Hirsutism

What is hirsutism?

Hirsutism is a common condition that causes excessive hair growth. It primarily affects women and people assigned female at birth (AFAB).

You may develop coarse, dark hair growth on your upper lip, chin, chest, abdomen or back instead of the fine hair sometimes referred to as “peach fuzz” that commonly grows in those areas. Hirsutism can cause distress, but it’s treatable.

Who does hirsutism affect?

Hirsutism mainly affects women and people AFAB. It can affect men and people assigned male at birth (AMAB), but it’s difficult to tell the difference between hirsutism and typical thick, dark, long hair growth (terminal hair).

You’re more likely to have hirsutism if you have a family history of conditions that cause it, especially polycystic ovary syndrome (PCOS) and congenital adrenal hyperplasia. Obesity can also increase your chances of having hirsutism.

You’re also more likely to have hirsutism if you’re Mediterranean, Hispanic, South Asian or Middle Eastern.

Hirsutism rarely affects children. If it does, it’s typically a sign of early puberty.

How common is hirsutism?

Hirsutism affects 5% to 10% of women and people AFAB who are around child-bearing age. It affects over 40% of women and AFAB at some point during their lives.

How does hirsutism affect my body?

Hirsutism doesn’t affect your physical health. However, it can affect you psychosocially (how society and social groups affect your thoughts and emotions) and psychologically (how you think about yourself and your behavior). You may experience emotional stress, anxiety and depression.

What are the symptoms of hirsutism?

The main symptom of hirsutism is dark hair growth.

Another symptom of hirsutism is virilization. Virilization is a condition in which you develop the secondary sex characteristics of men and people AMAB. Virilization occurs when your androgen levels are high. Androgens are a group of sex hormones that help people enter puberty and mature physically. Men and people AMAB make more androgens than women and people AFAB.

Some of the secondary sex characteristics you may develop from virilization include:

• Deeper voice.
• Decreased breast size.
• Increased muscle development.
• Clitoris enlargement (clitoromegaly).
• Increased sex drive.
• Acne.

What does hirsutism look like?

Hirsutism causes thick, coarse, dark hair to grow on parts of your body that would commonly grow as fine, thin hair. For example, hair may grow thicker and coarser on your face, chest, back, lower abdomen, upper arms or lower legs.

What is the cause of hirsutism in women?

In many cases, hirsutism doesn’t have a known cause. However, several conditions cause hirsutism, including:

• The natural production of androgens. All people have androgens, but men and people AMAB make more of them. If a person AFAB has high androgen levels or their hair follicles are more sensitive to androgens, they may develop hirsutism.
• Polycystic ovarian syndrome (PCOS). PCOS is a common hormonal condition that causes women and people AFAB to produce too many androgens. Other symptoms of PCOS include acne, abnormal menstruation, diabetes, weight gain and fertility problems.
• Postmenopause. The hormonal changes that take place in your body after menopause may lead to increased facial hair, including a mustache or whiskers.
• Cushing’s syndrome. Cushing’s syndrome happens when your body has too much of the hormone cortisol, which can impact the set of organs that affect your hair, skin, nails, glands and nerves (integumentary system). Other symptoms of Cushing’s syndrome may include rapid weight gain in your face, wounds that heal poorly, high blood pressure (hypertension) and diabetes.
• Other conditions. If hirsutism occurs suddenly along with symptoms, like a deeper voice, acne or increased muscle development, you may have a more serious condition. More serious conditions may include an adrenal gland disorder or an ovary disorder, such as congenital adrenal hyperplasia or a tumor on your adrenal glands or ovaries that produce androgen.
• Medications. Some medications can cause hirsutism, including anabolic steroids, testosterone, cyclosporine (Sandimmune®), minoxidil (Rogaine®), danazol (Danocrine®) and phenytoin (Dilantin®).

Does hirsutism always mean PCOS?

PCOS isn’t the only cause of hirsutism. However, 70% to 80% of all people with PCOS develop hirsutism.

Is hirsutism contagious?

No, hirsutism isn’t contagious.

How is hirsutism diagnosed?

Your healthcare provider will conduct a physical examination to determine the extent of the uncommon hair growth. They’ll also note any other physical signs that may accompany the hair growth, such as acne.

Once your healthcare provider has diagnosed hirsutism, they may use the Ferriman-Gallwey scale to grade its severity. The Ferriman-Gallwey scale examines nine areas of your body: your upper lip, chin, chest, upper abdomen, lower abdomen, upper arms, thighs, upper back and lower back/butt (buttocks).

These areas receive a 0-4 score based on hair growth. A low number means your hirsutism is mild, and a high number means your hirsutism is more severe.

