Case Study :
Neha (name changed), a 30-year-old woman working as a software engineer in a multinational company in Bengaluru, sought medical help from Dr Anirban Biswas after experiencing excessive hair growth on her chin, chest, and lower abdomen over the past year. She was also dealing with acne breakouts, fatigue, and irregular menstrual cycles.
Neha was socially active but felt embarrassed about her appearance due to the visible hair growth. Despite trying hair removal treatments, the hair kept growing back thicker and faster. She was also frustrated by the lack of improvement in her skin.
Diagnosis
Dr. Biswas conducted a comprehensive evaluation, Neha’s clinical assessment revealed:
Medical History: Irregular periods (every 40–50 days), family history of early menopause, and acne since adolescence.
Physical Exam: Noticeable hirsutism (Ferriman-Gallwey score: 8), with hair on the chin, upper lip, chest, and lower abdomen.
Diagnostic Tests:
Elevated DHEAS (Dehydroepiandrosterone sulfate) levels (DHEAS: 500 µg/dL, normal range: 35-430 µg/dL).
Elevated testosterone levels (total testosterone: 70 ng/dL, normal range: <50 ng/dL).
Pelvic ultrasound showed polycystic ovaries.
Mild insulin resistance was noted with a high fasting insulin level.
Diagnosis: Hirsutism due to high androgen levels, likely related to PCOS.
Treatment Plan
Dr. Anirban Biswas took a multifaceted approach to manage Neha's hirsutism by addressing the high androgen levels, reducing symptoms, and balancing hormones through a combination of lifestyle changes, dietary adjustments, and medical treatment.
1. Customized Diet Plan
Neha’s diet was designed to support hormonal balance, reduce insulin resistance, and lower DHEAS and testosterone levels: (see below )
2. Medical Support
Oral Contraceptives: A low-dose combined oral contraceptive (COC) was prescribed to help regulate Neha's menstrual cycles and reduce androgen production.
Anti-Androgens: Spironolactone was recommended to block the effects of testosterone on the skin and hair.
Supplements:
Myo-inositol (2g daily) to help improve insulin sensitivity and support ovulation in PCOS.
Vitamin D and magnesium supplements to support overall hormonal balance.
3. Exercise and Lifestyle Changes
Exercise Plan: Neha was encouraged to engage in 30–45 minutes of moderate exercise (yoga, walking, or swimming) at least 4-5 times per week to improve insulin sensitivity and reduce stress.
Stress Reduction: Regular practice of mindfulness meditation and deep breathing exercises to lower cortisol, a stress hormone that can exacerbate hirsutism and disrupt other hormones.
Outcome
After 6 months, Neha's androgen levels showed significant improvement:
DHEAS levels decreased to 390 µg/dL (within the normal range).
Testosterone levels dropped to 50 ng/dL (within the normal range).
Hirsutism was noticeably reduced, with slower regrowth of facial and body hair.
Acne improved, and her menstrual cycles became more regular, occurring every 30–32 days.
Neha lost 5 kg and reported feeling more confident and energetic.
Neha’s Reflection
"Patience is key! Diet, exercise, and self-care can make a real difference. Dr. Biswas helped me regain control of my life and confidence with a plan that worked for me. Don’t hesitate to seek professional help."
Understanding Hirsuitism : Causes, Diagnosis & Treatment
What is Hirsuitism ?
Hirsutism is excessive hair growth in women in areas where hair is typically minimal, such as the face, chest, or back. It can result from hormonal imbalances, genetics, or certain medical conditions.
Causes of Hirsutism
Hormonal Imbalances:
High levels of androgens (male hormones), such as testosterone.
Polycystic Ovary Syndrome (PCOS) is the most common cause.
Cushing's syndrome or adrenal hyperplasia.
Medications:
Anabolic steroids.
Certain medications like danazol or minoxidil.
Genetics:
Family history of hirsutism.
Other Conditions:
Thyroid dysfunction.
