What is hirsutism?


Hirsutism is characterised by excess body hair in a typically male distribution. The hair is pigmented and thick. It may be particularly obvious when it is on the moustache or beard areas. The other common sites are the chest, abdomen, thighs and back. Pubic hair growth may extend upward from the usual bikini-line to the middle of the abdomen (umbilicus) (Figure 8.1). For a woman to be hirsute is understandably embarassing.

 

Figure 8.1 Hirsutism - Excess Hair Distribution

What is cyproterone acetate?


Cyproterone acetate is an anti-androgen; it competes at the receptor sites (hormones) with androgens and reduces their effects. Dianette (Schering) is a special combined oral contraceptive pill that contains 2mg cyproterone acetate.

Higher dose cyproterone acetate may be considered. It is prescribed in a 'reverse-se quential dose regimen' when there is an inadequate response to previous medication. Usually, progestogens are taken in the latter half of cyclical oestrogen therapy, in HRT for example (HRT and progestogen). Cyproterone acetate is stored in the fat tissues and when it is administered late in the cycle there is a tendency for the period to be delayed. Cyproterone acetate 50mg or 100mg is, therefore, given on the first 10 days of each course of the pill. When cyproterone acetate is given in combination with the pill, it is likely to reduce hair growth, lighten the hair colour, and decrease the hair thickness in hirsute areas. Your doctor may re quest blood tests from time to time to check hormone levels and to ensure that your chemistry is not being affected adversely. Until recently, it was believed that cyproterone pills (Dianette) carried a greater risk of being associated with thromboembolism. This no longer appears valid.2007-01

Medical treatments for hirsutism are not rapidly effective, overnight remedies. New hair follicles are developing all the time and each lasts for about three years. In one study of hirsute patients, 10-20% of patients were improving after six months and 90% were happy after 36 months. These treatments only work whilst they are being taken. They do not cure the underlying abnormality so that when treatment is discontinued the hirsutism may recur.

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This is the personal website of David A Viniker MD FRCOG, Consultant Obstetrician and Gynaecologist at Whipps Cross University Hospital, London.

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