Non-Hormonal Causes for Extra Hair Growth

Most women seeking help with removing unwanted hair will likely have Polycystic Ovary Syndrome (PCOS), a common endocrine condition that causes higher testosterone levels in women. However, there are non-hormonal causes of extra hair growth in both men and women.

Hormonal or testosterone driven extra hair growth is called hirsutism. on-hormonal extra hair growth is called hypertrichosis. Hirsutism appears in a pattern on specific areas of the body that are, by definition, driven by testosterone. These areas include the upper lip, sideburns, chin, neck, chest, lower abdomen, lower back, buttocks and inner thighs. Testosterone causes these hairs to become thicker, darker and coarser. Conversely, hypertrichosis is usually generalized extra hair growth and can involve lanugo (downy hair on a newborn), vellus (fine hair / peach fuzz) or terminal hair (thick, coarse and usually dark hair).

There are both congenital and acquired causes of hypertrichosis. Congenital causes are generally quite rare with the exception of one condition called Prepubertal Hypertrichosis. This condition presents in healthy infants and continues through childhood and adulthood. The hair growth is often present on the temples, spreading across the forehead involving the eyebrow and there is often marked hair growth on the upper back and arms. This hair growth involves the terminal hairs but is not driven by higher testosterone levels and is not associated with PCOS.

Acquired causes of hypertrichosis include mediations and some disorders. The medications that most commonly cause hypertrichosis are phenytoin, cyclosporine and minoxidil. Phenytoin is a medication that is used to control seizures in people with seizure disorder or in people that have had a brain injury to prevent a new seizure. Cyclosporine is a medicine that lowers a person’s immune response and it is sometimes given to people who have had organ transplants, rheumatoid arthritis or psoriasis. Minoxidil is a medication that can be used for severe hypertension when it is taken by mouth. When it is applied topically, as Rogaine, it is used to prevent scalp hair loss in both men and women. At the higher prescription dose of topical minoxidil, extra facial hair growth has been reported.

There are disorders that can also cause acquired hypertrichosis. Malnutrition caused by a variety of situations including anorexia and celiac disease can cause extra hair growth and is primarily found on the trunk of the body and limbs. This is thought to result from the carbohydrate restriction that occurs in these types of disorders. Other diseases that may result in generalized hair growth are liver injury, brain injury, childhood onset of hypothyroidism and HIV/AIDS.

Polycystic Ovary Syndrome (PCOS)

PCOS is a constellation of findings that stem from two hormone abnormalities, high levels of androgens (testosterone being the most common) and high levels of insulin which controls the change of sugar, starches, and other food into energy for the body to use and store. In PCOS the ovaries make more androgens than normal which then inhibits the development and release of eggs during ovulation. Many women with PCOS have too much insulin in their bodies because they have problems using it. Excess insulin increases the production of androgens also. Together, these two hormone abnormalities cause a pattern of symptoms in approximately 5- 10% of reproductive age women including:

• irregular periods
• acne
• infertility
• heart disease
• blood vessel disorders
• ovarian cysts
• weight gain
• type 2 diabetes
• male pattern baldness or thinning hair (a condition known as androgenic alopecia)
• skin tags
• hirsutism (excessive hair growth in areas of the body that are driven by testosterone)
• anxiety or depression

Both men and women make testosterone. Women make testosterone and other hormones (androgens) from both the ovaries and the adrenal glands. Similarly, hair growth at the upper lip, chin, sideburns, neck, chest, upper and lower back, lower abdomen and inner thighs is not necessarily a “male” pattern. Women grow hair in these areas, and under the influence of testosterone, hairs grow thicker, darker and coarser.

PCOS affects many systems in the body. As a woman nears menopause, many symptoms may persist even though ovarian function and hormone levels change. Excessive hair growth continues, and hair thinning / malepattern baldness gets worse. The risk of complications from PCOS such as heart attack, stroke, diabetes, and endometrial cancer increases.

If you have PCOS, you should seek help from an endocrinologist. First, it is important to diagnose PCOS early because the insulin dysregulation leads to a heightened risk of type 2 diabetes and cardiovascular disease. This risk will be more pronounced in overweight and obese women with PCOS. Second, the treatment of hirsutism should be a combination therapy. Electrolysis will work better when combined with the appropriate work up and management which includes suppression of testosterone. The effects of testosterone can be changed with medicines like birth control pills which lower testosterone levels while increasing binding proteins that make testosterone less available to affect the hair follicles. Anti-testosterone medications like spironolactone and finasteride:e are also available to help block the effect of testosterone at the hair follicles. All these medications work better when combined with electrolysis and vice versa.

There is no single test to diagnose PCOS. Your endocrinologist will take the following steps to find out if you have PCOS or if something else is causing your symptoms:

• Medica History: menstrual periods, weight changes, etc.
• Physical Exam: blood pressure, body mass index (BMI), waist size and areas of increased hair growth
• Pelvic Exam: check for enlarged / swollen ovaries or for cysts in the ovaries.
• Blood Tests: check for androgen hormone and glucose (sugar) levels
• Vaginal Ultrasound: check for ovarian cysts and thickening of the endometrium (will be thicker if periods are irregular).

Women’s Health Research National Institute of Child Health and Human Development: 1-800-370-2943
www.nichd.nih.gov/womenshealth

American Association of Clinical Endocrinologists:
904-353-7878
www.aace.com

American College of Obstetricians and Gynecologists:
202-638-5577
www.acog.org

American Society for Reproductive Medicine:
205-978-5000
www.asrm.org

International Council on Infertility Information Dissemination, Inc.:
703-379-9178
www.inciid.org

Polycystic Ovarian Syndrome Association, Inc.
www.pcosupport.org

The Hormone Foundation:
800-467-6663
www.hormone.org

Paradoxical Hypertrichosis (PH)

The popularity of laser hair removal has created a phenomenon called paradoxical hypertrichosis. Basically, lasers can promote hair growth. PH has an incidence rate from .6% to 10% (although this is probably underreported), and mostly occurs in the face and neck. All lasers and light sources have the potential to cause hair growth, especially, in people with darker skin, with dark, thick hair and with underlying hormone conditions; Although, light skinned individuals have gotten PH on their facial area as well. Further, this unwanted hair growth appears to be mostly permanent.

Oddly enough, the literature says that laser therapy (the source that caused the problem in the first place) is the treatment of choice. Several people with PH have been treated with electrolysis in this office and it has permanently removed the hair. Electrolysis is the only hair removal method approved by the FDA for permanence.