Tumors in the ovaries or adrenal glands.
Diagnostic Tests
Blood Tests:
Testosterone levels (total and free).
DHEA-S (dehydroepiandrosterone sulfate).
LH and FSH ratio to check for PCOS.
Cortisol levels (for Cushing's syndrome).
Prolactin and TSH levels.
Imaging:
Pelvic ultrasound to check for ovarian cysts (PCOS).
CT or MRI scan if adrenal or ovarian tumors are suspected.
Foods to Avoid
To reduce symptoms of hirsutism, avoid foods that may increase androgen production or worsen insulin resistance:
Sugary Foods: Sweets, desserts, and sugary beverages.
Refined Carbohydrates: White bread, pastries, and processed snacks.
Dairy Products: Milk and cheese (may increase androgen activity in some women).
High-fat Animal Products: Fatty cuts of red meat, which may contain hormones.
Processed Foods: Chips, fast food, and pre-packaged meals.
Natural Treatments and Lifestyle Changes
Dietary Adjustments:
Include anti-inflammatory foods like leafy greens, berries, and omega-3 rich foods (e.g., fish, flaxseeds).
Add foods that stabilize blood sugar levels, such as whole grains, legumes, and nuts.
Herbal Remedies:
Spearmint Tea: Known to reduce androgen levels when consumed daily.
Saw Palmetto: May inhibit testosterone production (consult a doctor before use).
Cinnamon: Helps manage blood sugar, potentially improving PCOS symptoms.
Weight Management:
Losing 5-10% of body weight can reduce symptoms, especially in PCOS-related hirsutism.
Exercise:
Regular exercise improves insulin sensitivity and reduces androgen levels.
Stress Management:
Practice yoga, meditation, or deep-breathing exercises to lower cortisol levels, which can exacerbate hormonal imbalances.
Medical Treatments
Oral Contraceptives: Help regulate hormones and reduce androgen production.
Anti-Androgens:
Spironolactone blocks androgen effects.
Finasteride inhibits testosterone conversion.
Topical Creams:
Eflornithine (Vaniqa) slows facial hair growth.
Procedures:
Laser hair removal or electrolysis for long-term hair reduction.
Tips for Daily Management
Avoid plucking or shaving, which can irritate the skin and worsen the condition.
Use gentle skincare products for sensitive areas prone to hair growth.
Wear sunscreen to protect skin after hair removal treatments.
Keep track of your menstrual cycle and symptoms to help identify patterns or triggers.
Consult a dermatologist or endocrinologist for personalized care.
Diet Plan to reduce Testosterone in Females
To help reduce androgen (testosterone) production in females, focus on foods that stabilize blood sugar levels, improve insulin sensitivity, and promote hormonal balance. These foods often help manage conditions like PCOS, a common cause of elevated androgens. Here's a list of foods:
1. High-Fiber Foods
Fiber helps reduce insulin levels, which can lower testosterone production indirectly.
Whole grains (oats, quinoa, barley).
Vegetables: Broccoli, cauliflower, spinach, kale, and carrots.
Fruits: Apples, berries, pears, and citrus fruits.
2. Anti-Inflammatory Foods
These reduce chronic inflammation, which can worsen androgen levels.
Fats: Avocados, olive oil, flaxseeds, chia seeds, walnuts.
Spices: Turmeric, ginger.
Omega-3s: Fatty fish (salmon, mackerel, sardines), walnuts, flaxseeds.
3. Low-Glycemic Index (GI) Foods
They help prevent insulin spikes that stimulate androgen production.
Lentils, chickpeas, and beans.
Sweet potatoes and yams.
Non-starchy vegetables like zucchini and bell peppers.
4. Phytoestrogen-Rich Foods
Phytoestrogens mimic estrogen and help balance hormones.
Soy products: Tofu, soy milk, edamame.
Flaxseeds (rich in lignans).
Sesame seeds.
