Laser hair removal keeps us very busy. It seems everyone wants to throw away their razors and do away with shave bumps, ingrown hair, and stubble. They want their skin to be smooth and hair free. Legs, underarms, bikinis, are all popular treatment areas, but facial hair on women remains the number one area for laser hair removal. It is immensely satisfying to help someone with this embarrassing problem, and a dream come true for the sufferer.
At times we can find this hair to be especially difficult and stubborn to treat. It’s important to recognize that this problematic hair might be due to medical factors which, if untreated can continue to stimulate follicles in the area to change from fine, vellus hair to unsightly, terminal follicles. Often these factors affecting hair growth can be corrected with appropriate medical intervention. While this may prevent additional hair growth, the follicles that have already been stimulated will remain unless treated with the laser. These conditions can be caused by, or lead to serious health problems and should always be considered when treating a woman with hair growth in a male pattern distribution.
HIRSUTISM
“We are all very proud of the Ideal Image team, who for over the past 9 years has provided the highest level of service to our Guests” states Joseph Acebal, Co-Founder and Co-CEO. “The original and continued vision for this company is to be the premier laser hair removal provider in the world, and achieving over 2.5 million laser hair removal treatments is a testament to succeeding that goal. We thank the tens of thousands of Guests who have entrusted Ideal Image to help “Change Your Life Forever”, which is the Company’s motto, as we have helped our Guests feel confident about themselves and provide daily convenience in their lives.”
CAUSES
The most common medical cause of hirsutism is altered androgen metabolism. This appears to be caused by the conversion of weak androgens to potent androgens. That is exactly what happens when there is an increased conversion in the skin of testosterone to dihydrotestosterone (DHT). DHT can be a very powerful stimulator of terminal hair growth and is even more active on sebaceous glands as often evidenced by an increase in acne with this condition.
MORE CAUSES
Increased circulation in the bloodstream of free testosterone and other androgens can cause hirsutism. Testosterone is present in all women, but the presence of estrogen stimulates the production of sex hormone binding globulins (SHBG) which binds androgens rendering them inactive. While estrogen stimulates the production of SHBG in the liver, the presence of androgens decreases the production. Conditions such as menopause can decrease the presence of estrogen bringing the onset of terminal hair growth. Fat can cause an increased production of androgens. Androgens can also be ingested by mouth as well as taken in the form of certain medications.
EVEN MORE CAUSES
Finally excess androgens can be secreted in certain conditions by ovarian or adrenal gland hyper-function. This occurs in the common condition of polycystic ovarian disease (PCOS) and can also occur in the less common condition of adrenal hyperplasia. Tumors of the ovaries or adrenal glands, while very rare, can also be a cause of excess androgens. Other medical conditions can be associated with hirsutism such as Cushing syndrome, underactive thyroid, and hyperprolactinoma, a prolactin secreting tumor. Even obesity can cause hirsutism as the excess fat can indirectly result in the increased production of androgens in the ovaries and can cause an increase in hair stimulating, free androgens by altering the balance of the regulators.
MEDICAL EVALUATION
Physicians evaluating hirsutism may order blood levels of testosterone, to check out an ovarian source. They may also order levels of DHEA-S to look for an adrenal source of excess androgens. If the testosterone is over 200 an ovarian ultrasound is used to look for a functioning ovarian tumor. If DHEA-S is over 700, an MRI or CT scan is ordered to rule out an adrenal tumor. If the DHEA-S is in the range of 500 – 700, then further endocrine testing is needed to rule out adrenal hyperfunction such as hyperplasia. Thyroid hormones may be evaluated to rule out an underactive thyroid, and an ultrasound can be performed to look for evidence of polycystic ovarian disease.
If the onset of excess hair growth began in early adolescence, 17-hydroxprogesterone level may be tested to look for a condition referred to as late onset congenital hyperplasia.
While hirsutism is a common condition, many of the above conditions are rare and the physician’s clinical judgment will determine if a minimal workup versus an exhaustive workup is warranted.
TREATMENT
Treatment will be directed toward the underlying cause of the hirsutism. If the workup is normal, treatment is directed toward reducing the available free androgens in blood circulation or reducing the more potent DHT. Low dose oral contraceptive pills (OCP’s) and hormone replacement therapy can increase SHBG. Spironolactone, a diuretic, is often used for hirsutism as it acts as an antiandrogenic drug. The combination of low dose OCP’s and spironolactone at 25 to 200mg is often used to combat hirsutism. These medicines can take several months to work for this condition.
AND THEY LIVED HAPPILY EVER AFTER
Recognition and effective treatment of underlying medical problems manifesting as hirsutism could make a profound difference in a patient’s long term health. Directed treatment combined with state of the art laser hair removal will also help the patient realize their dream of becoming hair free. The take home message is that unexpected hirsutism should be evaluated by a physician and even a normal workup may warrant medications to alleviate the stimulation of unwanted hair growth and acne.
