Male pattern hair loss treatment. All about hirsutism

Some young girls and women suffer from unwanted hair growing on their face and body. This skin condition is called " ", which means the presence of male-type terminal (or terminal) hair in women. According to statistics, hirsutism is present in 5-10% of women. Some causes of hirsutism are well known - in most cases it is the result of hormonal dysfunctions, mainly an increase in the production of male hormones in a woman's body (produced by the ovaries and / or adrenal glands).

"Idiopathic" hirsutism occurs when the cause is not fully known. It is assumed that in this case it is inherited (transmitted genetically) in the family. Other than excess hair, these women do not show any of the symptoms associated with other types of hirsutism.

CAUSES OF IDIOPATHIC HIRSUTISM IN WOMEN AND GIRLS

Idiopathic hirsutism in women is a disorder associated with excessive and unwanted hair growth on the face and body. Hirsutism is usually due to one of three main causes:

1. Non-androgenic factors not associated with increased androgenic activity.
2. Excess male hormones.
3. Idiopathic hirsutism, the cause of which is unclear.

Since androgens are the main hormones that affect the stimulation and growth of hair, including in women, the most common cause of hirsutism is a violation of the production of male hormones. Idiopathic hirsutism is the second most common cause of hirsutism in women after polycystic ovary syndrome (PCOS), which in turn is associated with androgen dysfunction. Idiopathic hirsutism is, according to various estimates, from 5 to 17% of all cases of increased hairiness in women.

Idiopathic hirsutism can be defined as an excess of male-pattern hair growth in androgen-responsive parts of the body, while such girls and women do not have signs of endocrine or androgenic disorders. This type of hirsutism occurs with regular ovulation and a normal amount of male hormones in the blood.

For girls with excess hair on the body and / or face, one of the most important tasks is to conduct a through examination to distinguish idiopathic hirsutism from other forms of this disorder. While much more research needs to be done on its pathophysiology, women with this type of hirsutism could potentially have excessive peripheral action of 5a-reductase in the skin and hair follicles, other changes in androgen metabolism, or greater androgen receptor sensitivity.

Hair types, their life cycle

To better understand what hirsutism is, what are its types, signs and symptoms, you need to remember the life cycle of a human hair.

• Lanugo: These are soft, fluffy hairs (fluff) that form during the embryonic stage in the womb and are shed late in pregnancy or early postpartum.
• Vellus (vellus): unpigmented, soft and short hairs that occur on the surface of the body.
• Terminal: pigmented, dense, coarse and long hair that forms eyebrows, eyelashes, hair on the head, pubis, armpits.

The constant transformation and development of the vellus into terminal hairs is a normal physiological process driven by the male hormones testosterone and dihydrotestosterone (DHT, DHT) in androgen sensitive areas of the body. This cycle usually begins at puberty and continues through adulthood and gradually decreases with age and the decline of reproductive function in men and women.

The normal life cycle of hair consists of three alternating steps:

1. Anagen stage: growth.
2. Catagen phase: transitional period.
3. Telogen phase: rest, rest.

Typically, girls with idiopathic hirsutism do not show any symptoms until puberty, and increased hair growth may occur during adolescence. In this case, hirsutism is usually genetic (related to heredity). Familial hirsutism is a common and common occurrence in women of the Middle Eastern, Caucasian peoples. In most cases, these girls have normal regular periods.

Occasionally, obesity and/or insulin resistance is noted (in which case PCOS may be diagnosed). Most women with idiopathic hirsutism have normal androgen levels in their blood. In these cases, the main cause and / or hirsutism is due to the high sensitivity of the skin to normal levels of male hormones (enhanced action of 5 alpha reductase in skin and hair follicles).

Male sex hormones (androgens) are important in determining the type and distribution of hair on human body. Under the influence of androgens, the hair follicles that produce vellus hair can be stimulated and start producing final hair. Local 5a-reductase (5a-RA) activity largely determines the production of dihydrotestosterone (DHT) and hence the action of androgens on hair follicles.

The pathophysiology of idiopathic hirsutism is thought to be a primary increase in 5a-reductase activity and possibly an alteration in androgen receptor function. Such women respond well to taking or therapy with 5a-reductase inhibitors. Pharmacological suppression of ovarian or adrenal androgen secretion may be an additional, albeit limited, benefit. New therapies, such as laser hair removal, or the use of new biological response modifiers, may play an important role in providing more effective treatments for unwanted hair removal.

IDIOPATHIC HIRSUTISM: SYMPTOMS

The main symptom of idiopathic hirsutism in girls is excessive growth of terminal (terminal) hair in areas sensitive to androgen. However, menstruation (and ovulation) and circulating blood androgen levels remain normal. Moreover, studies on the idiopathic type of hirsutism have found an altered functioning of androgen receptors and a violation of their metabolism. About 40% of women with hirsutism also show signs of anovulation and are therefore diagnosed with PCOS rather than idiopathic hirsutism.

HIRSUTISM	The primary symptoms of idiopathic hirsutism are excessive terminal hair growth in androgen sensitive areas. The average value of the Ferriman-Gallway index is about 1-9 (usually above 6).
MENSES	Menstruation is usually regular with normal ovulation. This means that women with idiopathic hirsutism are not infertile.
MALE HORMONES	The content of androgens circulating in the blood remains unchanged (normal).
SKIN SENSITIVITY	Increased local activity of 5a-reductase. Experts believe that a genetic change in the function of androgen receptors and 5a-reductase is possible, which can affect the manifestation of hirsutism.

CLINICAL SCREENING FOR IDIOPATHIC HIRSUTISM

Women with idiopathic hirsutism should be diagnosed with the following medical tests:

• daily measurement of basal body temperature (diagram),
• blood tests for progesterone in the luteal phase, as well as DEA (DHEA sulfate, DHEAS), testosterone;
• tests for levels of 17-OH progesterone (follicular phase), cortisol, ACTH.

Idiopathic hirsutism is also often diagnosed in women by exclusion, when serum androgen levels and ovulation appear normal.

Ferriman-Gallwey scale and hirsut number

To correctly identify the type of hirsutism, it is very important to evaluate the Ferriman-Gallwey scale (Ferriman-Gallwey).

The Ferriman Index was originally developed for anthropological research and the clinical assessment of hair growth in women (1961) in four different degrees of severity on 11 body parts: face (above lip, chin), chest, upper and lower back, upper and lower abdomen, arms and forearms, legs. (Since 2001, experts have added several more areas to this list: sideburns, neck, phalanges of fingers and toes, upper surfaces of the feet, perianal region.)

