Definition of Hirsutism
Hirsutism (HUR-soot-iz-um) is a condition of unwanted, male-pattern hair growth in women. Hirsutism results in excessive amounts of stiff and pigmented 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. Hirsutism may arise from excess male hormones called androgens, primarily testosterone. Hirsutism may also be due to a family trait.
A combination of self-care and medical therapies provides effective treatment for many women with hirsutism.
Symptoms of Hirsutism
Hirsutism is stiff and pigmented body hair, appearing on the body where women don’t commonly have hair — primarily the face, chest and back.
When excessively high androgen levels cause hirsutism, other signs may develop over time, a process called virilization. Signs of virilization may include:
- Deepening voice
- Decrease in breast size
- Enlargement of the clitoris
At puberty, a girl’s ovaries begin to produce a mix of female and male sex hormones. This causes 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 common condition is caused by an imbalance of sex hormones that may result in irregular periods, obesity, infertility and sometimes multiple cysts on your ovaries.
- Cushing’s syndrome. Cushing’s syndrome occurs when your body is exposed to high levels of the hormone cortisol. It can develop when your adrenal glands make too much cortisol, or it can occur from taking medications such as prednisone over a long period of time.
- 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 may cause hirsutism.
- Medications. Some medications can cause hirsutism. One such drug is danazol, which is used to treat women with endometriosis.
Sometimes, hirsutism can occur with no identifiable cause. This happens more frequently in certain populations, such as women of Mediterranean, Middle Eastern and South Asian ancestry.
Several factors may influence your likelihood of developing hirsutism. These include:
- 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.
Complications of Hirsutism
Hirsutism can sometimes be emotionally distressing. Some women feel self-conscious about having unwanted body hair. Also, although hirsutism doesn’t cause physical complications, the underlying cause of a hormonal imbalance can.
If you have hirsutism and irregular periods, you may have a condition called polycystic ovary syndrome, which can inhibit fertility. Women who are taking certain medications to treat hirsutism should avoid pregnancy because of the risk of birth defects.
Preparing for your 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. You may also want to:
- Write down key personal information. Let your doctor know if there have been any changes in your menstrual cycle or if your sex drive has noticeably increased.
- List all your medications and supplements. Include the specific name and dose of these medications and how long you’ve been taking them.
- Take a family member or friend along. Sometimes it can be difficult to remember all the information provided to you during an appointment. Someone who accompanies you may remember something you missed or forgot.
- Write down questions to ask your doctor. You might want to ask about potential diagnostic tests or specific treatments your doctor might recommend.
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- When did you begin experiencing symptoms?
- 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?
Tests and diagnosis
Tests that measure the amount of certain hormones in your blood, including testosterone, may help determine whether hirsutism is caused by elevated androgen levels. If androgen levels in your blood are elevated, your doctor may recommend an ultrasound or a CT scan to check your ovaries and adrenal glands for tumors or cysts.
Treatments and drugs
Treatment for hirsutism often involves a combination of self-care methods, hair-removal therapies and medications.
Medications taken for hirsutism usually take several months before you see a significant difference in hair growth. Medications may include:
- Oral contraceptives. Birth control pills or other hormonal contraceptives, which contain the hormones estrogen and progestin, treat hirsutism by inhibiting androgen production by your ovaries. 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. The most commonly used anti-androgen for treating hirsutism is spironolactone (Aldactone). Because these drugs can cause birth defects, it’s important to faithfully 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.
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. Electrolysis is an effective hair-removal procedure, but it can be painful. A numbing cream spread on your skin before treatment may reduce this discomfort.
- Laser therapy. In this procedure, a beam of highly concentrated light (laser) is passed over your skin to damage the hair follicles and prevent hair from growing. You may have some skin redness and swelling after laser therapy to remove hair. Laser therapy for hair removal also carries a risk of burns and skin discoloration. Laser treatments are also expensive.
Lifestyle and home remedies
Self-care methods to remove unwanted 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 down to the surface of your skin.
- Waxing. Waxing involves applying warm wax on your skin where the unwanted hair grows. Once the wax hardens, it’s pulled back from your skin against the direction of hair growth, removing 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.
Instead of removing unwanted body hair, some women use bleaching. Bleaching removes the hair color, making the hair less visible. Bleaching may cause skin irritation, so test the bleach on a small area first.
Hirsutism generally isn’t preventable. But if you have polycystic ovary syndrome, controlling obesity may help reduce hirsutism.