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Hirsutism

Overview

Hirsutism (HUR-soot-iz-um) is a condition of unwanted, male-pattern hair growth in women. Hirsutism results in excessive amounts of dark, course hair on body areas where men typically grow hair — face, chest and back.

The amount of body hair you have is largely determined by your genetic makeup. There's a wide range of normal hair distribution, thickness and color due to differences in heredity. However, hirsutism is a medical condition that can arise from excess male hormones called androgens, primarily testosterone. It can also be due to a family trait.

A combination of self-care and medical therapies provides treatment for many women with hirsutism.

Hirsutism

Hirsutism is excess hair most often noticeable around a woman's mouth and chin.

Symptoms

Hirsutism is stiff and dark body hair, appearing on the body where women don't commonly have hair — primarily the face, chest and back. What's considered excessive can vary depending on ethnicity and culture.

When excessively high androgen levels cause hirsutism, other signs might develop over time, a process called virilization. Signs of virilization might include:

  • Deepening voice
  • Balding
  • Acne
  • Decreased breast size
  • Increased muscle mass
  • Enlargement of the clitoris

Causes

At puberty, a girl's ovaries begin to produce a mix of female and male sex hormones, causing hair to grow in the armpits and pubic area. Hirsutism can occur if the mix becomes unbalanced with too high a proportion of male sex hormones (androgens).

Hirsutism can be caused by:

  • Polycystic ovary syndrome. This most common cause of hirsutism is caused by an imbalance of sex hormones that can result in irregular periods, obesity, infertility and sometimes multiple cysts on your ovaries.
  • Cushing's syndrome. This occurs when your body is exposed to high levels of the hormone cortisol. It can develop from your adrenal glands making too much cortisol or from taking medications such as prednisone over a long period.
  • Congenital adrenal hyperplasia. This inherited condition is characterized by abnormal production of steroid hormones, including cortisol and androgen, by your adrenal glands.
  • Tumors. Rarely, an androgen-secreting tumor in the ovaries or adrenal glands can cause hirsutism.
  • Medications. Some medications can cause hirsutism. These include danazol, which is used to treat women with endometriosis; systemic corticosteroids and fluoxetine (Prozac) for depression.

Sometimes, hirsutism can occur with no identifiable cause. This happens more frequently in certain populations, such as in women of Mediterranean, Middle Eastern and South Asian ancestry.

Risk factors

Several factors can influence your likelihood of developing hirsutism, including:

  • Family history. Several conditions that cause hirsutism, including congenital adrenal hyperplasia and polycystic ovary syndrome, run in families.
  • Ancestry. Women of Mediterranean, Middle Eastern and South Asian ancestry are more likely to develop hirsutism with no identifiable cause than are other women.
  • Obesity. Being obese causes increased androgen production, which can worsen hirsutism.

Complications

Hirsutism can be emotionally distressing. Some women feel self-conscious about having unwanted body hair. Some develop depression. Also, although hirsutism doesn't cause physical complications, the underlying cause of a hormonal imbalance can.

If you have hirsutism and irregular periods, you might have polycystic ovary syndrome, which can inhibit fertility. Women who take certain medications to treat hirsutism should avoid pregnancy because of the risk of birth defects.

Diagnosis

Tests that measure the amount of certain hormones in your blood, including testosterone or other testosterone-like hormones, might help determine whether elevated androgen levels are causing your hirsutism. If so, your doctor might recommend an ultrasound or a CT scan to check your ovaries and adrenal glands for tumors or cysts.

Your doctor might also examine your abdomen and do a pelvic exam to look for masses that could indicate a tumor.

Treatment

Treatment for hirsutism often involves a combination of treating the underlying disorder, if there is one, self-care methods, hair-removal therapies and medications.

