Gender Affirmative Treatment of Hypertrichosis With Intense Pulsed Light - Effect on Hair Reduction and Quality of Life

Background Hypertrichosis is defined as excessive hair in men and women while the term hirsutism is used for women with increased hair count due to hormonal changes such as increased levels of androgens. Hypertrichosis can be focal och general and hereditary or acquired. In hereditary hypertrichosis, genes or in uterus exposure to certain medications have been suggested as causes for the condition. In acquired cases, the hypertrichosis is often triggered by hormonal changes due to different medical conditions.

Investigating the cause of hypertrichosis is done by examining the patient's medical history and a complete examination of the skin. An often-used tool, for severity assessment of hypertrichosis is Ferriman & Gallwey scale. This international scale is used both by clinicians and patients for both research and in clinical practice. The Ferriman & Gallwey scale investigate 9 parts of the body with each part visually described with increasing density of hair as 4 pictures ranging from 0 point (no hair) to 4 points (dense hair). According to Ferriman & Gallwey scale, a total of ≥8 points in white and black, ≥9-10 points for mediterranean, south american and middle eastern, and ≥2 points for east Asian women indicate hypertrichosis.

Hirsutism is a common feature in women with Polycystic Ovarian Syndrome. The increased density of hair becomes noticeable during puberty and affected women report a great negative impact from the condition on their quality of life. Signs of depression and anxiety are common in women with hirsutism, due to increased social isolation and remarks regarding the hair growth and its colour by their surroundings.

Individuals with gender dysphoria and in transition of gender reassignment from the biological male sex to female, are sometimes prescribed estrogen or anti-androgens to decrease male characteristics on their body. Feminizing hormone therapy for male-to-female gender dysphoria aim to minimize body and facial hair growth. In women with mild hirsutism, there is evidence that oral contraceptives and anti-androgen treatment could be beneficial against hair growth on the body. However, the effects of these medications together with other methods such light-based treatments as intense pulsed light or lasers have not been evaluated. Intense Pulsed Light (IPL) which transmit light as energy to become absorbed as heat in the hair follicle. Repeated treatments are necessary to obtain a significant reduction of hair and long-term effects of IPL in reducing hair varies. Theoretically, the combination of anti-androgens and estrogen together with IPL, should have a synergetic effect in hair reduction no matter the intention for hair reduction. Thus, the aim of this study is to evaluate the effects of IPL, in patient with hirsutism/hypertrichosis, with or without hormonal therapy, regarding hair reduction and potential impacts on quality of life.

Materials and methods Study design Observational Cohort study Patients Patients with hirsutism and gender dysphoria are medically treated and have their follow-ups by other specialities than dermatology. However, the laser clinic at the department of dermatology and venereology, Umeå university hospital receives referrals from other departments across northern Sweden for reducing body hair in these patients. Consecutive patients referred to the department of dermatology and venereology at Umeå University Hospital due to hypertrichosis will be assessed according to our inclusion and exclusion criteria.