Departments of Obstetrics and Gynecology, and Medicine (R.A.), The
University of Alabama at Birmingham, Birmingham, Alabama 35233;
Department of Obstetrics and Gynecology, Columbia University, New York,
New York 10032, and Department of Endocrinology, University of
Palermo at Caltanissetta, 90139 Italy (E.C.); and Alopecia Research &
Associated Technologies (ARATEC), and Department of Biochemistry and
Molecular Biology, University of Miami School of Medicine (M.E.S.),
Miami, Florida 34478
Hirsutism, the presence of terminal (coarse) hairs in femalesin a
male-like pattern, affects between 5% and 10% of women.Of the sex
steroids, androgens are the most important in determiningthe type and
distribution of hairs over the human body. Underthe influence of
androgens hair follicles that are producingvellus-type hairs can be
stimulated to begin producing terminalhairs (i.e.,
terminalized). The activity of local 5-reductase(5-RA)
determines to a great extent the production of dihydrotestosterone
(DHT),and consequently the effect of androgens on hair follicles.
Whilethere are two distinct 5-RA isoenzymes, type 1 and type 2, the
activityof these in the facial or abdominal skin of hirsute women
remainsto be determined. Although the definition of idiopathic
hirsutism(IH) has been an evolving process, the diagnosis of IH should
beapplied only to hirsute patients with normal ovulatory functionand
circulating androgen levels. A history of regular mensesis not
sufficient to exclude ovulatory dysfunction, since upto 40% of
eumenorrheic hirsute women are anovulatory. The diagnosisof IH, when
strictly defined, will include less than 20% ofall hirsute women. The
pathophysiology of IH is presumed tobe a primary increase in skin
5-RA activity, probably of bothisoenzyme types, and possibly an
alteration in androgen receptorfunction. Therapeutically, these
patients respond to antiandrogenor 5-RA inhibitor therapy.
Pharmacological suppression of ovarianor adrenal androgen secretion
may be of additional, albeit limited,benefit. New therapeutic
strategies such as laser epilationor the use of new biological
response modifiers may play animportant role in offering a more
effective means of treatmentto remove unwanted hair. Further
investigations into the genetic,molecular, and metabolic aspects of
this disorder, includingonly well defined patients, are needed.
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-reductase (5