The Ferriman-Gallway scoring system (Hirsut Number) is used by doctors to assess the amount of excess hair on a girl's body/face. The scoring chart for each body area examined starts from 0 (no excessive terminal/terminal hair growth) to 4 (extensive growth), all numbers add up to maximum number 36. While most physicians accept a score of 8 as the starting point for a diagnosis of hirsutism, some experts believe that a score of 6 is sufficient to indicate hirsutism. Based on this score and other clinical tests, hirsutism can be graded as mild, moderate, or severe (thus a hirsutism score below 6 may be considered normal).

While more objective instruments are available, they are complex, expensive, or difficult to use. The ease of use and low cost of the Ferriman-Gallway system make it a potentially attractive tool for widespread use by endocrinologists and gynecologists.

If you want to check your hirsutism level (hirsutism number):

1. Look at the image and select the distribution of hair growth in all 9 body parts shown.
2. Choose the appropriate score for each picture.
3. Add up all points. The total resulting amount will be your index, or hirsute number on the Ferriman-Gallway scale.

Results: transcript

1 to 9	Idiopathic hirsutism. Medical examination is not required. It is recommended to avoid excessive exposure to the sun and tanning.
10-16	Transitional stage. Further observation and evaluation of body hair growth over a period of 3-6 months is required. If growth is noted, see a doctor.
17-25	Hirsutism (a symptom of diseases). It is highly recommended to perform hormonal tests, identify the underlying cause of hirsutism and prescribe treatment.
26-36	Severe hirsutism (possible swelling). See a doctor urgently. Some tumors (such as those of the adrenal glands) can cause severe hirsutism.

TREATMENT OF IDIOPATHIC HIRSUTISM

Treatment of any kind of hirsutism should aim to stop or at least slow down the formation of new terminal hairs. The duration of treatment will be determined by the rate of hair growth in accordance with the phases of their life cycle. It takes at least 6 months of therapy to see some positive results.

As a rule, the treatment procedure should include three stages:

1. Suppression of excessive androgen production, if this is the cause of hirsutism in a woman (in the case of polycystic ovaries).
2. Peripheral blockade of androgens with antiandrogen drugs (if necessary).
3. Mechanical/cosmetic removal of unwanted hair.

The various permutations and combinations of this tripartite treatment for hirsutism in women are as follows: oral contraceptive pills (COCs, OCs), antiandrogens, and spironolactone block androgenic activity in the hair follicles. Flutamide and finasteride have similar results. and pioglitazone improve insulin sensitivity, which can also help treat hirsutism and acne (if a woman has insulin resistance). Cosmetic and mechanical hair removal consists in their lightening or chemical depilation, plucking, waxing (waxing), sugaring, shaving and procedures with a longer effect, for example, electrolysis, etc.

In some cases, natural remedies (such as peppermint tea) can be quite effective in treating hirsutism.

Failures in the work of the endocrine system in women can take the form of hirsutism. The disease not only seriously reduces self-esteem, but threatens infertility.

Women take their appearance seriously. Any pimple can make her doubt her own attractiveness. And if a thick mustache grows above the lip, then it is generally difficult for her to be in the spotlight. With hirsutism, active hair growth is observed not only above the lip, but also on the chin, chest, back, hips and buttocks.

The disease takes many forms, but the extent of its impact on a woman's life is enormous. In addition to problems with self-esteem, the disease also causes some deviations in the natural work of the female body. The only positive feature of hirsutism is its reversibility.

What is hirsutism?

This disease has an exclusively female face. Its occurrence is promoted by an increase in male hormones androgens in female body.

Usually it is necessarily accompanied by other failures of the endocrine system, which is expressed in:

• irregular menstrual cycle,
• acne development.

The main problem is considered to be the appearance of coarse dark hair on the body; in the stage of progression of hirsutism, they become so noticeable that they cause discomfort and embarrassment when they appear in public. The hairs immediately grow long, hard and dark.

It is important not to confuse hirsutism with hypertrichosis. In the latter case, active hair growth occurs only in those parts of the body where it is supposed to. For example, hair grows thickly not only on a man’s chest, but also wraps his shoulders in warm wool. Hirsutism involves the appearance of hair in places where it should not be, for example, on the female breast.

A gynecologist or an endocrinologist can make such a diagnosis, but it is recommended to contact both to clarify the course of treatment and possible negative consequences, to exclude the possibility of complications.

Symptoms of hirsutism

The body of a woman is usually covered with thin light and soft hairs (vellus). They are natural. If they suddenly try to replace the terminal hairs, which are characterized by high density and rigidity, then this is an occasion to think about a visit to the doctor.

Here are a few important details to keep in mind:

• The appearance of dark hair in Asian or Caucasian women is not necessarily associated with hirsutism.
• Rise of the dark long hair on the knees or hands is not associated with this disease.

Causes

Experts usually identify only four factors leading to the development of the problem:

1. Hereditary. Genetic features are necessarily associated with a change in the chromosome set in several generations of women in the same family. Most often, a similar phenomenon is observed in women from the Caucasus and the Mediterranean.
2. The result of taking medications. In some cases, it is impossible to exclude the use of drugs, the side effect of which is a change in the amount of androgens. This group includes corticosteroids in the form of Cortisol or Hydrocortisone; minoxidil and cyclosporine; Interferon and Streptomycin; Diacarb and Diazoxide. Oral contraceptives are dangerous because of the progestins they contain. The latter are distinguished by their androgenic action.
3. Hyperandrogenism. An unnatural acceleration of the process of androgen production can occur as a result of ovarian neoplasms (cyst, hyperthecosis, chronic anovulation), adrenal dysfunction (tumors of the adrenal glands, hyperplasia of their cortex), dysfunction of the pituitary gland (acromegaly, Itsenko-Cushing's syndrome).
4. Age and physiological changes in the body. A woman has to go through several serious life stages, accompanied by a serious change in hormonal levels. It can be puberty, pregnancy, postmenopause.

What can provoke

In the absence of timely treatment, the disease can take serious forms, because not only the hair follicles, but all internal systems are affected.

Seeing a doctor for an examination with unnatural hair growth is necessary to prevent:

• voice changes to low and rough, masculine;
• the appearance of bald patches on the temples;
• breast reduction;
• development of infertility as a result of partial atrophy of the uterus and ovaries;
• enlargement of the clitoris with a change in sexual interest;
• muscle enlargement with simultaneous breast reduction;
• chronic disruptions of the menstrual cycle.