5. Spearmint Tea
Studies suggest drinking spearmint tea (1–2 cups daily) can reduce testosterone levels over time.
6. Probiotic and Fermented Foods
Gut health impacts hormone regulation. Include:
Yogurt (unsweetened).
Kefir.
Sauerkraut and kimchi.
7. Magnesium and Zinc-Rich Foods
These minerals help reduce inflammation and regulate hormone production.
Magnesium: Nuts (almonds, cashews), leafy greens, dark chocolate.
Zinc: Pumpkin seeds, sunflower seeds, lentils.
8. Healthy Proteins
Lean proteins like chicken, fish, and plant-based options (lentils, tofu).
Avoid high-fat red meat, which may contain hormones that disrupt balance.
Foods to Avoid
Sugary Foods: Desserts, sodas, processed sweets.
Refined Carbohydrates: White bread, pastries, and other processed carbs.
Dairy: May raise insulin-like growth factor (IGF-1), contributing to higher androgens in some women.
Processed Foods: Chips, fast food, and ready-to-eat meals.
Sample 1-Day Meal Plan to Help Reduce Androgen Production
This 1-day meal plan is designed to balance blood sugar levels, promote hormonal balance, and reduce androgen levels.
Morning (Empty Stomach)
Spearmint Tea: 1 cup with a teaspoon of honey (optional).
Breakfast
Vegetable Quinoa Upma: Quinoa cooked with vegetables like carrots, peas, and spinach.
Side: 1 small bowl of fresh fruit (berries or apple slices).
Drink: 1 cup of unsweetened almond milk.
Mid-Morning Snack
Handful of Nuts and Seeds: Almonds, walnuts, and flaxseeds (1 tablespoon).
Drink: Warm water with a dash of lemon.
Lunch
Salad Bowl:
Mixed greens (spinach, kale, lettuce).
Toppings: Chickpeas, cucumber, avocado, and sesame seeds.
Dressing: Olive oil, lemon juice, and a pinch of salt.
Main:
Grilled fish (e.g., salmon) or tofu (for a plant-based option).
A small serving of brown rice or quinoa (1 cup).
Afternoon Snack
Spearmint Tea: 1 cup.
Snack: Roasted chickpeas or a slice of multigrain bread with hummus.
Dinner
Main Course:
Stir-fried vegetables (broccoli, zucchini, bell peppers) with garlic and turmeric.
Lentil soup or dal (1 cup).
1 small multigrain roti or a small serving of sweet potato.
Side: 1 cup of plain unsweetened yogurt (optional).
Evening Wind-Down
Bedtime Drink: Warm almond milk with a pinch of cinnamon.
Tips for Success
Drink plenty of water throughout the day (2–3 liters).
Avoid sugary snacks; opt for whole, natural foods.
Make meals rich in fiber to stabilize blood sugar levels.
Stick to regular meal timings to prevent blood sugar fluctuations.
Conclusion
This case study highlights the effective management of hirsutism associated with high DHEAS and elevated testosterone levels. Through a combination of medical intervention and a well-rounded, hormone-balancing diet, Neha was able to manage her condition and improve her quality of life.
FAQs
1. What is hirsutism?
Hirsutism is excessive hair growth in women in areas where men typically grow hair, like the chin, chest, or back, often due to hormonal imbalances.
2. Can hirsutism be treated naturally?
Yes, lifestyle changes, a balanced diet, and specific foods like spearmint tea and flaxseeds can help manage hirsutism naturally.
3. What causes hirsutism?
Hirsutism is caused by elevated androgen levels, often linked to PCOS, adrenal disorders, or idiopathic (unknown) factors.
4. Is there a permanent cure for hirsutism?
While there's no guaranteed permanent cure, managing the underlying cause, such as PCOS, can significantly reduce symptoms.
5. Does diet affect hirsutism?
Yes, a diet rich in fiber, low glycemic foods, and anti-inflammatory nutrients can help balance hormones and reduce androgen levels.
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