What Is Hirsutism?

Hirsutism is a common condition that affects mostly women. The condition results in excessive dark and coarse hair to grow in a male-like pattern. It tends to grow on the face, chest, back, thighs, or stomach. The hair growth typically results from an excess of male hormones (androgens), primarily testosterone. Hirsutism does not have a known cause, but usually indicates another underlying condition, such as polycystic ovary syndrome. Treatment options include medication, weight loss, and hair removal.

How Common Is Hirsutism?

Hirsutism is a common condition that affects mostly women and approximately 5-10% of the US population. It affects over 40% of women.

Symptoms of Hirsutism

The predominant symptom of hirsutism is dark hair growth that also tends to be thick and coarse. Another symptom, known as virilization, causes a person to develop the secondary sex characteristics of males. It occurs when androgen levels are high. Androgens are sex hormones that allow people to begin puberty and mature physically. Males make more androgens than females. Examples of secondary sex characteristics you may develop include:

• Deeper sounding voice
• Decreased breast size
• Increase in muscle development
• Acne
• Enlargement of the clitoris (clitoromegaly)
• Increased sex drive

What Causes Hirsutism?

Hirsutism has no known cause, although it can indicate other underlying conditions. Underlying conditions include:

• Polycystic ovary syndrome (PCOS): This is a hormonal condition that affects many females. This condition causes females to produce higher levels of androgens. Symptoms of PCOS include abnormal menstruation, weight gain, acne, fertility problems, and diabetes.
• Natural production of androgens: All humans have androgens, males simply produce more of them. Females that have higher levels of androgens or hair follicles that are more sensitive to androgens may develop hirsutism.
• Postmenopause: Hormone changes after menopause may result in increased facial hair that can be dark and coarse.
• Cushing’s Syndrome: This condition happens when your body produces too much cortisol. Too much cortisol in the body can impact the organs that impact the skin, hair, nails, glands, and nerves. A primary symptom of Cushing’s syndrome is rapid weight gain in the face, poor wound healing, hypertension, and diabetes.
• Other medical conditions: Other serious conditions that may have hirsutism as a symptom include adrenal gland disorder, congenital adrenal hyperplasia, or a tumor on the adrenal glands or ovaries that produce androgen.
• Medications: Certain medications may lead to excessive hair growth or developing hirsutism.

Additionally, people of Mediterranean, South Asian, and Middle Eastern heritage have a greater chance of developing hirsutism.

Hirsutism Diagnosis

Your doctor will conduct a physical examination, take a thorough medical and family history, and assess your symptoms to determine if you have hirsutism. Your doctor may also order blood work and other tests to determine your hormone levels, or to rule out other conditions.

Additionally, if your doctor suspects hirsutism, they may choose to use the Ferriman-Gallwey scale to examine nine areas of the body for hair growth. The scale assesses hair growth on nine surface areas of the body and rates the hair growth from mild to severe. Depending on your ethnicity, that number will determine if your hair growth is common or not.

Tests for Hirsutism

• Blood tests to assess hormone levels
• X-rays to assess the ovaries and adrenal glands to rule out other conditions
• Ultrasound to examine the uterus and ovaries

Treatment for Hirsutism

There are several effective treatment options for hirsutism. One of the first lines of defense your doctor may recommend is weight loss. Obesity can change hormone functioning and processing in the body, so maintaining a healthy weight may stabilize androgen hormones without the need for medication.

If hirsutism is due to an underlying health condition, such as PCOS or adrenal disorders, medication may be a helpful treatment option. Medications may include:

• Anti-androgen medications: This type of medication blocks androgen receptors, which lowers androgen production, thereby reducing the appearance of excessive dark, coarse hair.
• Combination birth control pills: These medications are used to increase estrogen and progesterone in the body, which help to shrink cysts from PCOS, as well as reducing excess hair growth.
• Eflornithine cream: This medication is used to reduce facial hair growth. The cream works by interfering with a chemical in hair follicles under the skin and inhibiting or slowing hair growth.
• Low-dose steroid medications: These medications help to stabilize overactive adrenal glands, which produce sex hormones, such as adrenaline and cortisol. Side effects may include weight gain, changes in mood, increased appetite, and blurred vision.
• Insulin-lowering medications: These types of medications help reduce blood levels of insulin and androgens. Due to their potential for more significant side effects, they are not typically a first option.
• Gonadotropin-releasing hormone (GnRH) agonists: This medication helps to reduce androgen production in the ovaries. The treatment requires injections and can be expensive.

In addition to weight loss and medications, another effective treatment option is hair removal. There are several different hair removal options including:

• Electrolysis: This treatment option uses tiny needles and a mild electrical current to destroy hair roots, one at a time. Electrolysis treats one hair follicle at a time, so sessions take a while, and usually it is not recommended for large surface areas.
• Laser hair removal: This uses concentrated light rays to damage the hair follicles, which results in the follicles being unable to produce hair. The hair that is already there will fall out. Laser hair removal treatments can provide nearly permanent to fully permanent results.
• Shaving: This is a simple and safe treatment option, but it takes consistent upkeep. Shaving regularly helps to prevent stubble but may increase the risk of ingrown hairs or cuts to your skin.
• Waxing and tweezing: This is an effective treatment option but does tend to be more painful. You also have an increased risk for skin irritation and ingrown hairs.
• Bleaching: Bleaching products can lighten the color of your unwanted hair and make it less visible. Be aware that bleaching products may cause skin irritation if they remain on your skin too long.

Can You Prevent Hirsutism?

Prevention or reducing your risk of developing hirsutism depends on its underlying cause. If it is due to PCOS, maintaining a healthy weight through a balanced and healthy diet and regular exercise may reduce your risk to developing hirsutism. If it is due to your current medications, consult your healthcare provider to discuss other options that can reduce your risk.

Hirsutism FAQs

What Age Does Hirsutism Begin?

Hirsutism typically begins to develop at the onset of puberty. In older adults, it may begin during times of hormonal fluctuations, such as pregnancy or postmenopause.

Does Hirsutism Go Away with Weight Loss?

Hirsutism symptoms may decrease or resolve with weight loss, as obesity is a contributing factor in hormonal functioning and processing.

What Does Hirsutism Look Like?

Hirsutism looks like excessive dark and coarse hair that develops in a male-like pattern. The dark hair tends to grow on the face, chest, back, buttocks, thighs, or stomach.