Forms and types of disease

• constitutional. An increase in the amount of facial hair in this case is usually associated with physiological changes, including age-related, as well as with hereditary characteristics. It is noteworthy that as a result of laboratory blood tests, it is often not possible to isolate an increased content of androgens. For these women, this condition is a natural behavior of the body.
• Idiopathic. This is what the diagnosis looks like when it is impossible to accurately determine the cause of the disease. The study of blood serum reveals high level free testosterone.
• Exogenous. It is associated with the need to introduce androgens into the body. For example, in the treatment of certain diseases.

Hirsutism and pregnancy

• Moderate and severe forms of the disease exclude the possibility of pregnancy.
• Changes that occur in the body throughout the development of hirsutism lead to the absence of ovulation.
• If you still managed to get pregnant, then the risk of miscarriage is early term big enough. A large number of male hormones prevent the tight fixation of the fetal egg in the uterus. This requires the presence of a sufficient amount of female hormones produced by the ovaries, and androgens interfere with this process. The risk decreases only at week 14, when the placenta is able to independently produce enough progesterone to balance the entire system. Mommy can relax for a while. At week 16, hormones produced by the fetal adrenal glands begin to enter the mother's body. They also differ in androgenic activity. The result of such activity is a pathology in which the cervix does not have enough strength to hold the fetal egg.
• There is another danger of hirsutism during pregnancy. Changes caused by male hormones can stop the process of uterine enlargement while the fetus continues to grow.

Diagnostics

To confirm the diagnosis of hirsutism, the patient must donate blood to study it for the concentration in it:

• testosterone;
• cortisol;
• dihydroepiandrosterone;
• androstenedione.

In the future, the results obtained are used to establish the cause of the pathology that has arisen:

• An increased amount of testosterone is usually associated with the presence of tumors. In this case, an additional examination is prescribed, including ultrasound of the ovaries and magnetic resonance imaging of the adrenal glands and brain. The purpose of the event is to detect the tumor.
• Dihydroepiandrosterone is an indicator of the work of the adrenal glands.
• Cortisol in large quantities warns of the possible presence of Cushing's syndrome.

Methods of treatment

Before starting treatment, you should consult with your doctor, go through all the necessary studies, determine the cause of the disease and exclude contraindications for treatment.

There are several options to solve the problem:

Drug

It is not customary to prescribe medications for mild forms of the disease. Before prescribing a drug, the doctor needs to make sure that the patient does not have a tumor that provokes the production of androgens.

A well-conducted preliminary examination helps not only to establish the cause of the disease, but also to adjust the medication course. In the case of hyperandrogenism, drugs are selected that reduce the sensitivity to androgen in the hair follicles, which suppress the activity of testosterone.

In case of violations of the adrenal glands or ovaries, they turn to hormonal drugs. It should be noted that in this case, you should not count on getting a result earlier than in 3-5 months.

Overview of drugs:

• If the occurrence of hirsutism is associated with a malfunction of the adrenal glands, the attending physician may prescribe Prednisolone, Cortisol, or Dexamethasone.
• If the reason lies in the malfunction of the ovaries, then resort to hormonal drugs in the form of oral contraceptives, such as Jeanine or Diane-35. Aldalactone and Clomiphene can also be included in the course of treatment.
• Antiandrogens should not be taken during pregnancy. To increase their effectiveness, if the patient is overweight, she needs to switch to a diet that limits carbohydrate intake. Vivid representatives of this group of drugs are Veroshpiron and Cyproterone acetate.
• To return testosterone to its active form, drugs such as Finasteride are used.
• Leuprorelin, Goserelin or Buserelin can be used when the disease appears under the influence of hypothalamic hormones.
• If the disease develops against the background of type 2 diabetes mellitus, then Rosiglitazone or Metformin must be used in the treatment.

Cosmetological

The drug method of treatment is aimed at eliminating the cause of the onset of the disease, and as a result, stopping the growth of new hair. Various secrets of cosmetology help to cope with the existing ones.

To get rid of unwanted vegetation, women use bioepilation using wax, lightening, chemical exposure:

• Chemical depilation allows you to cope only with moderately pronounced signs of the disease. Against thick and very coarse hair, she remains powerless. Various depilatory creams are usually used to treat areas of skin on the face. That is why you should not neglect the preliminary sensitivity test. With hirsutism, a woman is absolutely contraindicated in using chemicals that cause an allergic reaction.
• Lightening and bioepilation are often traumatic methods of hair removal for the skin. With sensitive skin, it is recommended not to resort to such radical methods.
• Electrolysis, laser hair removal and photoepilation. Each of these methods means a direct impact on the hair follicle in order to stop further hair growth. Existing hair dies. Beauty salon experts, financial opportunities and their own preferences, combined with the presence of contraindications to one or more procedures, help a woman choose the method that is right for her.

Homeopathic

No herbs are able to get rid of the disease and provide a long-awaited pregnancy without the appointment of an experienced homeopathic doctor. It takes into account the state of the woman's body, her psychological and emotional state, age, and even the characteristics of everyday life.

It is important to choose not only a list of necessary herbs, but also their dosage. A pharmacist in a pharmacy cannot cope with the last point.

With an appeal to traditional medicine and healers

Alternative medicine cannot be used as the only method of treatment. The action of this method is aimed at getting rid of unwanted vegetation in a gentle and at the same time economical way, as well as the gradual restoration hormonal background with phytoestrogens.

Treatment with folk remedies

To provide her body with the necessary amount of phytoestrogens, a woman should pay attention to:

• boron uterus;
• soy products;
• Red clover;
• liquorice root;
• hop.

Regular inclusion of them in combination or separately in your diet as an ingredient in tea, decoction or dish will help in the fight against the disease.

In the fight against hairline, traditional medicine suggests using the method of gradual lightening and thinning of hair. Hydrogen peroxide or green walnut juice can be used for this.

Self-treatment at home

A woman will not be able to cope with the disease without consultation and direct observation of a specialist. At home, it can only ensure the effectiveness of other treatments.

To do this, she needs:

• pay attention to your own weight, seriously deal with its adjustment if available extra pounds. Diets that exclude easily digestible carbohydrates from the diet are extremely effective.
• give up nicotine and alcohol in favor of the natural functioning of all body systems.

