Hirsutism is a condition causing excessive facial hair growth in women, often linked to hormonal imbalances like PCOS. This guide explores its causes, symptoms, and effective treatments, including medical options, hair removal methods, and natural remedies. Learn how to manage facial hair and improve confidence with the right approach.
Hirsutism and Facial Hair in Women
Facial and excessive body hair is typically associated with men due to the natural increase in testosterone during puberty, which stimulates hair growth. However, in women with hirsutism, this pattern of hair growth also occurs, often beginning around puberty but sometimes developing later in life.
Hirsutism is caused by elevated testosterone levels, which can result from underlying conditions like polycystic ovary syndrome (PCOS). Up to 80% of women with PCOS experience excessive facial hair growth as a symptom of the condition.
What is Hirsutism?
Hirsutism is a medical condition that stimulates excessive hair growth in women. Women with hirsutism have a male pattern of hair growth. In other words, they grow coarse, dark hair in places generally seen in men, such as over the lip, chin, or back. The direct cause is an increase in androgen or male sex hormones.
The factors that influence the production of hormones, such as testosterone, vary. It could be due to an abnormality in the woman's ovaries, adrenal gland, or pituitary gland, or it might be a side effect of medication. Some medications, such as bodybuilding steroids, contain androgens and can cause hair growth.
Causes of Facial Hair in Women
Women with hirsutism have elevated androgen levels, including testosterone, which are typically dominant in men. While women naturally produce small amounts of androgens, excess levels can overstimulate hair follicles, leading to excessive hair growth.
Approximately 70% to 80% of women with PCOS also experience hirsutism. PCOS is a hormonal disorder that disrupts androgen balance, though its exact cause remains unclear. It often runs in families and is sometimes linked to insulin resistance or chronic low-level inflammation. Hirsutism can also be a symptom of other conditions, such as Cushing's syndrome, which results from excessive cortisol production, or adrenal hyperplasia, a disorder that affects androgen hormone levels.
Understanding Hirsutism vs. Normal Hair Growth
Most women have some hair growth in non-scalp areas like their face and body. The hair consists of fine, light-colored strands, typically referred to as "peach fuzz." This barely visible hair helps regulate body temperature and protect the skin.
Women with hirsutism can develop excessive coarse hair, known as terminal hair. It may grow on their upper lip and chin. They may also get it on their chest, belly, back, forearms, and lower legs.
Symptoms of Hirsutism
The primary symptom of hirsutism is abnormal terminal hair growth. However, there may also be secondary symptoms, such as male-pattern hair loss and acne.
Common Symptoms of Female Facial Hair Growth
In its mild form, facial hair women grow is the same color as scalp hair. Those with mild hirsutism might see growth on:
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Upper lip
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Sideburns
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Chin
Those with more advanced forms of the condition will see more extensive hair growth. It may also appear on their:
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Upper back
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Lower belly
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Shoulders
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Chest
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Abdomen
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Legs
How to Recognize Hirsutism
The primary sign to recognize hirsutism is the male-pattern hair growth, including coarse hair on the breasts, abdomen, chin, and upper lip. Along with hair growth, women with hirsutism may develop secondary sex characteristics called ‘virilization’. Virilization includes deep voices, enhanced muscle growth, and decreased breast size. There may also be symptoms of an underlying condition, such as polycystic ovarian syndrome. This could include acne, irregular menstrual cycle, and fertility issues.
Causes of Excessive Facial Hair in Women
An imbalance of androgen hormones causes excessive facial hair in women linked to hirsutism.
Hormonal Imbalance and Hirsutism
Women naturally have fine, light facial hair called vellus hair, which helps regulate body temperature and protect the skin. Hirsutism causes women to grow terminal hair on their faces, which is thicker, pigmented, and more visible, similar to the hair on the scalp, eyebrows, and eyelashes.
This occurs when a woman's body produces excess androgens, like testosterone, stimulating the growth of terminal hair instead of vellus hair. This is similar to what happens in puberty when a boy's body starts producing more androgens, causing facial hair follicles to switch from growing vellus hair to terminal hair.
