Hirsutism Management Support Protocol

Hirsutism is excessive hair growth in women in areas where hair typically grows in men (face, chest, back, abdomen). It affects about 5-10% of women and is usually caused by excess androgens (male hormones) or increased sensitivity to normal androgen levels.

COMMON CAUSES:

•PCOS (most common cause, ~70-80%)

•Idiopathic hirsutism (no identifiable cause)

•Adrenal disorders (CAH, tumors)

•Medications (anabolic steroids, some others)

•Rarely: androgen-secreting tumors

EVALUATION IS IMPORTANT:

Hirsutism may be a sign of underlying conditions that need treatment. See a healthcare provider for proper evaluation, especially if:

•Rapid onset

•Signs of virilization (voice deepening, clitoral enlargement, male-pattern balding)

•Irregular periods

•Acne or oily skin

CONVENTIONAL TREATMENTS:

•Oral contraceptives (reduce androgens)

•Anti-androgens (spironolactone, finasteride)

•Topical eflornithine (slows hair growth)

•Hair removal methods (laser, electrolysis, waxing)

•Treat underlying cause (PCOS, insulin resistance)

LIFESTYLE FACTORS:

•Weight loss (if overweight) - significantly reduces androgens

•Low glycemic diet

•Exercise

* Spearmint tea has demonstrated anti-androgen effects in studies.

* Inositol helps with insulin sensitivity in PCOS-related hirsutism.

* Saw palmetto may inhibit conversion of testosterone to its more potent form (DHT).

Expected timeline: Supplements may take 2-3 months to show effects on hair growth. Hair already present needs removal; supplements help reduce new growth.

Clinical Perspective

Hirsutism: Excessive terminal hair in androgen-dependent areas in women. Scored by modified Ferriman-Gallwey scale (>8 significant). Causes: PCOS (most common, 70-80%), idiopathic, non-classic CAH (21-hydroxylase deficiency), androgen-secreting tumors (ovarian, adrenal), Cushing's, medications. Evaluation: testosterone, DHEAS, 17-OH progesterone (CAH screen), consider pelvic US, cortisol if Cushingoid.

CRITICAL: Rule out serious causes (tumors, CAH). Treat underlying condition. Weight loss in obese PCOS dramatically effective. OCPs and anti-androgens are first-line medical therapy. Supplements may provide modest benefit as adjunct, especially for insulin resistance component. Cosmetic treatments (laser, electrolysis) important for existing hair.

* Spearmint Tea (B-grade): Anti-androgen effects. RCT: (PMID: 19585478). 2 cups daily. Reduces free testosterone.

* Inositol (B-grade): Insulin sensitizer. Meta-analysis: (PMID: 28254159). 2-4g myo-inositol daily.

* Saw Palmetto (C-grade): 5AR inhibitor. Review: (PMID: 22789024). 320mg daily. Limited direct evidence for hirsutism.

* DIM (C-grade): Estrogen metabolism. Review: (PMID: 28778332). 100-200mg daily.

* Zinc (C-grade): Androgen modulation. Review: (PMID: 26845419). 25-30mg daily.

* Vitamin D (C-grade): PCOS insulin sensitivity. Systematic review: (PMID: 28750270). 2000-4000 IU daily.

* Berberine (C-grade): Insulin sensitizer. Review: (PMID: 26182896). 500mg BID-TID.

* Omega-3 (C-grade): Insulin sensitivity. Review: (PMID: 27840029). 2g EPA+DHA daily.

Assessment targets: Ferriman-Gallwey score, testosterone levels, menstrual regularity, weight, insulin resistance markers.

Protocol notes: Ferriman-Gallwey: scores 9 areas 0-4; >8 abnormal; >15 moderate-severe. Weight loss: 5-10% weight loss can significantly improve androgens and hirsutism. OCPs: reduce ovarian androgens, increase SHBG; first-line for most. Spironolactone: 100-200mg daily; first-line anti-androgen; contraception needed. Metformin: modest benefit for hirsutism in PCOS; better for metabolic issues. Hair removal: laser most effective for dark hair/light skin; electrolysis for permanent removal; needed for existing hair. Eflornithine: topical; inhibits ornithine decarboxylase; slows growth. Time: hair growth cycle means 3-6 months minimum to assess treatment. Ethnic variation: hirsutism scoring may need adjustment for ethnicity. Idiopathic: normal androgens, regular periods; cosmetic treatment often sufficient. Non-classic CAH: consider if elevated 17-OHP; genetic disorder.

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