1. Often women try to get rid of unwanted body hair in an emergency way. One of them is shaving. It's not worth the risk. Shaving inevitably causes skin irritation, causing the growth of coarser and thicker hair. At the same time, their growth rate will be noticeably higher compared to those already removed. In the future, you will have to make a lot of efforts to get rid of them.
2. Plucking thick hair can leave ugly scars on the skin, and also provokes irritation of neighboring skin areas. It should not be forgotten that this way Good for small amount of hair.
3. No methods of depilation or epilation will help cure hirsutism because the appearance of hair is just the tip of the iceberg. Without eliminating the cause itself, it is foolish to count on positive result and the absence of complications.
4. None of the treatment methods is capable of such a high result as an integrated approach. The combination of traditional medicine with natural remedies helps to reduce the side effects of chemicals.
5. To remove hair in this disease, it is recommended to spend money on electrolysis. The essence of the method is reduced to the impact of current on each hair follicle. The hair itself falls out, its further growth is not possible. At the moment, this is the only method that allows you to get rid of hair forever. In a severe form of the disease, it is extremely difficult to cope with dense vegetation in another way.

Hirsutism is excessive male pattern hair growth in women, manifested by the appearance of a mustache and beard, excessive hair growth on the trunk and limbs, mainly associated with an increase in the concentration of androgens (male hormones) in the blood.

Hirsutism is often associated with menstrual irregularities and infertility. In the future, there may be an increase in muscle mass, an increase in the clitoris, baldness at the temples, a coarsening of the voice and an increase in sexual desire. In addition, signs of defeminization may appear (for example, a decrease in the size of the mammary glands and the cessation of the formation of vaginal lubrication).

Causes of hirsutism

• Precocious puberty, menopause
• Idiopathic hirsutism (idiopathic androgen excess syndrome) is a poorly understood but commonly observed condition characterized by mild hirsutism, acne, and irregular menstruation without significant hormonal abnormalities.
• Taking medications (phenytoin, hexachlorobenzene, glucocorticoids, progestins, anabolic drugs, androgens).
• Disorders of adrenal origin (congenital or acquired adrenal hyperplasia, adrenal tumors)
• Disorders of ovarian origin (polycystic ovaries, androblastoma, granulosa cell tumor, luteoma of pregnancy, hyperthecosis, chronic anovulation, amenorrhea)
• Disorders of pituitary origin (Itsenko-Cushing syndrome, acromegaly)
• Genetic and chromosomal abnormalities

Diagnostics

Diagnosis of hirsutism is carried out by an endocrinologist using special research methods:

• Serum testosterone. The content of total testosterone less than 200 ng / ml (decreases when taking oral contraceptives or prednisone) is usually due to polycystic ovaries. A total testosterone concentration greater than 200 ng/mL suggests the presence of a tumor.
• Serum dehydroepiandrosterone sulfate (DHEAS) is an indicator of the secretory activity of the adrenal glands. A concentration above 700 ng / ml, which decreases with dexamethasone, indicates hyperplasia of the adrenal cortex. Elevated levels of DHEAS that do not decrease with dexamethasone suggest an adrenal tumor.
• Serum androstenedione: an increase in androstenedione indicates ovarian disease
• Serum 17-hydroxyprogesterone is elevated when various enzymes are deficient (eg, 21-hydroxylase, seen in congenital adrenal hyperplasia
• Cortisol: an increase in serum cortisol concentration occurs in Itsenko-Cushing syndrome
• Gonadotropins: A relative increase in the luteinizing hormone (LH)/follicle stimulating hormone (FSH) ratio is indicative of polycystic ovaries.

Treatment of hirsutism

• Removal of ovarian or adrenal tumors
• Stopping medications that promote hair growth
• Suppression of androgen production in the adrenal glands with prednisone or dexamethasone
• Treatment of Itsenko-Cushing syndrome, hypothyroidism or acromegaly
• Drug therapy for hirsutism is carried out after exclusion of androgen-secreting tumors.
• Oral contraceptives with antiandrogenic properties (eg, Diane-35, Janine) are the drugs of choice for idiopathic or ovarian-related hirsutism. The concentration of testosterone in the blood decreases within 1-3 months, which is accompanied by an improvement. With contraindications to taking oral contraceptives, medroxyprogesterone is prescribed at a dose of 150 mg intramuscularly every 3 months. Contraindication for all drugs is pregnancy.
• Antiandrogenic drugs (prescribed when oral contraceptives are ineffective) are less effective and cause more side effects. Spironolactone (100–200 mg/day): The therapeutic effect develops slowly, side effects-increase in urination volume blood pressure, uterine bleeding; contraindicated in pregnancy. Cyproterone (50 mg 2 r / day): usually the drug is taken together with estrogens; during treatment, breakthrough bleeding, decreased libido and depression occur; contraindicated in pregnancy.
• Ketoconazole at a dose of 400 mg / day; contraindicated in pregnancy

Forecast

It may take 6-12 months of treatment to noticeably reduce excess hair growth. With long-term treatment of hirsutism, the prognosis for the cessation of new hair growth is good, but for the elimination of existing ones, it is doubtful. The goal of treating hirsutism is to stop new hair growth, not to remove old hair. After the appearance of coarse dark hair, a decrease in the content of androgens will not affect the nature of hair growth. Treating hirsutism will not completely get rid of excessive hair growth, although it will slow down the rate of hair growth.

Shaving hair is undesirable. this will lead to the need for daily shaving. Hair removal chemicals often cause skin irritation and may also require daily use. Epilation with wax provides a longer effect compared to shaving and chemical products. With moderate hirsutism, hair bleaching is effective. It is undesirable to pluck long hair, as this often leads to scarring.

A radical additional measure is electrolysis, which causes the destruction of hair follicles (disadvantages - high cost, pain and long duration of the procedure).

The best long-term results are obtained by a combination of hormonal and additional treatments for hirsutism.

Hirsutism - excessive growth of hard pigmented hair in women on the face and body in a male pattern. The appearance of coarse rod hair in certain areas - above the upper lip, chin (like a mustache and beard), on the back, abdomen, hips and other androgen-dependent areas that are highly sensitive to male sex hormones, causes cosmetic problems, accompanied by development in women psychological complexes.

Hirsutism occurs in 5-10% of women of childbearing age. Its severity is sometimes so great that patients resort to mechanical removal of excess hair. Hirsutism is not an exclusively cosmetic problem, on the contrary, it is often a sign of serious diseases of the endocrine system, and therefore requires careful examination, monitoring and correction by a gynecologist and endocrinologist.

It is necessary to differentiate hirsutism from hypertrichosis, which develops against the background of a number of diseases (hypothyroidism, anorexia, a reaction to taking a number of medications, etc.) and is characterized by total excessive hair growth, not limited to androgen-dependent areas.

