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What are my treatment options for severe hirsutism in Singapore?

Skin, Hair & Nails Endocrinology Women's Health

I'm a 20 year old female. I've had severe hirsutism for a very long time, which I believe to be idiopathic as my menses is regular, and I do not have acne. My hirsutism became worse this year. I was wondering what treatment options I have for hirsutism in Singapore?

DOCTOR’S ANSWER (4)

Hirsutism is excessive male-pattern hair growth. The excessive hair growth can occur in the upper lip, chin, midline chest, upper abdomen, limbs, or back. It can be associated with acne and/or male-pattern balding. We usually assess the severity of hirsutism using a clinical score. 

The most common cause of hirsutism in a premenopausal woman like yourself is polycystic ovary syndrome (PCOS). There are also other less common hormonal causes of hirsutism. Some drugs may result in hirsutism as well.

I would recommend that you get seen by a doctor to assess the severity of your hirsutism. Tests will need to be done to exclude PCOS and other hormonal causes of hirsutism before we can discuss treatment options.

Treatment for hirsutism includes:

  • Treating the underlying cause
  • Cosmetic hair removal methods (for example, shaving, plucking, waxing)
  • Drug therapy

Drug treatment involves the use of medications that can regulate the female hormones and/or reduce the effects of male hormone (testosterone) in the body. Drug therapy can provide more lasting improvement in women with moderate to severe hirsutism.

412 views 2 Jan 2019

I am sorry to hear that your symptoms have worsened this year.

Firstly, hirsutism in young females is not an uncommon symptom, especially if you have polycystic ovarian syndrome (PCOS) . PCOS is one of the most common causes of hirsutism in young females like yourself.

Even though your periods are regular and you do not have acne, it does not necessarily mean you definitely do not have PCOS and that your excessive hair growth is definitely idiopathic.

I would recommend that you seek a doctor's opinion first to have a work up done for your hirsutism, after which we can then look into effective ways we can help you treat it.

Hirsutism in young girls is usually caused by excessive male hormones in the body, which hence leads to such symptoms. An effective way of controlling this would be via certain birth control pills such as Diane-35, which can effectively control the levels of male hormones and improve your hirsutism.

In addition to that, you can also complement the treatment with hair removal methods such as IPL or laser hair removal.

Ultimately, it is most important for you to seek treatment with a doctor that's experienced in treating young girls like yourself.

Hope this addresses your concerns!

Regards,

Dr Michelle Chia

385 views 2 Jan 2019

Hello,

Thanks for writing in with this question as many readers may have the same issue but embarrassed to bring it up. I agree with Dr Abel Soh, you definitely need to have a proper assessment to determine the cause of hirsutism and treat the underlying cause. 

From a dermatologist's point, we do have treatment options for hair removal. Common hair removal methods such as shaving, waxing, threading, epilation provide temporary results, but there are related issues such as folliculitis, ingrown hairs, skin darkening at the treated areas, and skin irritation. 

From my experience, laser hair removal provides effective long term hair reduction and the risk of ingrown hairs, folliculitis etc is greatly reduced. The laser precisely targets hair follicles and heats them up, destroying each follicle in a controlled manner, minimising damage to surrounding skin. This is especially important when removing hair in sensitive areas such as the upper lip and chin, and I have noted that these areas are of great concern to many of my patients with darker skin types. 

You may have noticed many salons offering IPL hair removal, this is also an alternative but efficacy wise, laser hair removal has been proven to be superior to IPL. In the hands of an inexperienced operator, I have seen many patients suffering from burns and blisters due to inappropriate energy levels being used, so do be careful when selecting this treatment. 

Do get a professional assessment by a dermatologist for hair removal treatment options. Happy new year!

Best regards,

Dr Ker Khor Jia

399 views 2 Jan 2019
I'm sorry to hear that you have been troubled with hirsutism. In the first instance, we have to establish that it is just hirsutism or if there is virilization which is much more concerning. This includes hirsutism with other symptoms of excess testosterone such as shrinking of the breasts and deepening of the voice.
 
Evaluation is warranted to look for the cause of hirsutism so that we are able to treat the underlying cause. Polycystic ovarian syndrome is the commonest cause, accounting for about 70-80% of cases.
 
Other causes include excess steroid hormone production (this is also known as Cushing's syndrome, and is usually associated with weight gain and irregular periods), certain medications (for example medications to treat epilepsy), non-classic congenital adrenal hyperplasia (this is a milder form of a genetic disorder that can cause raised testosterone levels).
 
If there is no identifiable cause in women with normal male hormone levels and normal menstrual cycles, it is considered idiopathic hirsutism.
 
Treatment will depend on the underlying cause. If no cause is found and hirsutism is significant, treatment can be with medications (usually in the form of the oral contraceptive pill in the first instance) or direct hair removal methods such as laser therapy. 
 
I hope this helps. 
360 views 3 Jan 2019
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