Question of the Month
Q: I have a five-year old daughter who has hair growth on her back. She has always had a hairy back but over the years it seems to be more and growing longer. Her arms and legs are hairy but not excessive. She shows no signs of early puberty. Her pediatrician sent me to an endocrinologist. Some hormonal test were done and I was told that the hair on her back was just her make up. I am concerned for when she does go through puberty. Her dark black hair all over her back is already embarrassing her. Am I missing something?
A: In my practice I sometimes see young girls because of concern about increased body hair. According the endocrinological dogma, this should not happen before puberty but of course it does. I suspect it may be due to testosterone production by the ovaries in infancy when they make adult levels of hormones for a few weeks after birth. Once activated, the hair follicles tend to stay active. Though not all girls with body hair are very conscious of it, some are. Unfortunately the increasing emphasis in our culture on females having perfect bodies has started to affect girls even before puberty.
If pubic and/or underarm hair is present, then a hormonal work-up needs to be done. Even without this, some evaluation may be appropriate. If everything is normal, then treatment can be considered. Shaving off the hair is one option because it usually grows back only very slowly. Laser can be considered but is expensive and the level of pain may be unacceptable for a child. Medication such as spironolactone can also be considered. It has been used for several decades in children, though for other indications.
Some reassurance is also important. Because photographs of women in the media tend to show them without any extra hair at all, many who have it think they are the only ones. You can reassure your daughter that many other girls and women have as much hair as she does. It does not stop a woman from getting married, having children or doing anything else they want to do. Finally, summer clothes should be selected which meet the rather rigid fashion requirements of young people without being more revealing than necessary.
Facial and body hair begin to increase in everyone at puberty and continue to increase for a few years after that so if nothing is done in childhood, the problem should be closely watched. The earlier increased hair is treated, the better the result.
Hope this is helpful.
Geoffrey Redmond, MD
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