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Benign hirsutism in women is a common disorder that continues to be confusing to most physicians. However advances in androgen physiology have provided a logical basis for understanding pathophysiology and treatment: The androgens androstenedione and testosterone in women arise from both ovary and adrenal cortex. However hair follicle growth is dependent on local formation of another potent androgen Dihydrotestosterone.
Testosterone (androstenedione), Dihydrotestosterone is under regulation of an enzyme 5-alpha-reductase type I and II Treatment modes for androgen, excess in women include antiandrogens and 5 reductase inhibitors as well as at least experimentally, inhibition of pituitary LH (LHRH super-agonist).
1.Idiopathic
2.Polycystic ovary Syndrome (PCO)
3.Adult Adrenogenital syndrome
In the common idiopathic form, androgen levels are nearly normal and the major abnormality is local hyperproduction of DHT or increased response of hair follicle.
Since the idiopathic and PCO forms have similar pathophysiology, treatment is similar and based more on severity of hirsutism than details of pathophysiology. Spironolactone (aldactone) now generic.
Especially in Europe the antiandrogen, Flutamide has been used. Recently the development of the 5 2 reductase inhibitor finasteride, for treatment of benign prostatic hypertrophy, has been at least in the literature effective in benign hirsutism. Although not approved in the formulary, it is being used by some in low doses.
Alopecia
While DHT is a growth factor on facial and body hair in both sexes; in excess it leads to senescence (apoptosis) in head hair and follicle levels are increased in men (and women) with androgen related alopecia. Low dose Finasteride (2mg) the 5R inhibitor is moderately effective in stopping the process and some regrowth is possible. Finasteride use in men has minimal side effects.
The rare virilizing tumor of the ovary (even rarer, adrenal) produces a more severe disorder of virilization, amenorrhea and clitoral hypertrophy and is associated with high levels of testosterone, located by CT or MRI.