I’m a 21 year old female who suffers from hirsutism and acne. Can natural progesterone help me?

Hi Catherine,

I’m a 21 year old female who suffers from hirsutism and acne. I’ve suffered from acne since I was roughly 10 -12 years old. I suffered from hirsutism since I was 16. I tried every conventional treatment for my acne including the poisonous drug Accutane when I was 16-17. It only dried my skin out and worked temporarily to say the least. My acne returned a couple of months later with a vengance.

I had my hormones tested when I was 16 by my dermatologist and they came back normal, then again when I was 18 by an endocrinologist and again they came back normal. Again when I was 19 and they once more came back normal. Then again more recently three months ago I had them tested again when I switched doctors and they came back normal.

I opted not to go on birth control pills and spironaldatone - a drug for the hirsutism - because at best it only works temporarily and there are side effects, and I don’t want to put synthetic hormones into my body. I bought and read Dr. Lee’s book on Natural Progesterone and Menopause, ‘What Your Doctor May Not Tell You About Menopause’ hoping he would speak about hirsutism which he briefly did in his book.

Can balancing my hormones naturally with essential fatty acids and no sugar and natural progesterone cream help my hirsutism problem?

I am going to go for laser hair removal but wanna use the natural progesterone cream first. I also have regular periods. I have excess facial and body hair and did use electrolysis for my facial hair for a while but it was too expensive and yielded too long and no results cause I still have a hormonal balance I need to balance my hormones first and then proceed to take care of the hair topically with laser hair removal. I literally have to shave my face and body everyday. I have hair on my upper lip chin (I tweeze and shave) neck, stomach (dark course hair) chest v-line, nipple hair, lower back and buttocks hair. It’s going to cost me a bundle to laser hair remove all of it but I’m saving for that.

I also have one more question. If I take a vitamin supplement which contains Don Qui and Wild Yam extract in it to balance hormones will it interfere with natural progesterone cream which too contains wild yam extract?

Thank you,

Carolyn

Dear Carolyn,

I would imagine that your various doctors have, over the years, researched extensively your medical and family history for androgen excess, thyroid disorders, diabetes, cardiovascular disease, hypertension, cancer, etc., etc.

I’m wondering what a salivary hormone profile would show up in conjunction with blood work? Specifically testing testosterone levels (total and free), DHEA-S, androstenedione.

For example, high levels of testosterone and androstenedione that are accompanied by normal levels of DHEA-S indicate that the ovaries and not the adrenals are producing the excess androgens.

Unlike blood testing, saliva analysis is looking at the cellular level (the biologically active compounds) and saliva is therefore truly representative of what is clinically relevant. Blood analysis, on the other hand, is looking at compounds as they travel through the blood serum, most of which are protein bound.

Also important is the fact that hormones peak and trough during the day. Therefore capturing your hormone levels first thing in the morning - which saliva assays allow you to do from home - ensures you get an accurate snapshot of your hormones over a full menstrual cycle.

There are a host of contributing factors that determine androgen dominance. When hirsutism is associated with obesity and menstrual abnormalities, the source of androgen excess is often ovarian, typically PCOS (the most common cause of hirsutism). That’s why it’s important you have an ultrasound to assess the condition of your ovaries (to rule out PCOS).

When it is associated with average weight and normal periods, the source is often adrenal and, rarely, pituitary.

Excessive male-pattern hair growth affecting sites such as the face, neck, trunk, extremities, breasts, lower back, upper pubic triangle, areolae, and upper inner thighs is usually the result of excess androgens in your body.

And androgen-excess syndrome has several major features:

• seborrhea (a form of skin inflammation which has no known cause)
• acne
• hirsutism
• obesity
• hair loss (alopecia)
• velvety, light-brown-to-black, markings usually on the neck, under the arms or in the groin, associated with high insulin levels (acanthosis nigricans).

Whether a woman is hirsute often is difficult to judge because hair growth varies among individual women and across ethnic groups. What is considered hirsutism in one culture may be considered typical in another. For example, women from the Mediterranean and the Indian subcontinent have more facial and body hair than do women from East Asia, sub-Saharan Africa, and northern Europe.

Dark-haired darkly pigmented whites of either sex tend to be more hirsute than blond or fair-skinned people.

