A Rationale of Ginseng as a Novel Addition to the Antihirsutism Armamentarium

Dear Editor:

More than 40% of women in the United States have unwanted facial hair growth, a symptom of hirsutism, which causes many distressing psychologic problems affecting quality of life. Eflornithine hydrochloride cream (13.9%) was the first topical agent approved by the Food and Drug Administration to treat facial hirsutism. It has been used as a potent ornithine decarboxylase (ODC) inhibitor to treat hirsutism. ^1,2

Studies of 5-α-reductase activity and androgen metabolism in the skin of hirsute women and the excretion of androgen metabolites have demonstrated that 5-α-reduced androgens are probably of primary importance in hirsutism. ³ Finasteride inhibits 5-α-reductase and for this reason could be useful for the treatment of hirsutism. ⁴

It has been illustrated that hyperprolactinemia could be associated with hirsutism. It is believed that prolactin increases adrenal androgen and may be modestly elevated in some women with polycystic ovary syndrome (PCOS). ⁵

It is documented that insulin-sensitizing drugs—metformin and the thiazolidinediones (TZDs)—improve peripheral insulin action. They reduce circulating androgen levels in PCOS by lowering insulin levels and, probably, by direct effects on steroidogenesis. The reduction in circulating insulin levels also results in an increase in sex hormone–binding globulin (SHBG) levels. A study showed that insulin-sensitizing drug therapy significantly decreases hirsutism in comparison with placebo. ⁵

Oral contraceptive pills (OCPs) have been the traditional medical therapy for the long-term treatment of hirsute women with PCOS. ⁶ Oral contraceptives reduce the production of adrenal and ovarian androgens, by inhibiting 5-α-reductase, which in turn, decreases the levels of dihydrotestosterone. Additionally, OCPs reduce the levels of free testosterone by stimulating SHBG. ⁷

Ginseng is one of the most popular herbal agents in the world and is used for the prevention and treatment of many diseases. It occupies a prominent position in the list of best-selling natural products in the world. ⁸ Importantly, it has been shown that IH-901, a novel intestinal bacterial metabolite derived from the protopanaxadiol-type ginsenosides, inhibits ornithine decarboxylase activity dose dependently in mouse skin. ⁹

Liu and colleagues demonstrated that ginseng saponins exert antiproliferative activity on the human prostate cancer cell line. Ginsenosides, the main active constituents of ginseng, suppress the expression of biomarker genes, including 5-α-reductase. ^10,11

It is documented that American ginseng affects the central nervous system and has been illustrated to significantly alter the activity of hypothalamic catecholamines. Accordingly, recent findings propose that ginseng treatment can decrease prolactin secretion and has a direct nitric oxide–mediated effect at the level of the anterior pituitary gland. ¹²

Interestingly, it has been revealed that ginseng and ginsenosides possess antidiabetic and insulin-sensitizing effects, which may be partly realized by regulating adipocyte development and functions. ¹¹

Notably, in Western countries, ginseng is being used for postmenopausal women. Sequential studies have reported that ginseng exerts either direct or indirect estrogenic effect. Ginseng extract activates estrogen-responsive genes and is able to induce the growth of estrogen receptor–positive cells. ¹³

In short, ginseng, due to its inhibitory effects on ODC, 5-α-reductase, and prolactin secretion and also for insulin-sensitizing and estrogenic effects, may be a potential novel addition to hirsutism treatment. Clinical studies on this subject are warranted.