ABNORMAL HAIR GROWTH AND ACNE With your understanding from reading our earlier description of how abnormal, male pattern hair growth and acne may occur with PCOS, you can begin to understand the approach taken at our Los Angeles center to treating these conditions and dramatically improving the appearance of women with PCOS. As we have described, if high male hormone levels are the root of the evil in acne and excess hair growth with PCOS, lowering these abnormal levels back down to normal should be a major focus of concern in a center trating PCOS. And indeed, at our facility, we consoder the reversal of abnormal hormone values critical to the successful treatment of PCOS. The result? Over 94% of women at our center presenting with a complaint of excess hair growth report "dramatic" declines or a total halt to excess hair growth. HALTING EXCESS HAIR GROWTH At our center, women with excess hair growth ("hirsutism") associated with PCOS are placed on a fast track protocol aimed at diagnosing and correcting the hormone imbalances that are largely responsible for the abnormal hair production seen with PCOS. Within one to two visits, we will develop a full understanding of your problem, and where indicated, will offer you medical and cosmetic solutions that offer an extrememly high chance of dramatic improvement or a total halt to abnormal hair growth. It must be remembered that hair that has already developed as a result of years of abnormal hormone values will not disappear following the establishment of normal hormone values. New hair growth will be halted. So women that report to us having to wax or pluck or use electrolysis or laser to rid themselves of unwanted hair will find that, as the hormone levels normalize under treatment, less and less and finally little or no additonal hair removal will be needed. HOW IS HIRSUTISM TREATED  Rest assured there are a variety of medical and surgical treatments available to treat hirsutism.  Medical  Oral Contraceptives (Birth Control Pills)  Birth control pills are the most commonly suggested hormonal treatment for hirsutism.  Many reproductive age women take birth control pills to prevent pregnancy, but they also have benefits beyond pregnancy prevention.  Birth control pills work by decreasing the production of androgens, or male hormones, by the ovaries. Estrogen in the pills causes the liver to release more of a protein (sex hormone-binding globulin) that binds to androgens and reduces their action.  With less active hormones, symptoms of hirsutism and acne improve. In addition to slowing excessive hair growth, the pill regulates the menstrual cycle and protects against uterine pathology, such as cancer.  Antiandrogen medications  Spironolactone (Aldactone®) is a diuretic often prescribed in combination with birth control pills. It has been used to treat hirsutism because it directly blocks the effects of androgens in hair follicles. Some patients on spironolactone complain of dry skin, heartburn, headaches, irregular vaginal bleeding, and fatigue. About two-thirds of the women on high-dose spironolactone will have a significant decrease in hirsutism. Some birth control pills (Yasmin®, Yaz®) have estrogen and drosperinone, a hormone that works similarly to spironolactone, which combines the effects of the two medications.   Flutamide (Eulexin® ) is another antiandrogen medication which blocks the androgen receptors where the male hormones must bind to cause an effect.  As a result, flutamide minimizes the effect androgens have on the skin. Finasteride (Propecia®, Proscar®), which is often prescribed to men to prevent hair loss, works effectively in women with hirsutism by preventing testosterone from being broken down to more active androgens.  Each anitandrogen medication has their own benefits and safety profiles, but most important these medications are prescribed to women who are not pregnant, nor planning to become pregnant.  Steroid medications  In some situations, the excess male hormones are not coming from the ovaries, but another endocrine gland called the adrenal gland.  In patients who have an “overactive” adrenal gland, low doses of steroids may be prescribed to suppress their activity. Women taking steroids may experience dizziness during the day or have difficulty falling asleep, although these complaints generally improve after the first few days. These drugs may have serious side effects, including weight gain, thinning of the skin and bones, and decreased defense against infection. However, these side effects are seldom seen at the low doses used for treating hirsutism.  GnRH analogs  Severe forms of hyperandrogenism may be treated by medications called GnRH analogs (Lupron®, Synarel®, and Zolodex®). These medications treat hirsutism by suppressing ovarian androgens to very low levels. They also suppress estrogen and may cause menopausal-like symptoms. GnRH antagonists are also effective and may be approved for use for this purpose in the future. Cosmetic Therapy To optimize success, cosmetic removal of hair should always we accompanied by medical therapy. Temporary Hair Removal Plucking unwanted hairs for temporary treatment of mild hirsutism is often what most women resort to since it is the simplest and often most convenient way to get instant gratification. If only it were that easy!  Unfortunately plucking tears the hair from its living follicle and can irritate the skin. If the hair follicle or shaft becomes infected, the hair may curl into the skin and cause pimples or acne. Waxing carries the same risks of irritation and infection, especially in androgen sensitive areas. Depilatories are chemicals that dissolve the hair shafts and may cause irritation to sensitive facial skin. Bleaching can be used to make hair less noticeable in small areas of the body, particularly the upper lip.  Excessive bleaching may lead to irritation and skin damage. Shaving is probably the simplest and safest way to temporarily remove hair but requires frequent removal and may result in irritating stubble. Using an electric razor may lessen irritation. Shaving seldom has medical side effects. Eflornithine hydrochloride (Vaniqa™) is a facial cream that may be used in combination with the previously mentioned cosmetic therapies to slow the growth of excessive facial hair. Its safety in pregnancy or effectiveness on other body parts has not been established. Permanent Hair Removal There are two types of permanent hair removal: electrolysis and laser treatment. Electrolysis uses a very fine needle which is inserted into the hair follicle. A mild electric current is sent through the needle to permanently destroy the hair follicle's ability to produce hair. Since follicles are treated one at a time, it is somewhat impractical to use electrolysis to treat very large areas of the body. Laser treatments may be used on large areas of the body, although their longterm effectiveness is not as well documented as electrolysis. During laser hair treatment, a beam of light is passed through the skin to the hair follicle to destroy it. People with light skin and dark hair usually achieve the best results with laser hair removal. Both methods of hair reduction are moderately painful, depending on the area of skin being treated, and multiple treatments are usually required. Nevertheless, electrolysis and laser are very effective ways to remove unwanted hair. Without concurrent medical treatment, however, new hair will grow. It is best to delay laser or electrolysis treatment for at least six months after beginning medical treatment so that the growth of new terminal hairs will be reduced. Our center offers referrals to reputable electrologist and laser specialists who are happy to work with our patients knowing that the medical factors that can make their job more difficult are being controlled by the physicians at our center.  Home electrolysis kits rarely work because the follicle is so deep within the skin that it is difficult to treat. WHAT TO EXPECT FROM TREATMENT OF HIRSUTISM Hormone treatment generally prevents new terminal hairs from developing and may slow the growth rate of existing hairs. Generally about six months of hormone therapy is required before the rate of hair growth decreases significantly. Once a hormone treatment has proven to be effective, it may be continued indefinitely. Electrolysis or laser can remove any hair remaining after hormone therapy. Because it is usually not possible to cure the hormonal problem that causes hirsutism, ongoing medical treatment is required to manage it. Hirsutism will frequently return if medical treatment is stopped. Our center manages the ongoing hormone health of many, many patients that have been bothered by the effects of hormone imbalances and are now well controlled with the resulting excellent cosmetic responses usually seen while under our care.