PCOS and Its Link to Facial Hair Growth
Polycystic ovary syndrome (PCOS) is a lifelong hormonal disorder that typically begins during puberty and affects women throughout their entire life. While its precise cause remains unknown, PCOS disrupts hormone balance, leading the ovaries to produce an excess of androgens, often referred to as "male hormones," even though they are present in women as well. This surplus of androgens has several effects on the body, one of the most noticeable being its impact on hair growth. While PCOS cannot be cured, its symptoms can be effectively managed with proper treatment and lifestyle modifications.
The elevated androgen levels stimulate hair follicles, particularly on the face, to switch from producing fine, light vellus hair to thicker, darker terminal hair. This can result in hirsutism, the growth of coarse, male-pattern hair in women, which can be a significant concern for those with PCOS. It's important to note that while hirsutism is a common symptom of PCOS, not all women with PCOS will experience it, and not all women with hirsutism have PCOS. Other contributing factors can also play a role in excessive hair growth.
Other Factors Contributing to Hirsutism
Not all women with hirsutism have PCOS, although it is the most common cause. The terminal hair growth could result from hair follicles that are more sensitive to androgen hormone levels. It may also be a side effect of menopause or Cushing's syndrome.
Some medications can cause facial hair growth as well. Possibilities include:
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Anabolic steroids
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Minoxidil
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Danazol
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Phenytoin
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Synthetic testosterone
Diagnosing Hirsutism
Hirsutism is a hormonal disorder. When diagnosing it, your healthcare provider will look for signs of a hormone imbalance, such as acne. They will also take a complete medical history to determine if you have other conditions that might trigger the hair growth, such as PCOS.
Key blood tests can help confirm the diagnosis. Your physician might order blood tests to determine levels for:
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Thyroid-stimulating hormone (TSH)
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Prolactin
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Testosterone and
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DHEA-sulfate
They may do a pelvic ultrasound, x-rays, or a CT scan to look for other signs of a condition linked with hirsutism, such as cysts on the ovaries.
Once diagnosed, the next step is to grade the hirsute, or severity of the hair growth, using the Ferriman-Gallwey scale. This involves examining nine areas of the body and rating the level of terminal hair growth from zero to four. The nine areas are:
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Upper Lip
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Chin
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Chest
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Upper Back
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Lower Back
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Upper Abdomen
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Lower Abdomen
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Upper Arms
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Thighs
The higher the number, the more severe the growth. The final score is determined by totaling the numbers from these nine areas. On average, women with hirsutism who are white or black will have a common score of less than eight. Those of Mediterranean, Middle Eastern, or Hispanic descent tend to have scores of nine or 10. Women who are Asian will have lower scores, usually around two.
Experiencing unwanted hair growth in these areas can be concerning and may indicate an underlying hormonal condition like PCOS. Start by taking our physician-developed PCOS Symptoms Quiz to assess your symptoms, then schedule an appointment with your healthcare provider to discuss your symptoms and quiz results.
Hirsutism Treatments and Management
Treatment of hirsutism will likely involve medications, lifestyle changes, and changes to self-care routines.
Medical Treatments for Hirsutism
Your healthcare provider will assess your health and healthcare goals to determine the proper medical treatment for hirsutism and any potential underlying condition. There are several options available, including spironolactone and oral contraceptives.
Spironolactone for Hirsutism Treatment
Spironolactone is a diuretic medication that typically treats high blood pressure. It is also an anti-androgen drug that lowers hormone levels by blocking receptors. Blocking specific receptors prevents testosterone from binding with them and affecting hair follicles.
Spironolactone also reduces the production of androgen hormones from the adrenal glands. It inhibits enzymes from converting existing testosterone into other androgens.
Oral Contraceptives for Facial Hair Removal
For women who are not pregnant or looking to have a baby in the immediate future, the choice might be oral contraceptives. Birth control pills lower androgen levels. They increase specific hormone levels that bind to androgens to reduce their availability. That decreases the circulating testosterone, which can impact hair follicles and growth.
Medications and Their Impact on Hirsutism
Although medication can be an effective treatment for hirsutism, the results will vary from woman to woman. Sometimes, they may slow hair growth and reduce the coarseness but not eliminate it.
Facial Hair Removal Options for Women
For many women, the answer to managing hirsutism will include facial hair removal, such as:
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Laser therapy
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Electrolysis
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Shaving
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Plucking
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Waxing
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Depilation
You may use one or more of these methods to remove facial hair. For women who simply wish to diminish the appearance of the hair, bleaching can be an excellent option.
