How to assess the degree of increased female hair growth

The problem of hirsutism is relevant both for narrow specialists in gynecology and endocrinology, and for general practitioners. Patients come to the family doctor with complaints of increased body hair and the question of how to deal with it. Specialists begin to look for a problem in the state of the hormonal background of a woman, but it often happens that the problem is not detected, hormone levels are not detected within the normal range and pathology, but complaints persist. In the 21st century, in a world where women see perfectly smooth bodies on TV screens and in magazines, how to distinguish the far-fetched problem of hirsutism from normal hairline? To do this, you need to go back to the origins of the problem.

Hirsutism and hypertrichosis - features of increased hair growth

Hypertrichosis is commonly referred to as general excessive hair growth of all parts of the body, which does not depend on the hormonal state of the body. The causes of hypertrichosis can be both congenital, genetically determined, the characteristics of the body, and the influence of other factors, for example, the presence of concomitant diseases.

Hirsutism refers to excessive hair growth in women in hormone-dependent areas. Excessive hair growth appears not only in the usual places for women - in the groin, armpits, arms, legs, but also in places where the hairline is typical for men: on the face, chest, back, around the nipples, on the auricles.

The main causes of hirsutism

The main and most common cause of hirsutism is the high concentration of male hormones androgens in a woman's body. There may be several reasons for their excess:

• pathology of the ovaries directly (polycystic ovary syndrome, ovarian hyperthecosis, etc.);
• pathology of other endocrine organs (congenital dysfunction of the adrenal cortex, Itsenko-Cushing's syndrome, hypothyroidism, etc.);
• oncological endocrine pathology (prolactinoma, tumors of the ovaries and adrenal glands, etc.);
• medication (anabolic steroids).

Under the influence of male sex hormones testosterone and dihydrotestosterone in those areas where hair follicles normally give rise to thin and light fluffy hair in women, the growth of terminal hair is initiated - dark, long and hard. The conversion of testosterone to the more powerful hormone dihydrotestosterone is catalyzed by the enzyme 5-alpha reductase, which is localized predominantly in the skin.

Hormonally independent idiopathic hirsutism

The diagnosis of idiopathic hirsutism is established if the laboratory confirms the normal concentration of androgens in the woman's body, but the hair remains in the male pattern. The cause of idiopathic hirsutism may be an isolated increase in the activity of 5-alpha reductase or an increase in the number of androgen receptors in the female body. But it is important to remember that the exclusion of pathology of other organs and anamnestic data on a normal cycle may not be enough, since about 40% of women with hirsutism have regular cycles, in which, however, ovulation does not occur. To rule out ovarian pathology, additional research methods are needed, such as folliculometry.

There is also genetic hirsutism - increased body hair in certain ethnic groups. For example, among the peoples of the Caucasus, hirsutism is quite common, and is a variant of the norm, while in Asian women, increased hairiness is extremely rare.

Assessing the degree of increased hairiness

At the initial stage of diagnosis, the Ferriman-Galway scale can be used to determine the degree of hairiness in women of the Slavic ethnic group. The intensity of hair growth is determined in nine androgen-dependent zones and is evaluated in points from 0 to 4, after which the number of points is summed up and the hirsute number is determined.

The hirsute number is determined by the sum of points. The maximum number is 36 points.

• up to 7 points - normal hair growth;
• 8-12 points - borderline hairiness;
• more than 12 points - hirsutism.

When determining the degree of hairiness using the Ferriman-Galway scale, it is necessary to continue additional examination of the patient using laboratory and instrumental diagnostic methods, since the hirsut number allows only an approximate determination of the degree of hirsutism.

Professor Olga Bogomolets, a dermatologist, Doctor of Medical Sciences, spoke in detail about the methods of eliminating the problem of increased body hair .

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