Causes and mechanism of development of hirsutism

There are 3 types of hair:

1. primordial fluff- thin delicate hairs on the body that appear and disappear during the period of intrauterine development of the fetus. You can see them only in newborns born prematurely.

2. vellus hair- thin blond hair, the length of which does not exceed one or two centimeters.

3. terminal hair- hard rod hair with pronounced pigmentation. Short stiff hair forms eyelashes and eyebrows, and long ones grow on the head, in the armpits and external genitalia, and in men also on the face, chin, back, and abdomen.

Vellus hair is transformed into rod hair due to the influence of male sex hormones. In girls and adult women, androgen-dependent hair growth on the pubic and in the armpit area is considered natural. Hair growth of the shins and forearms is not associated with the influence of androgens. The amount and quality of hair on a woman's body depends on a number of factors, such as ethnicity, the level of sex hormones, and the degree of skin resistance to androgens.

Being the direct precursor of estrogens - female sex hormones, androgens in the female body are produced in the ovaries and adrenal glands, and determine the level of development of sexual desire, hair growth of the external genitalia, muscle building, bone growth in adolescence and the closure of growth zones. In order for the ovaries to function normally, a very important role belongs to the level of androgens.

Peripheral tissues are affected by testosterone and dihydrotestosterone. It is these hormones that contribute to the growth of coarse pigmented hair. Androgens, in turn, lengthen the phase of activity of the hair follicle, increase its size and hair diameter, and also increase the production of secretions by the sebaceous glands of the scalp and face. As a result of this influence of androgens, zonal changes in hair growth are observed, namely, hair falls out of the scalp, and in androgen-dependent areas of the body, their number increases sharply.

Increasing androgen production may be seen with:

- functional disorders of the female gonads- polycystic ovaries, tumor processes in the ovaries, amenorrhea of ​​the hypothalamic nature, etc. At the same time, there is a failure in the frequency of menstrual flow, infertility and an increase in the ovaries. This is the most common cause of hirsutism;

- functional disorders of the adrenal glands as a result of congenital or acquired pathology of the cortex, or due to a tumor of the adrenal glands;

- functional disorders of pituitary function, which is observed in acromegaly, prolactinoma, Itsenko-Cushing syndrome.

Hyperandrogenism in women can develop as a result of taking a certain group of drugs (corticosteroids, anabolics, interferon, streptomycin, androgens, etc.)

Hirsutism can also be hereditary, and more often it is detected in representatives of the Mediterranean and Caucasian ethnic groups, less often in Asians and European women.

If the cause of hirsutism is not identified, they speak of idiopathic androgen excess syndrome, which is characterized by increased sensitivity to it of the receptors of the skin and hair follicles. This form of hirsutism is also one of the most common and occurs in a quarter of all hirsutism visits. At the same time, the ovulatory function does not suffer, the menstrual cycle and the function of childbearing are preserved.

Diagnosis of hirsutism

If patients complain of excessive body hair, first of all it is necessary to find out whether it is pathological in this particular case, or is associated with ethnicity or personal perception. The next step is to differentiate hirsutism from hypertrichosis based on anamnestic and objective data.

Since hirsutism may indicate hyperandrogenism, attention should be paid to the presence of such signs as menstrual irregularities (oligomenorrhea or amenorrhea), infertility, acne, low timbre of voice, the presence of bald patches or the absence of hair on the head, an increase in muscle mass, increased sexual desire.

An analysis of the anamnestic data will make it possible to find out whether the patient's mother during pregnancy took certain medicines, which can contribute to the androgenization of the fetus, are there cases of hirsutism in the family, what drugs did the patient herself take, at what age did hirsutism appear, etc.

On examination, the severity of hirsutism is assessed according to the modified Ferriman-Gallway scale, which allows you to assess the prevalence of coarse hair in nine androgen-dependent zones - the upper lip, chin, shoulders, chest, upper and lower abdomen, back, lower back, hips. The assessment is made on a five-point scale, and the overall severity of hirsutism can vary between 0-36 points. If the indicator is 8 points or higher, then we can talk about the presence of hirsutism.

Pay attention to the physique, calculate the body mass index. Other signs of androgen excess are revealed - baldness, purple stretch marks on the abdomen, chest and thighs, oily seborrhea and acne, hyperpigmentation. A gynecological examination will reveal changes in pubic hair, assess the size of the clitoris, and increase the pigmentation of the inner thighs.

With an average and severe level of hirsutism, especially with its rapid progression and combination with other symptoms such as menstrual irregularities, clitoral enlargement, obesity, laboratory tests should be performed to determine the content of total testosterone in the blood serum, an increase in which may indicate a tumor process in the ovaries , and a decrease relative to the norm may indicate polycystic ovary syndrome. To identify the cause of hirsutism, it is mandatory to analyze the determination of hormones of the adrenal cortex, which makes it possible to suspect hyperplasia or tumor pathology of the adrenal glands. An increase in the level of cortisol in the blood serum may indicate Itsenko-Cushing's syndrome. To differentiate this disease, a small and large test with dexamethasone is also carried out.

In addition to laboratory studies, to clarify the cause of hirsutism, ultrasound or computed tomography of the pelvic organs and adrenal glands, magnetic resonance imaging of the brain is recommended. To exclude tumors in the ovaries, diagnostic laparoscopy is performed.

How to treat hirsutism?

Since hirsutism is not an independent disease, but is a symptom that accompanies various diseases of an endocrine nature, its treatment is primarily aimed at reducing the production of androgens and correcting the consequences of hyperandrogenism, which is primarily associated with the elimination of the root cause that caused the underlying disease. These can be tumor processes of the adrenal glands and ovaries, which are subjected to removal. With Itsenko-Cushing's disease, surgery is performed on the pituitary gland. If polycystic ovary syndrome is not corrected by conservative methods, laser vaporization of the ovaries is used.

Drug therapy for hirsutism is effective after removal of tumors that stimulate androgen synthesis. Since hirsutism in the vast majority of cases occurs due to excessive production of androgens, it is effective to prescribe drugs - antiandrogens: spironolactone, finasteride, flutamide, drugs that suppress testosterone levels and affect the sensitivity of hair follicles to androgens.

The most popular drugs for the treatment of hirsutism are currently considered combined oral contraceptives (Diana-35, Janine, Yarina, etc.), the progestogen component of which suppresses the production of androgens by the ovaries, and the estrogen component increases the level of the hormone that binds sex hormones, thus reducing free testosterone and its binding to androgen receptors. Treatment with these drugs is carried out for several months, and the cycle of administration sometimes has to be repeated. Oral contraceptives prevent the appearance of new hair, but do not reduce existing ones.

