Unwanted Hair (Hirsutism): Understanding Excessive Hair Growth

Quick Facts: Hirsutism affects 5-10% of women and is characterized by excessive hair growth in areas where men typically grow hair. While often related to hormonal imbalances, effective treatments are available.

What is Hirsutism?

Hirsutism is a condition in women that results in excessive growth of dark, coarse hair in a male-like pattern. This includes areas such as the face, chest, lower abdomen, inner thighs, and back. It's important to distinguish hirsutism from hypertrichosis, which is excessive hair growth anywhere on the body.

The condition is typically caused by excess male hormones (androgens), primarily testosterone, or increased sensitivity to normal androgen levels.

Areas Commonly Affected

  • Face: Upper lip, chin, sideburns, jaw
  • Chest: Around nipples and between breasts
  • Abdomen: From pubic area up to navel
  • Back: Upper and lower back
  • Buttocks: Around the tailbone area
  • Inner thighs: Extending from groin area
  • Arms: Forearms and upper arms

Ferriman-Gallwey Score

Healthcare providers often use the Ferriman-Gallwey scoring system to assess hirsutism severity. This visual scale rates hair growth from 0-4 in nine body areas, with a total score above 8 indicating hirsutism.

Associated Symptoms

Hirsutism may occur alongside other signs of hormonal imbalance:

  • Irregular or absent menstrual periods
  • Acne, especially along the jawline
  • Male-pattern baldness or hair thinning
  • Deepening of the voice
  • Increased muscle mass
  • Decreased breast size
  • Enlargement of the clitoris (rare)
  • Weight gain, especially around the midsection
  • Skin darkening in body folds (acanthosis nigricans)

⚠️ Seek Medical Attention If:

  • Hair growth develops suddenly or worsens rapidly
  • You experience signs of virilization (voice deepening, clitoral enlargement)
  • You have irregular periods along with hair growth
  • Hair growth is accompanied by unexplained weight gain
  • You notice other hormonal symptoms

Common Causes

Hormonal Conditions

  • Polycystic Ovary Syndrome (PCOS): Most common cause, affecting 70-80% of cases
  • Congenital Adrenal Hyperplasia: Genetic disorder affecting adrenal glands
  • Cushing's Syndrome: Excess cortisol production
  • Thyroid disorders: Both hyper and hypothyroidism
  • Androgen-secreting tumors: Rare tumors of ovaries or adrenal glands

Medications

  • Anabolic steroids: Used for muscle building
  • Testosterone: Hormone replacement therapy
  • Danazol: Used for endometriosis
  • Glucocorticoids: Such as prednisone
  • Some progestins: In birth control pills

Other Factors

  • Genetics: Family history of hirsutism
  • Ethnicity: More common in Mediterranean, Middle Eastern, and South Asian women
  • Obesity: Can increase androgen production
  • Insulin resistance: Often associated with PCOS
  • Idiopathic: No identifiable cause in some cases

Treatment Options

Hair Removal Methods

  • Shaving (temporary, needs frequent repetition)
  • Plucking/tweezing (for small areas)
  • Waxing (lasts 4-6 weeks)
  • Depilatory creams (chemical removal)
  • Threading (for facial hair)
  • Bleaching (makes hair less noticeable)

Medical Treatments

  • Birth control pills (reduce androgen production)
  • Anti-androgens (spironolactone, finasteride)
  • Topical eflornithine (slows facial hair growth)
  • Insulin-sensitizing drugs (metformin for PCOS)
  • GnRH agonists (for severe cases)
  • Corticosteroids (for adrenal causes)

Permanent Solutions

  • Laser hair removal (multiple sessions needed)
  • Intense pulsed light (IPL)
  • Electrolysis (permanent but time-consuming)
  • Combination treatments
  • Maintenance sessions

Self-Care and Management

  • Weight management: Losing weight can reduce androgen levels
  • Regular exercise: Helps with hormone balance
  • Healthy diet: Low glycemic index foods may help
  • Stress management: Chronic stress can worsen symptoms
  • Skin care: Gentle products to avoid irritation from hair removal
  • Support groups: Connect with others experiencing hirsutism
  • Regular monitoring: Track changes in hair growth patterns

When to See a Healthcare Provider

Schedule an appointment if:

  • You notice new or worsening hair growth in male-pattern areas
  • Hair growth is affecting your quality of life
  • You have irregular periods or fertility concerns
  • Over-the-counter treatments aren't effective
  • You're experiencing other hormonal symptoms
  • You want to explore medical treatment options
  • You're planning pregnancy (some treatments aren't safe)

Diagnostic Tests

Your healthcare provider may order:

  • Blood tests: Testosterone, DHEA-S, androstenedione levels
  • Hormone panels: FSH, LH, prolactin, thyroid hormones
  • 17-hydroxyprogesterone: To rule out congenital adrenal hyperplasia
  • Cortisol tests: For Cushing's syndrome
  • Insulin and glucose: To check for insulin resistance
  • Pelvic ultrasound: To examine ovaries for PCOS
  • CT or MRI: If tumor is suspected

Living with Hirsutism

Managing hirsutism is often a long-term process:

  • Be patient - medical treatments take 6-12 months to show full effects
  • Combine treatments for best results
  • Address underlying conditions like PCOS
  • Consider counseling for emotional impact
  • Explore makeup techniques for coverage
  • Stay informed about new treatment options
  • Maintain regular follow-ups with your healthcare provider