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Thursday, December 12, 2013
Skin Care and Diseases
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.
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.
Pranav Sheth, MD
College of Medicine
University of Cincinnati