Hirsutism is the medical term for excess body or facial hair in women. It is usually caused by an increased production of a group of hormones called androgens ("male hormones") or an increased sensitivity of the skin to these hormones. Women with hirsutism have an increased production rate of testosterone and androstenedione.

Symptoms are dark coarse hair in a male sexual distribution such as on the upper lip, chin, sideburns, chest, abdomen, arms and legs. In hormonal hirsutism, these changes are accompanied by signs of virilisation such as deepening of the voice, increased muscle bulk, severe acne vulgaris, androgenetic alopecia, sterility and menstrual disturbances.

Hirsutism usually affects women of Mediterranean ancestry, Middle-Eastern women, Hispanic women and African-American women who tend to have more body hair than women from other ethnic groups. Hirsutism also seems to run in families.

Some other causes of hirsutism are:

• Altered androgen metabolism (conversion from weak to potent androgens) - this is the most common cause of hirsutism and it appears to be the result of an increased conversion in the skin of testosterone to DHT.
  
  
• Increased androgen production - either the ovary (polycystic ovarian syndrome - PCOS) or the adrenal gland (dehydroepiandrosterone sulfate - DHEA-S) can be responsible for excess androgens. The adrenal gland is less common but there are several recognized genetic instances in which the adrenal gland over produces androgens.
  
  
• Decreased androgen binding in the circulation - only free androgen is biologically active. Estrogens increase liver manufacture of SHBG. Androgens decrease it. Thus lack of estrogens can effectively increase available blood androgens. Also any ingestion of androgens by mouth will further decrease SHBG and make those ingested androgens even more available to stimulate hair growth.
  
  
• External androgens - medications such as Estratest®, danazol, anabolic steroids in some of the body building supplements and even some birth control pills containing norgestrel (e.g., Lo-Ovral®, Ovrette®) can cause increased hair growth. Even when testosterone cream is use externally there can be absorption into the blood stream which stimulates body hair growth.

A recent study has concluded that the use of Diane 35, a contraceptive pill, in combination with finasteride (Propecia) is both a safe and effective treatment for hirsutism. This could also potentially offer similar benefits for women who are suffering from Androgenetic Alopecia. Another important point to note is that the study used a 5mg dose of Finasteride which is 5 times the dose of Propecia which appeared to have no adverse effects on the women in the study.

Fertility & Sterility March 2001

Comparison of Diane 35 and Diane 35 plus finasteride in the treatment of hirsutism.

Sahin Y, Dilber S, Keleştimur F

Department of Obstetrics and Gynecology, Kayseri, Turkey

Objective: To compare the clinical efficacy and safety of the combination of Diane 35 (2 mg of cyproterone acetate, and 35 mg of ethinyl estradiol) plus finasteride (5 mg), and Diane 35 alone in the treatment of hirsutism.

Design: Prospective randomized clinical study.Setting: Outpatients in Erciyes University Medical School.

Patient(s): Forty women with hirsutism were selected.Intervention(s): For 1 year, group 1 patients (n = 20) were treated with Diane 35 alone (2 mg of cyproterone acetate and 35 mg of ethinyl estradiol) daily on days 5 to 25 of the menstrual cycle and group 2 patients (n = 20) with Diane 35 plus finasteride (5 mg daily).Main Outcome Measure(s): Hirsutism was graded at 6-month intervals using the Ferriman-Gallwey method. The basal hormone levels of total and free testosterone (T), androstenedione, DHEAS, and sex-hormone-binding globulin (SHBG) were measured by radioimmunoassay before the study. Total T, free T, SHBG, and DHEAS were also measured at 6-month intervals for 1 year. Multiscreen blood chemistry and side effects were evaluated during the treatment.

Result(s): Thirty-four patients completed the 12-month study period. A significant decrease in the hirsutism score as compared to baseline was observed after 12 months with both Diane 35 treatment (mean +/- SD, 15.62 +/- 4.89 vs. 9.75 +/- 3.97) and Diane 35 plus finasteride treatment (16.27 +/- 6.90 vs. 8.38 +/- 4.44). The percentage decreases in the hirsutism score (mean percent +/- SD) were 30.26 +/- 14.56 vs. 34.70 +/- 11.60 at 6 months, 38.09 +/- 11.46 vs. 48.14 +/- 14.27 at 12 months in the Diane 35 and the Diane 35 plus finasteride groups, respectively. The percentage reduction in the hirsutism score in the Diane 35 plus finasteride group at 12 months was greater than in the Diane 35 group (P <.05).

Conclusion(s): The percentage decrease in the hirsutism score at 12 months was higher in the Diane 35 plus finasteride group than in the Diane 35 group. We believe that Diane 35 plus finasteride is an effective and safe combination for the treatment of hirsutism.