Medical Problems: Hairiness In Females

OVERVIEW

This page is designed to organize content that is relevant to the topic of hairiness in females. This term is used often in medicine, and it is important that we become as familiar as possible with it.

WHAT EXACTLY IS IT?

Before going any farther, let us make sure we clearly define the “medical problem”. The presence of excess hair in women can be characterized by the following terms:

  1. Hypertrichosis: excessive hair growth NOT caused by androgens. Possible causes can be congenital or it may be caused by metabolic disorders such as thyroid dysfunction, anorexia nervosa, and porphyria.
  2. Hirsutism refers to a male pattern of hair growth on a woman’s face, chest or back. Typically caused by excessive androgens.
  3. Virilization refers to the development of male-like characteristics in a female. These can include: facial/body hair, deepened voice, male pattern baldness, increased muscle bulk, clitoralmegaly.

While many elements of the clinical workup can be shared between hirsutism and virilization, these are important terms to keep in mind.

WHY IS IT A PROBLEM?

Hairiness in females is typically unwanted and can be a sign of a more serious underlying condition.

ORGANIZING THE DIFFERENTIAL

The differential diagnosis for hairiness in females can be organized in a few different ways:

  • Can’t miss diagnosis
  • Organ systems 
  • Disease category
  • Diagnostic modality
  • Most common diagnosis
FRAMEWORK

What type of hairiness are we dealing with?

Primary: these will be patients that are born with these features/develop them from an early age. Primary hairiness requires considering more genetic/congenital processes that could be responsible.

Secondary: these patients develop features later on in life. Given their onset genetic/congenital process are less likely to be the cause. This can be further subdivided into 2 groups:

  1. Premenopausal: certain conditions are more likely in this setting
  2. Postmenopausal: certain conditions are more likely in this setting

What hormone is mediating hair growth?

Testosterone: the ovaries are typically thought to be the source of testosterone and high levels can cause

DHEAS: the adrenals are typically the source of DHEAS. DHEAS may be elevated secondary to increases in other hormones such as:

  • Prolactin: elevated levels of prolactin are thought to stimulate adrenal release of DHEA-S
CLINICAL “WORKUP”

Now that the possible causes of hairiness in females have been established, the focus can shift to how one would actually “work-up” a patient who presents with this complaint.  

FURTHER READING

American Family Physician: Hirsutism in Women

Page Updated: 11.13.2016