Along with them, for local therapy of hirsutism, creams are used, which include eflornithine hydrochloride - Vanica, Eflora, which slow down the growth of facial hair.

In addition to the above, there are also cosmetic methods for the treatment of hirsutism, due to which excess hair is removed or masked. Such methods include lightening hair with a solution of hydrogen peroxide, instrumental plucking, shaving, and waxing. Depilation and shaving do not have a lasting effect, so they are resorted to only in extreme cases. Most effective methods getting rid of unwanted hair with hirsutism are photoepilation and laser hair removal, during which the destruction of hair follicles occurs, and the growth of new hair in these areas becomes impossible.

• polycystic ovary syndrome

  Polycystic ovary syndrome is an endocrine pathology of the female body, which is characterized by a violation of the menstrual cycle with the absence of the ovulatory process and, as a result, an increased level of male sex hormones - androgens

• Viril Syndrome

  Virilism syndrome (virilism) - a symptom complex characterized by the appearance in females of secondary sexual characteristics characteristic of the male body

• Androsteroma

  Androsteroma - a tumor originating from the reticular zone of the adrenal cortex and characterized by excessive production of androgens

• Polycystic ovaries

  Polycystic ovaries is an endocrine syndrome that is accompanied by pathological changes in the functioning of the ovaries, pancreas, adrenal cortex, as well as the pituitary and hypothalamus.

• Consultation of a gynecologist-endocrinologist

  A gynecologist-endocrinologist is one of the most sought-after specialists at the North-West Endocrinology Center. Consultations of a gynecologist in St. Petersburg are among the most popular, and consultations of a gynecologist-endocrinologist are especially popular. The vast majority of diseases that bring women to a consultation with a gynecologist have the causes of their problems in the disrupted functioning of the endocrine system. That is why many patients who seek help at the endocrinology center need a consultation with a gynecologist-endocrinologist, and in some cases, also with a consultation with an endocrinologist.

• Ultrasound of the retroperitoneum and kidneys

  Due to their position, the kidneys are clearly visible on ultrasound. This anatomical position makes the ultrasound of the kidneys the main method for assessing their size, location and internal structure. It is safe to say that 99% of all kidney diseases (urolithiasis, kidney cysts, kidney tumors) are diagnosed with ultrasound. Additional techniques (urography, computed tomography) are usually used as clarifying techniques that allow the most complete description of the nature of changes in the kidneys. However, it is ultrasound of the kidneys that is the first and main diagnostic method - largely due to its availability, safety and complete painlessness.

• Analysis for dihydrotestosterone

  Dihydrotestosterone (DHT) - an active natural androgen (a steroid hormone that regulates the development of male sexual characteristics, the functioning of the prostate gland)

• Analysis for androstenedione

  Androstenedione is formed in the cells of the testicles, ovaries and adrenal glands, later in the gonads it turns into the sex hormone testosterone

- this is an excessive growth of rod hair in women, due to male sex hormones - androgens.

There are two types of hair in humans: vellus and rod. Cannon hair grow from the same type of hair follicles. By its structure, vellus hair is delicate, thin and short. rod hair they sprout from a different type of hair follicles. This type of hair is pigmented, the hairs are hard, coarse, thicker. Under the influence of male sex hormones, hair follicles (follicles) of the first type can turn into follicles of the second type, and, accordingly, stiff hair of the rod type will already grow from them.

Where does hair normally grow in women?

Where do adult normal women grow rod hair on the body? First of all, such rod hair is presented on the scalp and eyebrows. Associated with the action of androgens, such hair grows in the armpits and on the pubis. The growth of rod hair on the shins and forearms is considered to be unrelated to the effects of male sex hormones. The appearance of the growth of rod hair on other parts of the body can be regarded as hirsutism.

The difference between hirsutism and hypertrichosis (excessive hair growth)

It should be noted that hirsutism must be distinguished from excessive hair growth ( hypertrichosis). Hypertrichosis in contrast to hirsutism, it is characterized by increased growth of vellus hair. This growth vellus hair is not associated with the action of androgens and may be the result of various metabolic and endocrine disorders (for example, with insufficient thyroid function), taking certain medications (minoxidil and others), and, finally, hereditary and constitutional features. The exception is the so-called idiopathic hirsutism, which is not related to hormonal imbalance. I must say that a slight growth of hair on the upper lip, around the nipples, along the midline of the abdomen from the pubis to the navel or just above the navel, is often noted in endocrinologically healthy women.

The relationship of hirsutism and hyperandrogenism (increased levels of male sex hormones in the blood)
Hirsutism is one of the most persistent and often one of the earliest symptoms of hyperandrogenism.

Hyperandrogenism- This is a state of the body in which there is an increase in the level of concentration of male sex hormones (androgens). That is, the concept of hirsutism is closely related to the concept of hyperandrogenism. Hyperandrogenism is the result of significant disturbances in the complex system of regulation of sexual function, including the hypothalamus, pituitary gland, ovaries and adrenal glands.

What can hyperandrogenism lead to?

This condition is usually accompanied by a number of consequences and complications, including, in addition to hirsutism, menstrual irregularities, metabolic disorders, miscarriage, and quite often infertility. Most common cause lack of ovulation in women suffering from infertility is hyperandrogenism. Depending on the age at which the factors leading to hyperandrogenism begin to act, various clinical manifestations of the disease develop. These manifestations vary from violation and lengthening of the second phase of the menstrual cycle to chronic absence of ovulation in combination with hirsutism, all kinds of metabolic disorders, miscarriage and infertility. In addition to violations of the sexual and reproductive functions, hyperandrogenism can lead to the development of pathologies of various, non-genital organs. This condition significantly increases the risk of developing breast cancer, uterine mucosa (endometrium), diabetes mellitus, arterial hypertension, myocardial infarction.

How common is hirsutism?
Among the adult population, the incidence of hirsutism is 25-30% (with the exception of Asians and residents of northern countries). Hirsutism is not always associated with androgenism. However, the presence of hair growth on the back, shoulders, chest, and upper abdomen may indicate that in this case, hirsutism is accompanied by hyperandrogenism.

