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PCOS-Hirsuitism (Excess Body Hair)
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Elevated testosterone, a male hormone, causes thinning of the scalp hair while increasing facial hair (hirsutism) in women. * It can also cause PCOS symptoms including lowering of the voice, classic” pear shaped” body appearance, irregular (or no) ovulation, and other symptoms. Normalization of testosterone levels can often be achieved by using a combination of oral contraceptives and Aldactone. Aldactone is a diuretic and it also decreases androgen production.
All patients with hirsutism undergo a physical and laboratory examination, which includes menstrual history, evaluation of progression of hair growth, review of current medications, etc. The laboratory evaluation should include thyroid hormones, prolactin levels, fasting insulin, glucose levels, free testosterone, DHEAS and 17-hydroxprogesterone. These laboratory fertility tests are typically performed in the morning before day eight (8) of the menstrual cycle.
Hirsutism is present in approximately 25% of women and in a higher percentage of those who are infertile. Hirsuitism may signal underlying endocrine, or metabolic, abnormalities such as androgen excess and PCOS. Other signs of elevated androgens include hair loss, irregular menses, acne, Acanthosis Nigerians infection, and others. Approximately 5-15 % of women with hirsutism have no identifiable underlying cause.
Once diagnosed with hirsutism, patients are placed on individualized treatment plans that may include oral contraceptives and Aldactone. Women, who have PCOS, and elevated insulin levels, may be placed on Glucophage (metformin). Additionally, DFMO cream may be prescribed. Studies demonstrate that 60% of women using DFMO show reductions in hair growth after 8 weeks of treatment. One of the potential side effects of DFMO is skin stinging, seen in only 8% of patients. 
Medical treatment of hair growth may take up to six (6) months and other methods may include electrolysis and laser. Electrolysis requires frequent sessions that may be painful. Laser is sometimes used but it may cause skin damage and is slightly less effective than electrolysis. Laser seems to produce the best results in women with dark hair and lighter skin. We do not recommend “plucking” or “waxing” hair.
*(Note: Women taking over the counter DHEA and androstenedione may experience excess hair growth.)
Hirsuitism Treatments
Vaniqa-A cream that is applied for 4 hours twice daily may decrease hair growth after only 8 weeks of therapy.
Electrolysis- for permanent hair removal it involves insertion of sterile probes into the hair shaft followed by heat and/or chemical treatment. This necessitates frequent sessions and multiple treatments per follicle. Scarring, hypopigmentation, and skin puckering can result if not performed correctly.
Laser hair removal uses treatment principals similar to electrolysis but with quicker and more effective long-term results. The laser utilizes light to heat melanin (the pigment in the hair) so the hair and the surrounding follicle structures are damaged and destroyed, sparing the skin.
Shaving or clipping with scissors- is the fastest temporary hair removal method and will not promote hair growth.
Tweezing and waxing - the worst techniques producing thicker, darker and denser follicles. Also the skin may develop acne, ingrown hairs, folliculitis and scarring.
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