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Endocrine Reviews Aug 2000Hirsutism, the presence of terminal (coarse) hairs in females in a male-like pattern, affects between 5% and 10% of women. Of the sex steroids, androgens are the most... (Review)
Review
Hirsutism, the presence of terminal (coarse) hairs in females in a male-like pattern, affects between 5% and 10% of women. Of the sex steroids, androgens are the most important in determining the type and distribution of hairs over the human body. Under the influence of androgens hair follicles that are producing vellus-type hairs can be stimulated to begin producing terminal hairs (i.e., terminalized). The activity of local 5alpha-reductase (5alpha-RA) determines to a great extent the production of dihydrotestosterone (DHT), and consequently the effect of androgens on hair follicles. While there are two distinct 5alpha-RA isoenzymes, type 1 and type 2, the activity of these in the facial or abdominal skin of hirsute women remains to be determined. Although the definition of idiopathic hirsutism (IH) has been an evolving process, the diagnosis of IH should be applied only to hirsute patients with normal ovulatory function and circulating androgen levels. A history of regular menses is not sufficient to exclude ovulatory dysfunction, since up to 40% of eumenorrheic hirsute women are anovulatory. The diagnosis of IH, when strictly defined, will include less than 20% of all hirsute women. The pathophysiology of IH is presumed to be a primary increase in skin 5alpha-RA activity, probably of both isoenzyme types, and possibly an alteration in androgen receptor function. Therapeutically, these patients respond to antiandrogen or 5alpha-RA inhibitor therapy. Pharmacological suppression of ovarian or adrenal androgen secretion may be of additional, albeit limited, benefit. New therapeutic strategies such as laser epilation or the use of new biological response modifiers may play an important role in offering a more effective means of treatment to remove unwanted hair. Further investigations into the genetic, molecular, and metabolic aspects of this disorder, including only well defined patients, are needed.
Topics: 3-Oxo-5-alpha-Steroid 4-Dehydrogenase; Androgens; Biomarkers; Female; Hair; Hirsutism; Humans; Receptors, Androgen
PubMed: 10950156
DOI: 10.1210/edrv.21.4.0401 -
Nihon Rinsho. Japanese Journal of... Feb 2004Aromatase, a key enzyme in estrogen synthesis, is tissue-specifically regulated in various tissues and plays an important role through endocrine and intracrine estrogen... (Review)
Review
Aromatase, a key enzyme in estrogen synthesis, is tissue-specifically regulated in various tissues and plays an important role through endocrine and intracrine estrogen production in various physiological functions. Therefore, aromatase deficiency caused crucial impairments of physiological functions in the gonadal tissues as well as extra-gonadal tissues. Because aromatase is protective for androgenic exposure by catabolizing, virilization of a pregnant mother and pseudohermaphroditism of a baby girl consequently result from the deficiency. Similarly, because aromatase is productive for a multifunctional physiological factor, estrogens, impaired metabolisms of bone, carbohydrate, and fat etc. result from the deficiency. We discuss the etiology, clinical symptoms, and therapeusis by classifying it into two types of complete and incomplete aromatase deficiencies.
Topics: Androgens; Aromatase; Disorders of Sex Development; Estrogen Replacement Therapy; Estrogens; Female; Humans; Infant, Newborn; Male; Metabolic Diseases; Placenta; Pregnancy; Pregnancy Complications; Urogenital Surgical Procedures; Virilism
PubMed: 14968547
DOI: No ID Found -
La Revue Du Praticien Nov 1993Hirsutism is a male pattern of hair distribution in women. It may be caused by hypersecretion of androgens by the adrenal glands or the ovaries and/or by cutaneous...
Hirsutism is a male pattern of hair distribution in women. It may be caused by hypersecretion of androgens by the adrenal glands or the ovaries and/or by cutaneous sensitivity to circulating androgens due to hyperactivity of 5 alpha-reductase. The degree of hirsutism is evaluated and its cause suspected by physical examination, but the aetiological diagnosis is indicated by plasma testosterone essays: if the testosterone level is above 1.2 ng/mL, investigations must be made to find out whether hirsutism is caused by a virilizing tumour of the ovary or the adrenal gland, or by a congenital adrenal hyperplasia of late presentation. If the testosterone level is below 0.6 ng/mL, hirsutism is idiopathic. Between these two figures the conditions is often idiopathic, but the patient must be investigated for polycystic ovarian dystrophy, adrenal hyperplasia or tumour. Whenever possible, treatment is aetiological, but it is always symptomatic, consisting of electrical depilation of the face and, chiefly, antiandrogens (e.g. Androcur) associated with oestrogens. This treatment usually effective, and it has transformed the outcome of hirsutism, even when the disease is idiopathic.
