A new study carried out for the first time in Sri Lanka has revealed that a significant number of young women in Sri Lanka suffer from excessive male pattern hair growth , a condition known as Hirsutism.
The study in which Endocrinologist and Consultant Diebetician, National Hospital of Sri Lanka Dr Noel Somasundaram participated , revealed the physical, emotional, and psycho social impacts of this condition and the adverse health effects. Most importantly, it also emphasized the fact that it is eminently preventable with healthy lifestyles, and victims have several treatment options available here.
Excerpts …
Q. Hirsutism is a subject very few people know about and are too embarrassed to talk about .
What is it.? Explain in detail in laymen language.
A. Hirsutism is the term for unwanted male-pattern hair growth on a woman. I suppose that is self explanatory. Women should not normally have hair growth on the face (upper lip, chin, sideburns), chest, abdomen, arms, legs and on the back- and if they have excessive and unwanted hair on the other areas it is called hirsutism. It is a problem of women.
Q. Is it true that more young adults especially females are at risk in Sri Lanka?
A. Yes. Hirsutism usually begins at puberty and therefore can be seen from teenage onwards and can be very distressing to the young girl.
Q. In July 2015 you took part in a study where you followed a selected number of young female undergraduates from a leading university to determine the pattern of body distribution of hair. What does this study reveal ?.
A. Hirsutism can be ethnic specific. In some races such as in Caucasians the body hair is very sparse, however, it is much higher in South Asian and Middle Eastern women. What we tried to figure out was the pattern of hair growth in young women of Sri Lanka so that we could create a standard pattern to describe the areas affected with increased hair growth and the extent of excessive hair growth. We use a chart to give a score for the degree of hair growth so that it is possible to describe the areas affected, and the severity can be understood and recorded for future reference.
The chart below is self explanatory. A score of 1-4 is assigned to each site based on the degree of hair growth in each of the area examined. A total score of 0 to 36 is possible for each person as there are 9 sites that are examined and each of this area can have a severity ranging from 0 to 4. The hirsutism score determines the severity of it. What we found was that a significant percentage of Sri Lankan women have hirsutism. This is because of our hereditary tendency to have more body hair. If the degree of hirsutism is severe or distressing then investigations and treatment are necessary.
Q.. Was the information something new to Sri Lanka? Had there been other studies done before this?
A. This is the first time such a study had been done.
Q. What are the health implications of Hirsutism?
A. Hirsutism can be normal- ethnically and genetically determined. If it is excessive then it is induced by higher than normal levels of testosterone. In this case it could be a manifestation of an internal hormonal imbalance.
Q. What causes it? Can it be malignant?
A. There are many reasons why the testosterone increases. It can be due to polycystic ovarian syndrome which is fairly common in young women. Other causes include excessive production of testosterone from adrenal or ovary from a tumour or abnormal hormonal metabolism. Hirsutism can be caused by a testosterone producing tumour in the adrenal gland or ovary and they can sometimes be malignant.
Q. Can it be inherited?
A. Yes, it can be hereditary and run in families. It can also be an ethnic phenomenon in some races like South Asians side burns can be a normal phenomenon. A hirsutism score 1 or more in many locations adding to a total score more than 7 warrants evaluation according to our study of normal women.
Q. Is obesity a cause?
A. Definitely. Obesity leads to polycystic ovary syndrome and testosterone activity is increased in this condition. By far the commonest cause of hirsutism is polycystic ovary syndrome.
Q. Are the symptoms visible from birth?
A. Newborn babies tend to have some degree of venous hair that disappears soon and this is not a problem. If there are hereditary hormone problems such as, congenital adrenal hyperplasia then the hirsutism tends be more severe and persistent.
Q. Can early detection help to reduce risks of it becoming severe?
A. Definitely. It is easier to treat if treatment is started early.
Q. Is it curable?
A. If there is an underlying condition and the correct treatment is started for the underlying condition them it is curable.
Q.Is it preventable?
A. As the most common cause is unhealthy lifestyle and obesity, balanced healthy diet and regular physical activity from childhood will prevent the development of polycystic ovarian syndrome and lead to healthier life.
Q. Is it treatable?
A. Definitely. There are multiple treatment options. It is also important to change underlying hormone imbalance usually by weight loss and a healthier lifestyle. In addition it would evaluate for any other underlying condition and take measures to correct it.
Q. What is the usual treatment given?
A. Treatment comprises the use of medication to reduce production or activity of testosterone, use of topical cream for reducing growth of hair follicles. Typically, it takes about six months for improvement to be visible as the lifespan of a hair follicle is more than three months. There are many local treatments to reduce hair follicles such as, laser or electrolysis. Common home remedies include use of waxing, epilatory creams or threading.
In all off these it is important to realize that on stopping there may be a reappearance of hair, so that persistence with treatment is important.
Q. Are medications a contributory factor?
A. Steroids, Danazol and antipsychotic medications are usually associated with hirsutism.
Q. Do you expect the numbers to grow of persons afflicted by this condition as we now have a large youth population?
A. Yes, with changing lifestyle and increasing obesity, fertility problems and hirsutism will increase. It is important to recognize that each girl child can be helped by parents and society to undertake healthy diet and engage in more physical activity from childhood in order to lead a normal life later on life.
Q. What are the inputs the state sector has made in helping these persons?
A. All the services of an endocrinologist as well as endocrine testing is available in all provinces. Treatment facilities are also available. In our endocrine clinics we have services for treatment of Hirsutism. Counselling by our team is also given to victims to understand the distressing changes in their bodies and offer hope through the use of medications and other measures.
Q. Is there social stigma attached to this condition?
A. It has been seen in the recent past more and more people are aware about Hirtuism and seek treatment and help. But more publicity and education to inform that Hirsutism can be effectively treated is required.
Q. Can a young woman with this condition pass it on to her baby?
A. Hirsutism if it is genetic can be passed on. The metabolic program of the unborn foetus can be adversely affected in the mother’s womb if the mother leads an unhealthy lifestyle or is overweight and has polycystic ovary syndrome. Healthy mothers will give rise to healthy children.
Q. Do you have any advice to give parents and young women suffering from Hirsutism ?
A. First of all do not despair. Seek the help of an endocrinologist. There are systems to investigate, identify the cause and offer effective treatment. Help children particularly girls to grow into healthy young ladies by investing in their health and encourage them in physical activity..