Carolyn, I take from your letter that hirsutism is clearly affecting your life in a big way. And I feel for you, I honestly do. Hirsute women do not fit with the social model of ‘beauty’ in Western culture.

I suffered from acute, unsightly acne on my face, neck, chest & back (and site-specific dermatitis) in my teens and early twenties. It was bad enough to be under the care of a skin specialist. His ‘resolution’ was the Contraceptive Pill. I was constantly shaving or ‘blonding’ thick, dark hairs on my arms, legs and around my groin, my eyebrows required some serious plucking every week, I had a noticeable mustache, and couldn’t figure out how I came to have the odd couple of long strands of hair around my nipples. To this day, despite hormone balancing, there’s no doubt I’m genetically hirsute … I feel like a ‘Yettie Monster’ if I let it go too long between wax jobs!

My youngest daughter, aged 15, is perhaps not quite as bad as you but she’s certainly very ’sensitive’ about the amount of hair on most parts of her body. She feels unattractive because of it, and so seems (to me) to be forever fighting against nature to get a handle on it. She ‘Nair’s’ her eyebrows and, only the other day, she went so far as to shave the area between her naval and pubic hair (and paid the price!) because she was embarrassed. Her beauty and flawless skin offer some compensation.

What’s important to understand here is that hirsutism, by itself, is a benign condition primarily of cosmetic concern. However, when hirsutism in women is accompanied by masculinising signs or symptoms such as infrequent or absent menstrual cycle, acne, deepening of the voice, male-pattern balding, increased muscle mass, increased libido, particularly when these arise well after puberty, it may be a manifestation of a more serious underlying disorder that requires extensive evaluation.

Circulating androgens arrive at the receptors, enter the cell, and are metabolised to the final, most potent androgens - testosterone which, in turn, is converted by an enzyme called 5 alpha reductase into another form of testosterone called dihydrotestosterone or DHT - the androgen hormone that triggers hair loss in androgenetic alopecia.

This altered androgen metabolism (conversion from weak to potent androgens) is the most common cause of hirsutism and it appears to be the result of an increased conversion in the skin of testosterone to DHT.

While, understandably, hirsute women like yourself tend to be more concerned about their appearance, consideration needs to be given to the increased risks conveyed by long-term androgen excess which include:

• infertility
• cardiovascular disease
• hypertension
• osteoporosis
• uterine cancer
• pituitary adenoma

Many drugs (exogenous androgens) can induce hirsutism. Medications such as Estratest?, danazol, anabolic steroids in some of the body building supplements and even some birth control pills containing norgestrel (e.g., Lo-Ovral?, Ovrette?) can cause increased hair growth. Even when testosterone cream is used on the vulva for certain vulvar skin conditions, there can be absorption into the blood stream which stimulates hair growth.

To some degree, estrogen reduces the effect of androgens in women. Estrogens increase liver manufacture of sex hormone binding globulin (SHBG). Androgens decrease it. Thus lack of estrogens can effectively increase available blood androgens. We see this at menopause when a woman’s estrogen levels decline, coinciding with excessive hair sprouting up on her face … and perhaps less and less of it growing on her head!

You can help your body oppose androgen dominance in a number of ways.

Progesterone is the one hormone in a woman’s body that modulates other hormones helping to restore balance. It’s certainly proving to be a major player in the successful treatment of PCOS. Progesterone supplementation might, therefore, be a good starting point.

Furthermore, I would certainly suggest you pay particular attention to diet and nutrition, avoid all refined carbohydrates and sugars, introduce a premium phytoestrogen-vitamin-mineral formulation (perhaps containing Wild Yam), incorporate a essential fatty acid supplement, get plenty of exercise, drink lots of filtered water, reduce weight (if need be), learn to manage your stress levels, and rest up.

And source yourself a healthcare professional who’s familiar with salivary hormone profiles and prescribing bio-identical hormone replacement therapy.

If, at the end of the day, if it has been confirmed by medical specialists once and for all that your excessive body hair is not associated with an endocrine disorder, then laser treatment, while prohibitive, may offer you a long-lasting solution to unwanted body hair … and perhaps a better quality of life.

Though I’d like to point out here that I personally have no understanding of the latest medical laser research and would not be prepared to endorse such an approach (but can say my kid brother routinely uses laser treatment to reduce unwanted body hair, and swears by it!).