Topics: Androgen Antagonists; Androgens; Female; Hirsutism; Humans
PubMed: 8128155
DOI: No ID Found -
British Medical Journal Feb 1980
Review
Topics: Androgens; Drug Therapy, Combination; Ethinyl Estradiol; Female; Hair Removal; Hirsutism; Humans; Polycystic Ovary Syndrome; Prednisolone; Virilism
PubMed: 6988040
DOI: 10.1136/bmj.280.6211.369 -
Clinics in Endocrinology and Metabolism Nov 1985The physiological control of adrenal androgen secretion has not been definitively established. However, there is evidence to suggest that a dexamethasone-suppressible... (Review)
Review
The physiological control of adrenal androgen secretion has not been definitively established. However, there is evidence to suggest that a dexamethasone-suppressible factor other than ACTH may have a specific role to play. The majority of patients with idiopathic hirsutism (hirsutism associated with regular menstruation) have findings suggestive of adrenal androgen excess, including enhanced androgen responsiveness following administration of metyrapone, and respond to treatment with dexamethasone, 0.5 mg given each night. Patients with idiopathic hirsutism have elevated androgens but normal oestrogen and gonadotrophin levels. In contrast, while patients with polycystic ovary syndrome (PCOS) also demonstrate evidence of adrenal androgen excess, these patients have elevated oestrone levels and gonadotrophin secretion is abnormal. Approximately 50% of patients with PCOS treated with dexamethasone resume regular menstruation. Oestrone excess appears to be primary to the abnormal gonadotrophin secretion and to the development of PCOS. In non-obese patients with PCOS elevated oestrone appears to occur as a consequence of the availability of the excessive amounts of its immediate precursor, androstenedione, an androgen mainly of adrenal origin. Androstenedione is converted to oestrone in fat. Obese amenorrhoeic subjects have normal androstenedione values but elevated oestrone levels with abnormal gonadotrophin secretion as seen in PCOS. These findings indicate that abnormal gonadotrophin secretion is associated with elevated oestrone levels whether these occur as a consequence of excessive adrenal androgen secretion, or the excessive conversion of normal amounts of available androstenedione. Patients with idiopathic hirsutism and elevated androstenedione levels but normal oestrone values appeared to be protected against the development of PCOS by relatively poor conversion of androstenedione to oestrone. It is likely, therefore, that if patients with idiopathic hirsutism gain additional adipose tissue, elevated oestrone levels will result and PCOS will develop. These observations explain the frequent association of PCOS and obesity. There is a close clinical association between elevated androgen levels and hirsutism and between elevated oestrone levels and menstrual disturbances. However, some patients with amenorrhoea but without hirsutism may demonstrate marked elevations of androgens and oestrone, the correction of which leads to the resumption of regular ovulation. This presentation, 'amenorrhoea with cryptic hyperandrogenaemia', is probably explained by diminished sensitivity of androgen receptors.(ABSTRACT TRUNCATED AT 400 WORDS)
Topics: 17-alpha-Hydroxyprogesterone; Adrenal Cortex; Adrenal Gland Neoplasms; Adrenal Glands; Adrenal Hyperplasia, Congenital; Adrenocorticotropic Hormone; Amenorrhea; Androgens; Androstenedione; Clomiphene; Cushing Syndrome; Dehydroepiandrosterone; Dehydroepiandrosterone Sulfate; Female; Hirsutism; Humans; Hydroxyprogesterones; Infertility, Female; Obesity; Polycystic Ovary Syndrome; Testosterone; Virilism
PubMed: 3002682
DOI: 10.1016/s0300-595x(85)80086-4 -
Journal of Obstetrics and Gynaecology... Dec 2023This guideline reviews the etiology, diagnosis, evaluation, and treatment of hirsutism.
OBJECTIVE
This guideline reviews the etiology, diagnosis, evaluation, and treatment of hirsutism.
TARGET POPULATION
Women with hirsutism.
OPTIONS
Three approaches to management include: 1) mechanical hair removal; 2) suppression of androgen production; and 3) androgen receptor blockade.
OUTCOMES
The main limitations of the management options include the adverse effects, costs, and duration of treatment.
BENEFITS, HARMS, AND COSTS
Implementation of the recommendations in this guideline may improve the management of hirsutism in women with this condition. Adverse effects and a potential long duration of treatment are the main drawbacks to initiating treatment, as is the possibility of significant financial costs for certain treatments.
EVIDENCE
A comprehensive literature review was updated to April 2022, following the same methods as for the prior Society of Obstetricians and Gynaecologists of Canada (SOGC) Hirsutism guidelines. Results were restricted to systematic reviews, randomized controlled trials, controlled clinical trials, and observational studies. There were no date limits, but results were limited to English- or French-language materials.
VALIDATION METHODS
The authors rated the quality of evidence and strength of recommendations using the modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, along with the option of designating a recommendation as a "good practice point." See online Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional [weak] recommendations).
INTENDED AUDIENCE
Primary care providers, family medicine physicians, obstetricians and gynaecologists, reproductive endocrinologists and others who manage the care of patients with hirsutism.
TWEETABLE ABSTRACT
Management of hirsutism involves a 3-pronged approach of mechanical hair removal, suppression of androgen production, and androgen receptor blockade.
SUMMARY STATEMENTS
RECOMMENDATIONS.
