Treatment Of Hirsutism

The response to treatment varies between 20 to 95%, depending on the drug, dosage used and individual response, and overall is far from being completely successful. The growth cycle of hair is long, varying between six and 24 months. Once hair growth has been stimulated by excessive androgen levels, maintenance of the same growth rate requires much less androgen. Drug treatment is essentially directed toward arresting growth of new hair while hair that is present may enter the catagen stage and eventually be shed from the follicle. Patients must therefore be advised that a response to therapy may not be seen for six to 12 months and that although it is possible to prevent further conversion of vellous to terminal hair, little change will be seen in the total number of terminal hairs. Some women may note a lighter hair colour, slowing the rate of regrowth and a decrease in the diameter of the hair shaft. As there are individual variations in response to treatment it must be individualised and continued beyond the growth cycle of the relevant hairs to decide on benefits. The response to therapy varies greatly not only between individuals but also between different sites on the body which depends on the local rate of hair growth. Of all signs of hyperandrogenism, alopecia is the slowest to respond as scalp hair has a growth cycle of over three years.

The patient should also be clearly informed from the onset that treatment is effective only while the medication is in use. Most of the patients report worsening of hirsutism, acne and oily skin after stopping medication. Patients with a relatively short history of hirsutism tend to respond better to treatment than those with long-standing hyperandorgenaemia and severe hirsutism. It is also easier to prevent hair growth than to treat established hirsutism. Adolescent girls who are beginning to develop hirsutism would therefore respond best to the medical therapy.

Women who respond to treatment may notice changes in unwanted hair growth by the third month, but most did not until six months. Beneficial effect will be obvious by 12 months although the effectiveness of treatment increases up to a maximum at approximately two years. Treatment may be withdrawn subsequently on a trial basis or maintained at the lowest dose.

Once therapy has started the patient's progress can be monitored on the basis of both clinical appearance and laboratory tests. The effectiveness of treatment is best assessed in terms of a reduction in the time a woman spends in mechanically removing the hair. Patients who exhibit progressive hirsutism or whose circulating androgens fail to decrease as expected on hormonal therapy should undergo further evaluation.

When adequate suppression of serum androgens has been maintained for six to 12 months but a satisfactory reduction in new hair growth has not been achieved other therapeutic options should be tried. The dose of the current medication can be increased, a new medication can be substituted, or a new medication can be added. Maximal doses are often only slightly, if at all, more effective than midrange doses. In theory, the combination of drugs that act at different sites may offer the best results. Adding an oral contraceptive has other benefits regarding contraceptive protection, which is necessary part of antiandrogen treatment, or for cycle control.

All forms of hormonal treatment will benefit from the concurrent mechanical hair removal. This provides an immediate effect while the impact of long-term hormone treatment is awaited. Although electrolysis is advertised as permanent hair removal in many women regrowth occurs. The combination of medical therapy to remove stimulus for new hair growth with electrolysis, which deals with established hair, thus offers the best cosmetic results. Patients should be advised that plucking of hairs causes irritation and stimulation of hair growth. In contrast, shaving does not cause hair to grow more rapidly. Depilatory creams should be avoided, particularly for the face, because they could cause irritation and pigmentation.