Best Facial Hair Removal Methods for Women
There's no single best facial hair removal method for all women. Finding the right approach often involves experimenting to see what suits your individual skin and hair type. A combination of methods, including medical treatments and at-home care, may be necessary to achieve the desired results.
Several factors influence the best choice for you, including time commitment, budget, and desired longevity. Shaving is a quick and easy option for temporary hair removal. For a more permanent solution, consider medical therapies like electrolysis.
Electrolysis involves inserting a fine needle into each hair follicle and using an electric current to destroy it. A numbing cream is typically applied beforehand to minimize discomfort. Tweezing is suitable for removing a few stray hairs, but it's not practical for larger areas and can be painful.
Painless Ways to Remove Facial Hair
Your pain tolerance will also influence your choice. Some medical and self-care methods can be uncomfortable or painful. If you want something pain-free, self-care changes might be best for you. Those would include:
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Shaving – Painless and quick but serves as a temporary removal process.
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Chemical depilatories – Dissolves hair and are primarily pain-free. However, the solution can irritate the skin. They last longer than shaving but are still a short-term option. How often you use them depends on the product and how fast your hair grows.
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Bleaching – With this option, the hair stays; you just change its color so it is less noticeable. Like chemical depilatories, the treatment can irritate sensitive skin. Do a skin test before using to see how you react to the chemicals.
Permanent Hair Removal for Women
You will likely need a medical option to remove the hair permanently. Electrolysis and laser treatments damage the follicle, preventing it from growing hair again.
Both possibilities for removing facial hair require multiple treatments to eliminate hair. Electrolysis, which uses an electrical current to damage follicles, is typically recommended for those with natural blond or white hair. Laser treatments tend to be better for those with darker hair colors.
Laser Hair Removal for Hirsutism
Laser therapy is a hirsutism treatment that uses concentrated light to damage the follicle, preventing hair growth. This method can remove 80% to 90% of hair. It can have side effects, such as lightening skin in the treatment area, inflammation, and burning.
Laser hair removal may be more effective when combined with other therapies, such as electrolysis. Both these options require multiple treatments to eliminate hair, though.
Typically, electrolysis is recommended for those with natural blond or white hair. Laser treatments are better for those with darker hair colors and light skin, although advanced technology may work on a more diverse range of skin tones.
Natural Remedies and Lifestyle Changes
Some women prefer to take a holistic approach to managing their hirsutism. Lifestyle and natural remedies can help control hair growth. If you take medication for PCOS or hirsutism, such as oral contraceptives, talk to your doctor before trying natural remedies.
Natural Treatments for Facial Hair Growth
Some natural remedies may help manage the hormonal imbalances linked to hirsutism and reduce excess hair growth. These include:
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Curcumin
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Saw palmetto
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Fennel
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Spearmint
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Licorice
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Zingiber and Neem
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Green tea
Both topical and oral applications of these herbal treatments may be beneficial.
Diet and Supplements for Hirsutism Management
Diet and lifestyle changes can play a significant role in managing hirsutism. Since weight and insulin resistance can contribute to the condition, a balanced diet is key. Focus on regular, smaller meals to stabilize blood sugar, prioritizing fiber and protein while limiting processed foods and sugar.
Diet can also directly impact hormone levels. Soy products (like tofu and soy milk) and seeds (such as sunflower, sesame, and flax) may help balance hormones by increasing estrogen, potentially reducing facial hair growth.
Stress management is also important, as stress hormones can trigger androgen production. Adaptogenic supplements may help build stress resilience by influencing the HPA axis. Ashwagandha is one example, and others include rhodiola, licorice, reishi mushrooms, and turmeric. These can be taken in capsules, teas, or added to food.
Home Remedies for Reducing Facial Hair Growth
There are natural home remedies that some use to reduce facial hair growth. For instance, there are homemade pastes that might help, such as:
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Papaya and turmeric
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Banana and oatmeal
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Lemon and sugar
Simply mix them, massage them into your skin, then rinse with cold water.
Hirsutism and PCOS
There is a clear relationship between hirsutism and polycystic ovary syndrome. Up to 82% of women diagnosed with PCOS also develop hirsutism.
Understanding PCOS and Its Impact on Facial Hair
Not all women with hirsutism have PCOS as well, but it is a common association. PCOS is a hormonal condition that leads to excessive androgen hormones. Excess testosterone and other androgens in your blood will stimulate the hair follicles to grow terminal or coarse, pigmented hair.