Topics: Female; Humans; Androgens; Canada; Hirsutism; Receptors, Androgen
PubMed: 38049282
DOI: 10.1016/j.jogc.2023.102272 -
Hormones and Behavior Sep 2008The neuronal nitric oxide synthase (nNOS) is involved in the control of male and female sexual behavior and its distribution in several regions of the...
The neuronal nitric oxide synthase (nNOS) is involved in the control of male and female sexual behavior and its distribution in several regions of the limbic-hypothalamic system, as well as its coexistence with gonadal hormones' receptors, suggests that these hormones may play a significant role in controlling its expression. However, data illustrating the role of gonadal hormones in controlling the nNOS expression are, at present, contradictory, even if they strongly suggest an involvement of testosterone (T) in the regulation of nNOS. The action of T may be mediated through androgen (AR) or, after aromatization to estradiol (E(2)), through estrogen receptors. To elucidate the role of AR on nNOS expression, we compared male and female rats with a non-functional mutation of AR (Tfm, testicular feminization mutation) to their control littermates. We investigated some hypothalamic and limbic nuclei involved in the control of sexual behavior [medial preoptic area (MPA), paraventricular (PVN), arcuate (ARC), ventromedial (VMH) and stria terminalis (BST) nuclei]. In BST (posterior subdivision), VMH (ventral subdivision), and MPA we detected a significant sexual dimorphism in control animals and a decrease of nNOS positive elements in Tfm males compared to their littermate. In addition, we observed a significant increase of nNOS positive elements in BST (posterior) of Tfm females. No significant changes were observed in the other nuclei. These data indicate that, contrary to current opinions, androgens, through the action of AR may have a relevant role in the organization and modulation of the nNOS hypothalamic system.
Topics: Androgen-Insensitivity Syndrome; Androgens; Animals; Animals, Genetically Modified; Female; Hypothalamus; Limbic System; Male; Models, Biological; Nitric Oxide Synthase Type I; Rats; Rats, Wistar; Receptors, Androgen; Sex Differentiation; Virilism
PubMed: 18582470
DOI: 10.1016/j.yhbeh.2008.05.015 -
Physiological Research 2011Hyperandrogenic states in pregnancy are almost always the result of a condition that arises during pregnancy. The onset of virilization symptoms is often very fast. The... (Review)
Review
Hyperandrogenic states in pregnancy are almost always the result of a condition that arises during pregnancy. The onset of virilization symptoms is often very fast. The mother is protected against hyperandrogenism by a high level of SHBG, by placental aromatase and a high level of progesterone. The fetus is protected from the mother's hyperandrogenism partly by the placental aromatase, that transforms the androgens into estrogens, and partly by SHGB. Nevertheless there is a significant risk of virilization of the female fetus if the mother's hyperandrogenic state is serious. The most frequent cause of hyperandrogenic states during pregnancy are pregnancy luteoma and hyperreactio luteinalis. Hormonal production is evident in a third of all luteomas, which corresponds to virilization in 25-35 % of mothers with luteoma. The female fetus is afflicted with virilization with two thirds of virilized mothers. Hyperreactio luteinalis is created in connection with a high level of hCG, e.g. during multi-fetus pregnancies. This condition most frequently arises in the third trimester, virilization of the mother occurs in a third of cases. Virilization of the fetus has not yet been described. The most serious cause of hyperandrogenism is represented by ovarian tumors, which are fortunately rare.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Adrenocortical Adenoma; Adrenocortical Carcinoma; Adult; Androgens; Aromatase; Female; Fetus; Humans; Hyperandrogenism; Luteoma; Ovarian Neoplasms; Ovary; Placenta; Pregnancy; Pregnancy Complications; Ultrasonography, Prenatal; Virilism
PubMed: 21114372
DOI: 10.33549/physiolres.932078 -
Expert Opinion on Investigational Drugs Mar 2002Many alternatives exist for treating hirsutism. Based on an analysis of scientific literature and on the experiences of the author, the most common anti-androgen agents... (Review)
Review
Many alternatives exist for treating hirsutism. Based on an analysis of scientific literature and on the experiences of the author, the most common anti-androgen agents are discussed in this review. Androgen receptor blockers (cyproterone acetate, flutamide and spironolactone), 5 alpha-reductase inhibitors (finasteride) and androgen-suppressing agents (gonadotrophin-releasing hormone [GnRH] agonists, oestroprogestins, corticosteroids and insulin-sensitising agents) are evaluated and compared. The importance of diagnosis in choosing the most appropriate anti-androgen treatment is also discussed.
Topics: Androgen Antagonists; Androgen Receptor Antagonists; Androgens; Cholestenone 5 alpha-Reductase; Female; Gonadotropin-Releasing Hormone; Hirsutism; Humans; Oxidoreductases; Treatment Outcome
PubMed: 11866665
DOI: 10.1517/13543784.11.3.357 -
Nederlands Tijdschrift Voor Geneeskunde Jan 2008
Topics: Androgen Antagonists; Androgens; Hirsutism; Humans; Obesity; Weight Loss
PubMed: 18323010
DOI: No ID Found