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TOO MANY MALE HORMONES

What Causes Hirsutism?

The hair follicles are sensitive to male hormones and increasing levels of these hormones promote the rate of hair growth and the transformation of fine, soft or "vellus" hair to coarser "terminal" hair. This effect occurs in hair on the face and the body but not on the scalp.
The most common cause of hirsutism is a slight over-production of male tiormones from the ovaries and from the adrenal glands. This slight increase in ovarian and/or adrenal male hormones can be detected in blood tests and although it does not cause any ill-effects upon health or fertility, it does stimulate the annoying growth of body hair. In some women with mild hirsutism, blood levels of male hormones are completely normal and the fault lies in excessive sensitivity of their skin and hair follicles to normal levels of male hormones.
There is often a family history of hirsutism in related females and it occurs most commonly in women of Southern-European and Middle-Eastern descent. Racial and genetic factors are obviously important. Hirsutism is rare among oriental women.
Women who are overweight are more likely to suffer with hirsutism because their excessive amounts of fat are associated with higher levels of male hormones. If they lose weight, their levels of male hormones usually decrease with a corresponding reduction in body and facial hair.
The gynaecological disorder of polycystic ovaries can cause hirsutism. In this condition, the ovaries may become enlarged and develop many small follicle cysts around the periphery. This problem is quite common, and around one in every six women probably has a tendency to polycystic ovaries. These polycystic ovaries secrete excessive amounts of male hormones which may result in hirsutism, acne and infrequent menstruation. Many women with polycystic ovaries are overweight and should try to lose their excessive weight which may in itself restore regular menstruation and normal levels of male hormones. Conversely, if such women gain weight their menstrual periods become less frequent and acne and excess hair increase. In some obese women, it seems that excessive amounts of male hormones from their fat somehow "virilize" their ovaries stimulating them to produce excessive male hormones and this can become a vicious circle. The tendency to polycystic ovaries is inherited and may be triggered by stress or weight gain.
Some medications may increase body and facial hair such as the anabolic steroids used by athletes and body builders. Other drugs such as Danazol, Dilantin and some brands of the oral contraceptive pill containing the masculine progestogen norgestrel may also increase facial hair.
Hirsutism is generally mild to moderate in degree but if it is severe or of rapid onset and progression, tests must be done to check for a severe glandular disorder that may lead to extreme masculine changes in appearance called virilization.
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EPILEPSY AND PREGNANCY

Women with epilepsy are quite often concerned about getting pregnant. There appear to be five reasons for this concern. They wish to know:
if they are likely to hand their epilepsy on to their children;
whether their fits will get worse during pregnancy;
whether it is safe for the baby that the mother should take anticonvulsants drugs during pregnancy;
if there will be any problems in the newborn baby from these drugs;
if they can safely breast feed the baby.
With regard to handing on epilepsy to one’s children – as mentioned earlier, if one parent has epilepsy, the chances of one of the children having epilepsy are no greater than in the population at large. If both parents have epilepsy, it would appear that the risk of a child having epilepsy is about 10 per cent. So in fact the chance of a child inheriting epilepsy, particularly idiopathic epilepsy, is negligible.
As far as seizures during pregnancy are concerned, the situation is not as clear as it might be. There is evidence that for some women, seizure control may deteriorate, while for others there may in fact be no change or even an improvement. A patient told me recently that “she would like to remain pregnant forever” as she had not had a single fit during her pregnancy, compared with six fits in the preceding nine months!
As a general working rule, it is suggested that people who have more than one grand mal fit a month are those who are most likely to have a deterioration in seizure control during pregnancy. The deterioration, if it occurs, is most likely during the first three months of pregnancy. There are a number of theories why this may happen, but none has been proved. It may be of value to check the blood anticonvulsant levels during pregnancy, especially if there is a deterioration in seizure control. The blood levels may fall, necessitating an increase in dosage during the pregnancy.
The main concern for parents is whether the anticonvulsants can harm the unborn baby (foetus). It is known by most people with epilepsy that this is a potential hazard. The effects include physical abnormalities in the baby, a process known as teratogenesis. Abnormalities have been reported in the offspring of mothers on all the commonly used anticonvulsants with the exception of carbamazepine. This is particularly applicable to phenytoin, barbiturates and sodium valproate. Babies born to mothers who have been on carbamazepine have not been shown to have any physical abnormalities, but have a smaller head size than other babies. This has not been shown to be any handicap to the babies who have been followed up for five years.
The risk of abnormalities in the baby is difficult to assess, but it seems to be most common in mothers on polytherapy (receiving numerous drugs), especially if they are on three or more anticonvulsants. The risk in mothers on phenytoin, with or without other medications, appears to be about a 10% chance of the baby showing features of the ‘foetal hydantoin’ syndrome. This syndrome consists of cleft palate, abnormalities of the fingers, possible heart abnormalities and mild mental retardation. Thus, at present, if it is possible, it would seem wise to try to change patients over to carbamazepine before conception. This may not be possible in all patients and, of course, many women will first visit their doctor when already pregnant, at which time there is no purpose in making the change.
Anticonvulsants taken by the mother during pregnancy may have some effects on the baby immediately after birth, as they are transmitted to the baby across the placenta. These include the possibility of a mild bleeding tendency and some drowsiness. In mothers who have been taking barbiturates, the infant may occasionally show features of a withdrawal reaction with irritability, jitteriness and poor sucking. None of these features is [...]

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