Hirsutism

Hirsutism (HUR-soot-iz-um) is a condition in women that results in extra growth of dark or coarse hair. The hair growth follows a male-like pattern. It may show up on the face, chest, back and other body parts where hair usually doesn’t grow on women.

With hirsutism, extra hair growth often happens due to excess male hormones called androgens. The main androgen involved is testosterone.

Self-care methods may be useful for removing unwanted hair. And medical treatment is available for those who wish to treat hirsutism.

Hirsutism is stiff or dark hair that appears on the body where women don’t commonly have hair. That can include areas such as the:

• Face.
• Chest.
• Lower stomach.
• Inner thighs.
• Back.

When high androgen levels cause hirsutism, other symptoms might develop over time. This is a process called virilization. Symptoms of virilization might include:

• The voice deepens.
• The scalp loses hair.
• Acne appears.
• Breast size becomes smaller.
• Muscle mass increases.
• The clitoris becomes larger.

If you think you have too much coarse hair on your face or body, talk with your health care team. Ask about treatment options.

Extra facial or body hair can be a symptom of another condition. Get a health care checkup if over a few months you have heavy or rapid hair growth on your face or body. Also get checked if you notice symptoms of virilization. You may be referred to a healthcare professional who finds and treats hormone disorders, called an endocrinologist. Or you might be referred to a healthcare professional who finds and treats skin problems, called a dermatologist.

Hirsutism can be caused by:

• Polycystic ovary syndrome (PCOS). This condition causes a shift in the balance of sex hormones. It often starts during puberty. Over years, PCOS may slowly lead to extra hair growth, irregular periods, obesity, infertility and sometimes multiple small cysts on the ovaries.
• Cushing syndrome. This happens when the body makes high levels of the hormone cortisol. It can develop because the adrenal glands make too much cortisol. Or it can come from taking medicines such as prednisone over a long time.
• Congenital adrenal hyperplasia. This is a condition that’s present at birth. It’s passed from parents to children through genes. The condition causes the adrenal glands to make irregular amounts of steroid hormones. For example, the glands might make too little cortisol and too much androgen.
• Tumors. Rarely, a tumor in the ovaries or adrenal glands can cause hirsutism. It does this by releasing androgen.
• Medicines. Some medicines can cause hirsutism. These include minoxidil (Minoxidil, Rogaine); danazol, which is used to treat endometriosis; testosterone (Androgel, Testim); and dehydroepiandrosterone (DHEA). If your partner uses products that have androgens that go on the skin, the androgens may affect you through skin-to-skin contact.

Hirsutism may happen with no clear cause.

Some factors can raise the risk of hirsutism, including:

• Family history. Some conditions that cause hirsutism run in families. They include congenital adrenal hyperplasia and polycystic ovary syndrome.
• Ancestry. Women of Mediterranean, Middle Eastern and South Asian descent are more likely to have extra body hair with no clear cause than are other women.
• Obesity. Being obese causes the body to make more androgens. That can make hirsutism worse.

Hirsutism can be distressing. You might feel self-conscious about having unwanted hair. Some people become depressed. Hirsutism itself doesn’t cause physical health problems. But if a medical condition is causing a hormonal imbalance, that may lead to other health concerns.

If you have hirsutism and irregular periods, you might have polycystic ovary syndrome. That can cause infertility. And people who take certain medicines to treat hirsutism should not try to become pregnant because of the risk of birth defects.

Hirsutism usually isn’t preventable. But losing weight if you’re overweight might help reduce hirsutism. That’s especially true if you have polycystic ovary syndrome.

To check for hirsutism, your healthcare professional gives you a physical exam. You also answer questions about your medical history and any medicines you take. You may need tests that measure the amount of certain hormones in your blood, including testosterone. If you have hirsutism, these tests might help find out whether higher androgen levels are the cause.

Your healthcare professional might examine your stomach area and do a pelvic exam. This is done to look for lumps that could be signs of a tumor. Sometimes, imaging tests such as an MRI and CT scan also are recommended to check for pelvic or adrenal tumors.

Treatment isn’t necessary for hirsutism with no sign of a hormonal condition.

For people who do need treatment or those who decide to seek treatment, it may involve:

• Treating underlying health problems.
• Starting a self-care routine to remove unwanted hair.
• Trying various therapies and medicines.

