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Saturday, 1st January 2005
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Young women seeking treatment for even minimal 'male-type' hair growth need endocrine evaluation for androgen excess, especially polycystic ovary syndrome.
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LOS ANGELES (Dec. 21, 2004) ? Among women in their
child-bearing years, even minimal amounts of unwanted hair
in male-type patterns ? especially in the presence of other
subtle changes ? may be a sign of a hormonal imbalance
linked to a variety of serious side effects and medical
conditions, according to the December 2004 issue of the
American Journal of Obstetrics and Gynecology.
In a study of 188 women conducted by researchers at Cedars-Sinai
Medical Center and the University of Alabama, Birmingham (UAB), 102
subjects with minimal excess hair growth had excessive levels of
androgens, "male" hormones that normally exist in women in lesser
amounts.
"We know that excess hair growth in the male pattern in women,
which we call hirsutism, generally is a good indicator that there is
an underlying hormone imbalance. Now this relatively large study
shows that nearly 55 percent of women who have minimal unwanted hair
growth have an androgen excess-related disorder, primarily the
polycystic ovary syndrome," said Ricardo Azziz, MD, MPH, MBA, Chair
of Cedars-Sinai's Department of Obstetrics and Gynecology, Director
of the Center for Androgen-Related Disorders, and Executive Director
of the Androgen Excess Society, an international research
organization.
Among all 188 women in the study complaining of minimal unwanted
hair growth, 102 were found to have an underlying androgen excess
disorder. Ninety-four of the 102 suffered from polycystic ovary
syndrome (PCOS), a disorder characterized by numerous small cysts on
the periphery of the ovaries. Women with PCOS often struggle with
menstrual irregularities, skin problems, and excess weight and they
are at increased risk of developing Type II diabetes, hypertension
and heart disease.
Four of the study participants were diagnosed with non-classic
adrenal hyperplasia (NCAH), an adrenal gland dysfunction that often
leads to premature development of pubic hair, irregular menstrual
periods, hirsutism and severe acne, although patients with milder
forms may notice few if any symptoms. Another four patients were
found to have a multi-system disorder that stems from a long-term
excess of insulin in the bloodstream that up-regulates ovarian
secretion of androgens. Called HAIRAN (hyperandrogenic insulin
resistant acanthosis nigricans) syndrome, the disorder increases
risk of hirsutism and masculinization. It may be recognized by
characteristic thickened patches of dark skin (acanthosis nigricans)
and other symptoms.
The patient evaluations were completed between Jan. 1, 1995 and
June 30, 2002 at UAB, where Dr. Azziz served as Professor in the
Department of Obstetrics and Gynecology and in the Department of
Medicine before joining Cedars-Sinai. Participants completed a
medical history form and underwent a complete physical exam during
which they were assessed for several conditions, including the
presence of coarse hairs on the upper lip, chin and neck, chest,
upper abdomen, lower abdomen, thighs, upper arms, upper back, and
lower back.
"In our study population of women with minimal unwanted hair
growth, there were few predictors of an androgen excess disorder,"
said Dr. Azziz, now serving as Professor and Vice-Chair of the
Department of Obstetrics and Gynecology and Professor in the
Department of Medicine at The David Geffen School of Medicine at
UCLA. "Compared to their non-affected counterparts, those with an
androgen excess disorder did not differ in race, body mass, degree
of hair growth or family history. However, patients with an
identifiable androgen excess disorder were slightly younger and more
likely to complain of infertility."
Acne was seen in about one-fourth of the study population,
affecting those with and without an androgen excess disorder
equally. But at least half of the women with acne and minimal
unwanted hair growth had elevated androgen levels and infrequent,
irregular ovulation cycles. Previous studies have shown that even
without excessive hair growth, 55 to 86 percent of women with acne
have elevated androgen levels. The authors recommend, therefore,
that women with acne, especially those who complain of unwanted hair
growth, receive in-depth hormonal evaluation.
The single best predictor of an androgen excess disorder among
patients with minimal excess hair growth was the presence of
oligomenorrhea, infrequent menstrual periods, although some women
who claimed to have regular periods were found to have irregular
ovulatory cycles, and a significant number of these women had an
androgen excess disorder.
A clinical diagnosis of hirsutism is made by a physician's
evaluation and based on standardized scales. Women with true
hirsutism often find professional help for their underlying
conditions because the severity of their symptoms forces them to
seek cosmetic services.
"Electrologists tend to be the front line for patients with
hirsutism. When electrologists recognize that the symptom is part of
a larger disorder, they are able to give appropriate referrals,
which enables patients to find the diagnostic and treatment help
they need. Women with only minimal unwanted hair growth, however,
often have an underlying hormonal imbalance that goes undetected
altogether," said Dr. Azziz, holder of The Helping Hand of Los
Angeles Chair in Obstetrics and Gynecology at Cedars-Sinai.
"Unfortunately," he added, "whether the outward symptoms are
minimal or significant, many women view hyperandrogenism as a
cosmetic rather than an endocrinologic abnormality. We find that
there is a great need for more education of physicians, related
practitioners, and the public regarding prevalence, signs, morbidity
and the treatments available for these disorders."
Cedars-Sinai's Center for Androgen-Related Disorders is one of
the first programs in the country specializing in both up- and
down-regulation of androgen levels in women. It offers in-depth
testing, comprehensive treatments and support, and research into
molecular mechanisms and future therapies.
Sources
Cedars-Sinai's Center for Androgen-Related Disorders.
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