The main causes of facial hair in women

Hormones are the main reason.
Since the increased growth of body hair is often accompanied by other skin changes, namely, an increase in its fat content, as well as the appearance of blackheads, pimples and seborrhea, women often turn to a dermatologist or cosmetologist for help. The described skin manifestations are regarded by these specialists as hyperandrogenic dermatopathy. However, many studies show that patients with hyperandrogenism are treated for a long time and often without effect by general practitioners, dermatologists, endocrinologists, gynecologists, pediatricians and neuropathologists. What is the reason for this state of affairs? It's all about a very large variety of clinical manifestations of the disease.

Types of hormones that cause facial hair in women
The fact is that determining the source of increased androgen production is rather difficult. The situation is complicated by the fact that androgens in the female body are produced by both the ovaries and the adrenal glands. And the hormones produced by the ovaries and adrenal glands have similar clinical effects.

What organs and under what diseases is an excess of hormones formed in hirsutism?

Why does such a failure occur and the ovaries or adrenal glands begin to produce androgens in an increased amount? In other words, what are the main causes of hyperandrogenism? There is a so-called adrenal androgenism And ovarian.

1. - due to increased synthesis of androgens by the cortical layer of the adrenal glands, which occurs with congenital hyperplasia of the adrenal cortex. This state of hyperplasia of the adrenal cortex is observed in the following pathologies:

• congenital adrenogenital syndrome
• precocious puberty
• congenital dysfunction of the adrenal cortex
• hormone-producing tumors of the adrenal cortex

1. Ovarian hyperandrogenism due to increased production of androgens various types polycystic ovary syndrome (PCOS), as well as androgen synthesis by hormonally active ovarian tumors.

In addition to ovarian and adrenal androgenism, there are two more types of this pathological condition, which are also associated with increased androgen production. However, the increase in synthetic activity is not due to direct damage to the ovaries or adrenal glands. These types of hyperandrogenism include the following:

1. Hyperproduction of androgens caused by damage to various central levels of regulation of the reproductive system. Such central regulators of the reproductive system, localized in the brain, include the hypothalamic-pituitary system. Due to damage to the work of the hypothalamic-pituitary system, such pathological conditions develop as: Itsenko-Cushing's disease, Morgagni-Stuart-Morel syndrome and others.
2. Hyperandrogenism caused by a violation of the metabolism of male sex hormones in peripheral tissues (skin), as well as a violation of the androgen-hormone receptor interaction in the skin.

What are steroid hormones? Where and from what are steroids synthesized?

For a better understanding of the processes occurring in the body with an excess of androgens, we will consider the general concepts of what androgens are, the mechanism and sites of their synthesis, as well as the biological effects of male sex hormones.
Androgens are steroid hormones. Steroid hormones, in addition to androgens, include estrogens and corticosteroids (adrenal hormones). The main representatives of androgens are testosterone and androstenedione. Steroid hormones are produced by the testicles, ovaries and adrenal glands. These glands have a common embryonic origin. Subsequently, during embryonic development during pregnancy and complex stages of development, each of the mentioned glands (testicles, ovaries, adrenal glands) begins to specialize in the predominant synthesis of one of the types of steroid hormones - estrogens, androgens or corticosteroids. Estrogens and androgens are synthesized from a common precursor for all steroid hormones - cholesterol.

The entire process of formation of each steroid hormone in the whole chain of synthesis is controlled by a strictly defined set of enzymes. Due to this control, differences in the form of the synthesized steroid, which predominate in the ovaries, testicles, adrenal glands, begin to appear already at the stage of development of the gonads (testicles and ovaries) and adrenal glands during embryonic development in the womb.
Both the ovaries and adrenal glands, as well as peripheral tissues, contribute to the production of male sex hormones, producing androgens in various quantitative ratios.

Where and how are androgens formed in ovaries?

The main process of androgen synthesis occurs in the stromal tissue of the ovary, and in the cells of the thecal membrane of the follicles at certain stages of follicle development. Androgens are formed from progesterone, with subsequent transformation into cholesterol. From the androgens themselves, estrogens are synthesized, which enhance the growth of the follicle, and lead to the formation of a dominant follicle. The significance of androgen synthesis by the stromal component of the ovary is especially well manifested during the period of extinction of the menstrual function, when the so-called “cellular” component of the ovaries, a set of follicles at different stages of their development, is reduced.

With hyperplasia of the ovarian stroma or the occurrence of a hormone-forming tumor, testosterone begins to be synthesized in increased quantities.

Where and how are androgens produced in the adrenal glands?

The main adrenal androgens are dehydroepiandrosterone and dehydroepiandrosterone sulfate. Adrenal androgens begin to form in the adrenal glands of the fetus during intrauterine development. The site of androgen synthesis is the reticular zone of the adrenal cortex. If before the period of puberty, this zone is poorly developed, then in the period from 5 to 10 years, its intensive development occurs with the production of androgens and the manifestation of secondary sexual characteristics (armpit and pubic hair).

What effects do androgens produce on peripheral tissues?

Hormones exert their influence in those places where there are receptors for them. Androgen receptors are present in the structures of the central nervous system, the male reproductive tract, bones, muscles, sebaceous glands of the skin, hair follicles and the mammary gland.

It is believed that testosterone, together with estrogens at the level of the central nervous system, affects sexual desire (libido). Androgens have an effect on the mammary gland that is opposite to the action of estrogens, as a result of which the gland tissue does not develop enough. This picture is observed in women who had an excess of androgens at the beginning of puberty (for example, with hyperplasia of the adrenal cortex).
The influence of androgens leads to an increase in muscle mass, growth tubular bones in length, increasing bone density.

The target of androgens in women is the skin. As a result of exposure to hair follicles localized on the face and body, delicate vellus hair turns into coarse and coarse, pigmented hair.
As mentioned above, hyperandrogenism is not an independent disease. It is part of a complex of metabolic metabolic disorders, which is inherent in a particular pathological condition. And hirsutism, we repeat, is the most characteristic manifestation of increased production of androgens.

Polycystic ovary syndrome (PCOS) as a cause of hirsutism

The incidence of polycystic ovaries. Clinical symptoms of polycystic ovary syndrome. The triad of Stein-Leventhal syndrome

Consider the increased production of androgens by the ovaries, since this pathological condition occurs most often in the population compared to other hyperandrogenic syndromes.

The classic manifestation of this pathological condition is polycystic ovary syndrome (PCOS). This pathology is quite common in gynecological practice, mostly in women with infertility and menstrual irregularities. The phenomenon of the so-called "cystic degeneration of the ovaries" was noticed as early as 1845. Also at the end of the 19th century, the operation of wedge resection or removal of the ovaries was proposed to reduce the level of androgens produced by them. In 1935, a triad of symptoms was described, including obesity, polycystic ovaries, and lack of ovulation. This triad is called the Stein-Leventhal syndrome. The frequency of this syndrome among women of childbearing age is 3-11%, and among patients with infertility - 18-20%. In women suffering from various menstrual irregularities and having hirsutism, polycystic ovary syndrome is detected in more than 60% of cases.

