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Skin Care and Diseases

Please help

11/29/2006

Question:

I went to an endocrinologist because I have increased hair on face and body. I am 37 yrs old and have had facial hair since age 20, but blond in nature except for about 5 whisker like hairs on my chin and it is relativley manageable. This summer, I started growing more hair on my arms. It is longer, thicker and darker than my other hair. I have some "public like" looking black hairs that have grown in and some other that is coming in definitely darker than I previously had. I have also had hair extend onto my wrists and up the line to my thumb and pinky. The hair on my knuckles has gotten longer and darker and I now have hair on my cheeks and under my chin. Though it is blonde, it is growing kind of long. The only change I had at that time is that I switched to organic milk/eggs/meat. My dr. said he has seen other cases where due to the organic switch, the decrease in estrogen in the organic has resulted in increased hair. I have since switched back to normal. My dr. pescribed spironolactone 25 mg 1x day. I tried to get 100 mg but he would not prescribe that. I also asked for the pill and was given femhrt 1/5 tab. I have read this can make hirsutism worse and can actually be a side effect of femhrt. I don`t want this to get worse!!! Will 25 mg of the spironolactone actually do anything to make a difference, and will the femhrt make everything escalate? What birth control pill could be used effectively with the spironolactone - that would also act as an anti-androgen and increase its effectiveness. Thank you so much for any advice you could give me. I feel very hopeless and very unsure of what was prescribed for my treatment. If anyone could help me, I can`t tell you how much it would mean to me.

Answer:

Without an evaluation, it is hard for me to tell you what is needed.

Other issues such as obesity, polycystic ovarian syndrome, depression/anxiety disorder, thyroid disease, metabolic syndrome, genetics, perimenopausal issues, over the counter or prescription medications, and (very uncommon) hormone producing tumors can sometimes play a role. If you are not comfortable with your physicians approach, you may want to seek a second opinion, preferably with a board certified dermatologist, if possible at a University setting, who has an interest in hair disorders or endocrinology.

I am not familiar with the "organic" switch effect on hair although the hypothesis is plausible.

As to the dosing of Spironolactone for "hirsutism", the doses can range anywhere from 25mg a day to 150mg a day. It can often take 6-12 months to see a notable effect on this medicine, no matter what the dose, and there is no good data that it works for the type of hirsutism that you are describing.

As to a hormonal agent, there isn't data studying oral contraceptives for this indication so any recommendations go on experience, bias, and hearsay. I have no recommendation although there is the thought that the brand name "Yasmin" contraceptive has additional anti-androgenic activity that theoretically may be helpful.

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Response by:

Pranav   Sheth, MD Pranav Sheth, MD
Formerly:
College of Medicine
University of Cincinnati