth may lessen over time.

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