Causes and mechanism of development of polycystic ovary syndrome

The basis of this syndrome is the primary lesion of the central structures (hypothalamic-pituitary system) that regulate menstrual function. A connection was found between the onset of the disease and the debut of sexual activity, a change of residence, physical and mental overload, childbirth, abortion, various intoxications - that is, various stressful influences. Violation of the central regulatory mechanisms can occur due to acute or chronic infection, poisoning in periods before and during puberty.

Of great importance is the increased level of androgen secretion several years before the onset of the first menstruation (menarche). Excess adrenal androgens are converted to estrogens, and their increased level eventually stimulates increased production of androgens in the ovaries, the overproduction of which becomes self-sustaining. That is, the so-called vicious circle closes.

The debut of the disease, as a rule, coincides with the onset of menstrual function (menarche) or in the nearest time to it. Ultrasound examination (ultrasound) in the vast majority of patients with similar disorders in the system of regulation of sexual function, polycystic changes are detected in the ovaries. On the other side, importance, in the occurrence of cystic changes in the ovaries, many authors attribute to disorders of fat metabolism (obesity), since androgens are transformed into estrogens in adipose tissue. And an excess of estrogens produced on the periphery leads to a violation of the hormone-producing function of the ovaries. Additional factors in the development of polycystic ovary syndrome are: increased insulin production and insulin resistance. This means that a significant increase in the amount of androgens occurs during a glucose loading test. An important role in the development of polycystic ovary syndrome is also assigned to defects in specific enzyme systems that ensure the normal synthesis of steroid hormones.

With such types of endocrine pathology as, for example, reduced thyroid function, the development of polycystic ovary syndrome can also occur.

How to diagnose polycystic ovary syndrome?

In isolation, neither ultrasound (cystic ovaries according to ultrasound), nor a hormonal study, which determines the levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) with the calculation of the LH / FSH ratio, can not be the only criteria for the diagnosis - "polycystic syndrome ovaries." The situation is such that this diagnosis is made much more often than it actually occurs. Criteria for the diagnosis of polycystic ovary syndrome are divided into clinical, hormonal, ultrasound and histological.

TO clinical symptoms polycystic ovary syndrome should include menstrual irregularities with the absence of ovulation, the presence of hirsutism, an increase in body mass index of more than 25 points.

Ultrasound Criteria(ultrasound criteria) - a decrease in the size of the uterus in combination with an increase in the volume of the ovaries.

Hormonal criteria of this syndrome are as follows - hyperandrogenism (increased concentration of testosterone, dehydroepiandrosterone in the blood), an increase in the LH / FSH ratio of more than 2.5, a reduced content of progesterone in the luteal phase (second) of the menstrual cycle.

Histological criteria polycystic ovary syndrome - a study of the state of the mucous membrane of the uterine cavity after a separate diagnostic curettage of the uterine cavity and cervical canal reveals atrophic or dysplastic changes in the endometrium, or, on the contrary, endometrial hyperplasia. Pathological criteria are thickening of capillaries in the ovarian tissue, thickening of the ovarian membrane, an abundance of maturing and atretic follicles (after surgical treatment).

Adrenal hyperandrogenism

Forms of adrenal hyperandrogenism

Consider now the increased production of androgens by the adrenal glands.
As a rule, it occurs in congenital hyperplasia of the adrenal cortex. This pathology is a hereditary disease and is associated with a congenital defect in the enzyme systems necessary for the synthesis of sex steroid hormones. This defect can be complete or partial. With a complete defect, the body is not viable. With incomplete blocking as a result of interaction in the system of the adrenal glands - hypothalamus - pituitary gland, excessive synthesis of androgens occurs with simultaneous hyperplasia (relatively speaking, an increase in volume) of the adrenal cortex. These violations form the clinical picture of this syndrome.

Distinguish viril, salt-losing and hypertonic forms hyperplasia of the adrenal cortex. We will dwell in more detail on the viril form of the syndrome of congenital adrenal hyperplasia.

Viril form of adrenal hyperandrogenism

This form is diagnosed in 90-95% of cases. The diagnosis can be made immediately after birth after examining the girl's genitals (enlargement of the clitoris, underdevelopment of the labia, and others). However, in 43% of girls, the diagnosis is made with a significant delay. The reason for seeking medical attention in these cases is the manifestation of signs of precocious puberty, usually at the age of 4-5 years. The development of this syndrome at a later date indicates a latent or compensated violation of androgen synthesis. As a rule, the impetus for the manifestation of the disease are stressful effects, neuroinfections, various intoxications, traumatic brain injuries, hormonal stresses (abortions, spontaneous miscarriages), and sometimes childbirth.

There is a hereditary predisposition to congenital adrenal hyperplasia. Signs of aggravated heredity are the presence in the family of undersized women with menstrual dysfunction, infertility, impaired sexual development.

Principles of treatment hyperandrogenism

In the treatment of patients with polycystic ovary syndrome, great importance is attached to the correction of endocrine disorders - weight loss and the use of insulin-lowering drugs. In the presence of hyperprolactinemia (increased concentration of prolactin in the blood) - drugs of dopamine agonists, drugs of glucocorticoids and antiandrogens.

First of all, to start the treatment of polycystic ovary syndrome, it is necessary to normalize body weight. This is the first and key step in the treatment of this pathological condition, since the normalization of body weight will indirectly lead to the normalization of all types of metabolism. When compiling a diet for weight correction, it is necessary to take into account the fact that the maximum calorie content of daily food should not exceed 2000 kcal. Moreover, the ratio of the main nutrients should be as follows: carbohydrates - 50%, proteins - 18%, fats - 32%. Moreover, 2/3 of the fats consumed should be represented by polyunsaturated fatty acids (omega-3, omega-6).
In the treatment of patients with congenital adrenal hyperplasia, the main role belongs to hormone replacement therapy. Treatment is most effective if started before the age of 7 years. For this purpose, glucocorticoid preparations are used.

It must be remembered that all issues related to the diagnosis and treatment of hyperandrogenism often lie within the competence of doctors of various specialties (gynecologists, endocrinologists, dermatologists, pediatricians), therefore, adequate therapy is the result of a comprehensive balanced approach to solving the diagnostic and therapeutic problem.