Medications

Cosmetic or self-care methods of hair removal alone don’t work for everyone with hirsutism. If that’s the case for you, you may want to talk with your healthcare professional about medicines that treat hirsutism. These medicines often take up to six months or more to make a difference in hair growth.

Choices include:

• Birth control pills. These also are called oral contraceptives. Birth control pills that contain the hormones estrogen and progestin can treat hirsutism caused by androgens. They’re a common hirsutism treatment for people who don’t want to become pregnant. Side effects can include nausea and headache. Your healthcare professional might tell you not to use the morning-after pill that contains levonorgestrel (Plan B One-Step).
• Anti-androgens. These types of medicines block androgens from attaching to cells in the body. Sometimes, they’re prescribed after six months on birth control pills if that medicine hasn’t helped enough.

  The most commonly used anti-androgen for hirsutism treatment is spironolactone (Aldactone, CaroSpir). The results are modest and take at least six months to be seen. Side effects can include irregular periods. These medicines also can cause birth defects. So it’s important to use birth control while you take them.

• Skin cream. This also is called topical cream. Eflornithine (Vaniqa) is a prescription cream for excessive facial hair in women. You put it directly on the affected area of your face twice a day. It helps slow new hair growth. But it doesn’t get rid of existing hair. It can be used with laser therapy or electrolysis hair removal procedures for better results.

Procedures

Hair removal methods may lead to longer-lasting results than self-care methods. They also can be used along with medicines. These hair removal methods include:

• Laser therapy. A beam of highly concentrated light, called a laser, is passed over the skin. It damages hair follicles and prevents hair from growing. This procedure also is called photoepilation. You might need more than one treatment of it. For people whose unwanted hair is black, brown or auburn, laser therapy often is a better option than electrolysis.

  Talk with your health care professional about the risks and benefits of the different lasers used for this hair removal method. People with tanned or darkly pigmented skin have a higher risk of side effects from certain lasers. These side effects include a darkening or lightening of the usual skin tones, blistering and inflammation.

• Electrolysis. This treatment involves placing a tiny needle into each hair follicle. The needle gives off a pulse of electric current to damage and, over time, destroy the follicle. You might need more than one treatment. For people with naturally blond or white hair, electrolysis is a better option than laser therapy.

  Electrolysis works, but it can be painful. A numbing cream spread on your skin before treatment might ease discomfort.

Self-care methods remove unwanted hair or make it less visible for a short time. These methods include:

• Plucking. Plucking is a good way to remove a few stray hairs. It is not useful for removing a large area of hair. Plucked hair often grows back. You can pluck using tweezers, thin cotton threads or other devices made for this purpose.
• Shaving. Shaving is quick and not costly, but you need to do it regularly.
• Waxing. Waxing involves putting 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. And it sometimes irritates the skin.
• Depilatory products. These products contain chemicals that dissolve hair when you place them on affected skin. They’re available in forms such as gels, creams and lotions. You’ll need to use them regularly. But they may irritate the skin.
• Bleaching. Bleaching lightens hair color. That makes it harder to see on people with light skin. Hair-bleaching products often contain hydrogen peroxide. They may cause skin irritation. Test any product you use on a small area of skin first.

When you make your appointment, ask if you should wait to remove unwanted hair until after the checkup. That might make it easier for your healthcare professional to assess your condition.

Before your appointment, make a list of:

• Key personal information. Include other medical conditions you have and changes in your menstrual cycle or sex drive.
• All medicines, vitamins and other supplements you take. Include the doses that you take.
• Questions to ask your health care professional.

For hirsutism, some questions to ask your healthcare team include:

• What’s likely causing my symptoms?
• What are other possible causes for my symptoms?
• What tests do I need?
• How long might my condition last?
• What’s the best course of action?
• What are some other treatment options?
• I have 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 suggest?

Feel free to ask other questions as well.

What to expect from your doctor

Your healthcare professional is likely to ask you questions such as:

• When did your symptoms begin?
• Has the extra hair grown slowly or quickly?
• Is the amount of hair you have similar to that of the other women in your family?
• Has your menstrual cycle changed? Have you stopped having your period?
• Have you gained weight?
• Have you developed new acne?
• Has the size of your breasts changed?
• Has your voice has changed?
• Are you planning to become pregnant soon?