Excess body hair-hirsutism – causes and treatment option advice for health professionals. Do you agree with me if I claim that “ The number of hair follicles one  is going to have in adult life  is  established before birth.-in both males  & females!!! How many members will agree with me??

Hirsutism causes and treatment option advice 

Many women are bothered by what they feel to be excess or an undesirable distribution or amounts of body hair – about 2-5% of Indian women. A degree of hairiness which may be acceptable in one culture or country may not be acceptable to either the individual or general society in a different community.

 So the problem of body hair must be considered not only in terms of what is biologically normal or abnormal but also according to various social environments. Excess body hair may be a manifestation of an underlying hormonal disorder, which if treated may result in less hair growth.

 The medical term ‘HIRSUTISM’ is used to describe the condition of excessive thick dark hair growth in women in the androgen sensitive regions of the body in a pattern not considered normal for a woman.

What controls Normal Body Hair?? What amount and at what sites of female body may have normal hair growth for which she and her parents should not worry at all??

Normal body hair growth is determined A) genetically and differs both within and between B) different racial groups as mentioned.  The number of hair follicles one is getting to have is  established before birth.

Where , in human body we can see hairs??  Hair follicles are found all over the body except for the palms, lips and soles of the feet. Most body hair is fine and unpigmented.

Body hair growth is governed by the action of sex hormones on the hair follicles. But growth of hairs in  males / females , are not  only dependent on A) e the absolute levels of sex hormones in the blood  but also the B) sensitivity of the hair follicles to the hormones.

Thus two men / women with the same blood hormone levels will have different body hair growth patterns according to the C) number of hair follicles over their bodies and B) how sensitive their hair follicles are to the growth stimulating effects of the hormones.

The main hormones stimulating hair growth are called ‘androgens’. Androgens are commonly called ‘male hormones’ but this is somewhat misleading, as androgens are normally produced by both the adrenal glands and ovaries in women and have important actions in normal healthy women.

. Who appeared in the universe  first ??  Is it “Chicken” or “ Egg “= who first came in the world. Lady members please excuse this old man( Prof S K Pal)  for  mentioning the sentence that “There can’t be any female unless she possess good amount of male hormones” .Why ? Here is the answer. We know that the most well known androgen is testosterone(Abbreviated as T) .. Testosterone is converted to oestrogen in the ovaries and body fat. So for being a good woman (be it girl child, daughter, wife, mother)  she badly needs enough male hormones. So that orstrogens are synthesized. Is there any de novo oestrogen synthesis? Yes. Fork adrenals and possibly  adequately prime Granulosa cells by FSH .

What about  DHEAS?? The other important hormones that are converted in cells into androgens are dehydroepiandrosterone (DHEA) and androstenedione (A). The skin and hair follicles convert DHEA and A to testosterone therefore high levels of DHEASO4 &  androstenedione (A)-the two    weak androgens can cause acne and excess hair growth.

Not all areas of body (i.e body hairs ,I mean Hair follicles)  are identically sensitive to sane amount of  circulating abovementioned 3  classical androgens.  For instance certain parts of the body are more sensitive to the influence of androgens and are called “ androgen sensitive areas of the body”-both in males & females. . These areas include the A) upper lip, B) sides of the face, C) chin, D) central chest and E) around the nipples, F) lower abdomen, G) back, H) upper arms, and I) inner thighs .

Of note that sites like I, H, F D & C in woman signifies clinically moderate androgen excess in order of response. To simplify my knowledge on abnormal hair growth, last hair to appear in women is Back of chest & Upper thighs.  . In contrast, the arms and lower legs are less sensitive to the effects of hormones. In woen slight rise of all those 3 male hormones can  stimulate hair growth in these highly  hormone sensitive areas by increasing the speed of hair growth but also increase the pigmentation (darkening) of hair and the thickness of the hairs(coarse) . Thus androgens convert fine unpigmented hair into coarser dark more rapidly growing hair.

Where does hairs appears first in a teenagers: Evolution of hairs in women as she attains puberty: A lesson for mothers caring her girl toddler: Puberty begins with the development of A) underarm first and by 2-3 months at B)  pubic hair. These are termed as  sexual hairs (in males teens also) , Why it happens –Who controls  such response?? It is  not gonads but only  when the adrenal glands ‘switch on’ and produce increasing amounts of androgens at the onset of puberty. We do not know what triggers this initial phase of maturation. By the end of puberty there is considerable variation in the amount of body hair between individuals (both males and females, even in siblings—due to receptor population, It’s sensitivity to steroids & lastly enzymatic which control synthesis of DHT the hair follicle. Contrary to common belief, there is minimal role of T levels. So ,if a young adult woman develops abnormal hair growth it does not mean that her Tetsto  is very high. It  cant be equaled like that .. As women ages,> 40 yrs there is less conversion to Oestrogens while adrenal gland continues to pour Androgens, But ovaries are tired meanwhile. As such there is relative increase in T ratio over Oestrgen their overall amount of coarse body hair tends to gradually increase, again but admittedly with a wide range of individual variation. However take home message is to enquire a young adult with  ab hair groeth is “Does your mother/ paternal aunt have similar kind of hairs? If yes-Diag is most probably Familial hirsutism and not PCO.