Hirsutism - Causes, symptoms and treatment. MF.

Treatment of hirsutism

Treatment of hirsutism is the most difficult task, which is caused not only by hypersecretion of androgens, but also by their peripheral metabolism.

At the level of the target tissue, in particular of the hair follicle, transformation of T into active dihydrotestosterone under the influence of the enzyme 5α-reductase occurs. An important role is played by the increase of free androgen fractions, which aggravates the clinical manifestations of hyperandrogenism.

Treatment of hirsutism involves blocking the action of androgens in various ways:

• inhibition of synthesis in the endocrine glands,
• increase in the concentration of HDG, i.e., reduction of biologically active androgens,
• inhibition of the synthesis of dihydrotestosterone in the target tissue by inhibiting the activity of the 5α-reductase enzyme,
• blockadereceptors to androgens at the level of the hair follicle.

Given the role of adipose tissue in the synthesis of androgens, an indispensable condition in the treatment of hirsutism in obese women is the normalization of body weight. A clear positive correlation between the level of androgens and the body mass index is shown. In addition, given the role of insulin in hyperandrogenism in women with

PCOS , insulin resistance therapy is necessary.

Combined oral contraceptives are widely used for the treatment of hirsutism, especially when the forms are not clearly expressed. The mechanism of action of COCs is based on inhibition of LH synthesis, as well as an increase in the level of PMSD, which reduces the concentration of free androgens. The most effective, based on clinical studies, COCs containing desogestrel, gestodene, norgestimate.

One of the first anti-androgens was cyproterone acetate( androkur), the mechanism of action of which is based on blockade of androgen receptors in the target tissue and suppression of gonadotropic secretion. Antiandrogen is also a diane-35, a combination of 2 mg.cyproterone acetate with 35 μg. Ethinyl estradiol, which also has a contraceptive effect. Strengthening of the antiandrogenic effect of diane can be achieved by an additional appointment of androkur - 25-50 mg each.from the 5th to the 15th day of the cycle. Duration of treatment is from 6 months to 2 years or more. The drug is well tolerated, from side effects, sometimes at the beginning of the reception, there is sluggishness, pasteurism, mastalgia, weight gain and decreased libido.

Spironolactone( veroshpiron) also has an antiandrogenic effect. It blocks peripheral receptors and the synthesis of androgens in the adrenals and ovaries, helps to reduce body weight. With a long intake of 100 mg.on the day there is a decrease in hirsutism. Side effect: a weak diuretic effect( in the first 5 days of treatment), lethargy, drowsiness. Duration of treatment - from 6 months to 2 years or more.

Flutamide is a non-steroidal antiandrogen used in the treatment of prostate cancer. The mechanism of action is based primarily on inhibition of hair growth by blockade of receptors and a slight suppression of the synthesis of T. Side effect is not noted. Assigned to 250-500 mg.per day for 6 months or more. After 3 months, marked clinical effect without a change in the level of androgens in the blood.

Gonadotropin releasing hormone agonists( zoladex, diferelin depot, buserelin, decapeptil) are rarely used to treat hirsutism. They can be prescribed at a high level of LH.The mechanism of action is based on blockade of the gonadotropic function of the pituitary gland and, consequently, of the LH-dependent synthesis of androgens in the ovarian cells. The disadvantage is the appearance of symptoms typical for the climacteric syndrome caused by a sharp decrease in the function of the ovaries. These drugs are rarely used to treat hirsutism.

The medical treatment of hirsutism is not always effective, so various types of epilation( electro, laser, chemical and mechanical) have become widespread.

Hyperandrogenia and chronic anovulation are observed with endocrine disorders such as adrenogenital syndrome, neuro-exchange-endocrine syndrome, Cushing's disease and hyperprolactinaemia. In this case, the ovaries develop morphological changes similar to the syndrome of polycystic ovaries, and there is a hyperandrogenism. In such cases, we are talking about the so-called secondary polycystic ovaries and the main principle of treatment is the therapy of the above diseases.