Medications

Medications taken for hirsutism usually take up to six months, the average life cycle of a hair follicle, before you see a significant difference in hair growth. Medications include:

  • Oral contraceptives. Birth control pills or other hormonal contraceptives, which contain estrogen and progestin, treat hirsutism caused by androgen production. Oral contraceptives are a common treatment for hirsutism in women who don't want to become pregnant. Possible side effects include dizziness, nausea, headache and stomach upset.
  • Anti-androgens. These types of drugs block androgens from attaching to their receptors in your body. They're sometimes prescribed after six months on oral contraceptives if the oral contraceptives aren't effective enough.

    The most commonly used anti-androgen for treating hirsutism is spironolactone (Aldactone). Because these drugs can cause birth defects, it's important to use contraception while taking them.

  • Topical cream. Eflornithine (Vaniqa) is a prescription cream specifically for excessive facial hair in women. It's applied directly to the affected area of your face and helps slow new hair growth, but doesn't get rid of existing hair. It can be used with laser therapy to enhance the response.

Procedures

To remove unwanted hair permanently, options include:

  • Electrolysis. This treatment involves inserting a tiny needle into each hair follicle. The needle emits a pulse of electric current to damage and eventually destroy the follicle. You might need multiple treatments.

    Electrolysis is effective but can be painful. A numbing cream spread on your skin before treatment might reduce discomfort.

  • Laser therapy. A beam of highly concentrated light (laser) is passed over your skin to damage hair follicles and prevent hair from growing. You might need multiple treatments.

    You might develop skin redness and swelling after laser therapy. Laser therapy for hair removal is expensive and carries a risk of burns and skin discoloration, especially in people with tanned or dark skin.

Preparing for an appointment

You're likely to start by seeing your family doctor. He or she might refer you to a doctor who specializes in hormone disorders (endocrinologist) or skin problems (dermatologist).

What you can do

When you make your appointment, ask if you should avoid removing your unwanted hair, so the doctor can better evaluate your condition. Make a list of:

  • Key personal information, including other medical conditions and changes in your menstrual cycle or sex drive
  • All medications, vitamins and other supplements you take, including doses
  • Questions to ask your doctor

For hirsutism, some questions to ask your doctor include:

  • What's likely causing my symptoms?
  • What are other possible causes for my symptoms?
  • What tests do I need?
  • Is my condition likely temporary or chronic?
  • What's the best course of action?
  • What are the alternatives to the primary approach you're suggesting?
  • I have these other health conditions. How can I best manage them together?
  • Should I see a specialist?
  • Are there brochures or other printed material I can have? What websites do you recommend?

Don't hesitate to ask other questions.

What to expect from your doctor

Your doctor is likely to ask you questions, such as:

  • When did your symptoms begin?
  • Has your menstrual cycle changed, or have you stopped having your period?
  • Have you gained weight?
  • Have you developed new acne?
  • Has the size of your breasts changed?
  • Have others commented that your voice has changed?
  • Are you planning to become pregnant soon?

Lifestyle and home remedies

Self-care methods to remove unwanted facial and body hair include:

  • Plucking. Using tweezers is a good method to remove a few stray hairs, but is not useful for removing a large area of hair.
  • Shaving. Shaving is quick and inexpensive, but it needs to be repeated regularly since it removes the hair only at the surface of your skin.
  • Waxing. Waxing involves applying warm wax on your skin where the unwanted hair grows. Once the wax hardens, you pull it from your skin to remove hair. Waxing removes hair from a large area quickly, but it may sting temporarily and sometimes causes skin irritation and redness.
  • Chemical depilatories. Generally available as gels, lotions or creams that you spread on your skin, chemical depilatories work by breaking down the protein structure of the hair shaft. Some people are allergic to the chemicals used in depilatories.

Bleaching

Instead of removing unwanted body hair, some women use bleaching. Bleaching removes the hair color, making the hair less visible. Bleaching can cause skin irritation, so test the bleach on a small area first. Also, bleaching can make hair stand out on dark or tanned skin.

Prevention

Hirsutism generally isn't preventable. But losing weight if you're overweight might help reduce hirsutism, particularly if you have polycystic ovary syndrome.

Last updated: November 5th, 2016

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