QUESTION: Dear doctor, I am a female but I have noticed beards on my chin. Is it normal for women to have beards? What is the cause? Lilian.
ANSWER: Hello Lilian,
Hair growth in women in the male pattern is referred to as Hirsutism, which is the excessive growth of thick terminal hair in an androgen-dependent distribution.
The distribution is in women’s upper lip, chin, chest, back, lower abdomen, thigh, and forearm.
It should not be confused with hypertrichosis, which is generalised excessive growth of vellus hair, which is lightly pigmented, fine, short hair often found on the face, arms, stomach and legs.
For the case of hirsutism, hair is terminal, coarse, and thick like that found on the scalp, underarms and pubic area.
Although Hirsutism is common (10 per cent of women) and usually benign, it is one of the most common presentations of endocrine disease.
Causes
Causes are familial, idiopathic or are due to androgen secretion by the:
– Ovary (PCOS: polycystic ovarian syndrome, ovarian cancer).
– The adrenal gland ( late-onset congenital adrenal hyperplasia, Cushing’s syndrome, adrenal cancer), or
Drugs (steroids).
– Hirsutism of recent is associated with virilisation (the development of male physical characteristics such as muscle bulk, body hair and deep voice in a female) and is suggestive of an androgen-secreting tumor but this is rare.
Clinical assessment
The severity of hirsutism is subjective. Some women suffer profound embarrassment from a degree of hair growth that others would not consider remarkable.
Important observations are a drug and menstrual history, calculation of body mass index, measurement of blood pressure, and examination for virilisation (clitoromegaly, deep voice, male-pattern balding, and breast atrophy) and associated features, including acne vulgaris or Cushing’s syndrome.
Investigations
– Ultrasound is one to rule out bilateral polycystic ovaries.
- A random blood sample is taken to determine the levels of hormones: Testosterone, prolactin, Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH).
If testosterone levels are more than twice the upper limit of normal for females, idiopathic hirsutism and PCOS are less likely, especially if LH and FSH levels are low.
Under these circumstances, other causes of androgen excess should be sought.
Management
– Most patients will have used cosmetic measures such as shaving, bleaching and waxing, before consulting a doctor.
– Management is directed at the presenting complaint, but all PCOS patients who are overweight should be encouraged to lose weight.
– Losing weight can improve several symptoms, including menstrual irregularity, and reduces the risk of type 2 diabetes.
– Local measures: Shaving.