Treatments for PCOS-Related Facial Hair
Treating the underlying hormone imbalance may help control PCOS-related facial hair growth. Oral contraceptives are often the gold standard treatment for PCOS and can help control facial hair growth.
Other medication options to treat PCOS-related facial hair include:
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Spironolactone: This can reduce the effect of the androgens on the skin.
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Eflornithine: A cream that can slow the growth of facial hair.
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Metformin: A treatment for type 2 diabetes and insulin resistance. Reducing insulin levels can also lower androgens in the blood.
Supplements proven to help treat PCOS facial hair:
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Inositol: Helps reduce androgen levels and improve insulin sensitivity, which can help reduce excess hair growth
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Vitamin D: Studies have shown a correlation between vitamin D deficiency and hirsutism severity; supplementation may help reduce excess hair growth
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Chromium: Helps with insulin sensitivity, which can indirectly help reduce androgen levels that contribute to hirsutism
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Spearmint: Contains compounds that have anti-androgenic properties and may help reduce testosterone levels that contribute to excess hair growth
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Saw Palmetto: Acts as a natural DHT blocker, which may help reduce unwanted facial and body hair growth
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Zinc: Helps regulate hormone production and may help reduce excess androgen levels that contribute to hirsutism
Hair removal is something you can do whether you take medication or not. Some options for hair removal include:
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Laser therapy
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Electrolysis
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Shaving
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Plucking
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Waxing
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Chemical depilatories
Laser therapy and electrolysis are permanent solutions to facial hair growth. The other self-care methods are temporary options.
Managing PCOS and Excess Hair Growth
Managing your PCOS and hair growth may take a combination of options, such as:
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Medications to treat PCOS
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Hair removal treatments
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Lifestyle changes
No two women's bodies are the same, so finding the right option may require some trial and error.
Psychological and Social Impact of Facial Hair
Society has established gender norms that can have a strong emotional impact. Facial hair is a male characteristic that signifies masculinity and maturity.
When women have facial hair, it can make them self-conscious and uncomfortable, especially in social situations. The stigma attached to facial hair in women can also leave them feeling isolated or bullied.
Emotional and Mental Health Considerations
Having hirsutism can have a significant impact on mental health. Women with this condition can develop:
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Depression
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Anxiety
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Psychological distress
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Negative body image
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Low self-esteem
The psychological impact of facial hair can be extreme enough to impact the quality of life. It can limit social interactions and affect personal relationships.
Coping with Hirsutism and Societal Expectations
Managing hirsutism requires ongoing effort and can be stressful. Finding the right hair removal method, often a combination of treatments, is key. Support groups can provide valuable peer support. Raising awareness about the condition helps reduce stigma. Self-advocacy, including learning about the condition and practicing self-compassion, is essential.
When to Seek Medical Advice
You should talk to a doctor anytime your body changes or you have a concern. This includes whether you begin to get or have facial or excessive body hair growth.
Consulting a Doctor for Facial Hair Concerns
See your doctor if you notice sudden facial hair growth or if you suddenly grow hair in other areas of your body. Pay attention to other symptoms you might be experiencing, such as:
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Weight gain
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Acne
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Changes in your period
These are all potential signs of PCOS, which is a condition that can lead to complications if left untreated. You should always speak with your doctor if you have a concern.
Available Treatments and Expert Guidance
Seeing your doctor is the first step in understanding the available treatment options. Your healthcare provider can also advise you on lifestyle changes and support you as you manage your condition.
Moving Forward: Managing Hirsutism with Confidence and Care
Women experiencing hirsutism have multiple pathways for managing unwanted hair growth, beginning with understanding the underlying causes, such as PCOS, and working with healthcare providers to develop appropriate medical interventions like hormone-balancing medications. While exploring treatment options, incorporating both medical approaches and personal care strategies can help create a comprehensive management plan that suits your individual needs and lifestyle.
Remember that hirsutism is a medical condition deserving of the same attention and care as any other chronic health concern. Rather than allowing societal stigma around female facial hair to impact your self-worth, focus on building a support system and pursuing the treatment options that best serve your physical and emotional well-being. With proper medical care, self-compassion, and ongoing support, you can effectively manage hirsutism while maintaining your confidence and quality of life.