After examining the areas, your healthcare provider will add the scores together. If you’re Black or white, a total score less than 8 is common. If you’re Mediterranean, Hispanic or Middle Eastern, a total score less than 9 or 10 is common. If you’re Asian, a total score less than 2 is common.

What tests will be done to diagnose hirsutism?

If you have hirsutism, your healthcare provider may perform a variety of tests, including:

• Blood tests to check your hormone levels.
• Ultrasound to examine your ovaries and uterus.
• X-rays to evaluate your ovaries and adrenal glands to rule out other conditions.

What are the treatment options for hirsutism?

Yes, hirsutism is treatable. Treatments include:

Weight loss

Weight loss is often the first step in treating hirsutism. Losing even 5% of your body weight can lower your androgen levels and stop excessive hair growth.

Medications

• Birth control pills (oral contraceptives): Birth control pills are the most common medication used to treat hirsutism. They lower androgen levels, regulate your menstrual cycle and prevent pregnancy. Side effects may include breast tenderness or swelling, headaches, irritability or moodiness, nausea and spotting between periods (abnormal menstruation).
• Androgen-suppressing medications: These medications, including spironolactone (Aldactone®), finasteride (Proscar®) and flutamide (Eulexin®), can effectively treat mild cases of hirsutism by lowering the amount of androgens your body produces. Side effects of these medications may include dry skin, heartburn, spotting between periods, dizziness, fatigue and liver damage.
• Low-dose steroid medications: If overactive adrenal glands cause your hirsutism, your healthcare provider may prescribe low-dose steroid medications. Your adrenal glands are small glands just above each kidney. They produce sex hormones, including adrenaline and cortisol. Side effects may include increased appetite, weight gain, changes in mood and blurred vision.
• Insulin-lowering medications: These medications, including metformin (Glucophage®) and thiazolidinediones like pioglitazone (Actos®), reduce blood levels of insulin and androgens. These medications are controversial and shouldn’t be a first-line treatment because of their significant side effects. Side effects of these medications may include allergic reactions, breathing problems, slow or irregular heartbeat, blood in your pee (urine), and signs and symptoms of low blood sugar (hypoglycemia).
• Gonadotropin-releasing hormone (GnRH) agonists: These substances decrease androgen production in your ovaries. This therapy requires injections and can be expensive, and it doesn’t offer any more benefits than birth control pills. Side effects may include hot flashes, weight gain, fluid retention and a decreased libido (hypogonadism).
• Eflornithine skin cream: Eflornithine skin cream (Vaniqa®) is a topical product that you rub on your affected areas. It doesn’t remove hair, but it slows down how fast your hair grows. It may take six to eight weeks to see noticeable results. Once you stop using the cream, your hair starts to grow at the same rate as before you started using the cream. Side effects may include allergic reaction, hair bumps, discoloration (red, purple or brown skin) and stinging or burning.

Hair removal options

• Electrolysis: This technique uses a tiny needle and a mild electrical zap to destroy your hair roots one by one. Each hair follicle requires treatment, so it may not be practical to use electrolysis over a large area of your body. Side effects are rare, but they may include slight discoloration (red, purple or brown skin), temporary dark spots and a slight tingling sensation.
• Laser hair removal: In this technique, heat from a laser destroys cells that have a lot of pigment (color). Dark hair has a lot of pigment, so it absorbs the most heat. Hair transfers heat to the hair follicles and destroys them, so hair can’t grow. Side effects may include blisters, burns, scars, dark areas of skin (hyperpigmentation) and light areas of skin (hypopigmentation).

Home remedies

• Shaving: This is the most common method of hair removal. It’s simple and safe, but you must shave regularly to prevent stubble. Side effects of shaving may include cuts and ingrown hairs.
• Bleaching: Bleaching products lighten unwanted hair. Be aware that some bleaching products can cause skin irritation if they remain on your skin for too long.
• Waxing and plucking (tweezing): Waxing or using tweezers to remove hair from the root is effective but painful. Side effects may include skin irritation and ingrown hairs.

How soon after treatment will I feel better?

It depends on the severity of your hirsutism and your treatment.

Medications may take weeks or months before you see noticeable results.

You may need to schedule electrolysis appointments every week or every other week. The appointments can last for up to a year and a half. For laser hair removal, you’ll likely need six to eight treatments, and appointments are about six to eight weeks apart.

Shaving immediately cuts your hairs down, but it doesn’t remove the roots. You may have stubble in as little as a few hours. Waxing and tweezing your hair removes the roots. The results should last from three to six weeks. The effects of bleaching may last up to a month.

How can I reduce my risk of developing hirsutism?

Reducing your risk of developing hirsutism depends on its cause.

If you have PCOS, losing weight through healthy eating and regular exercise may help reduce your risk.

If you’re taking any medications that may cause hirsutism, talk to your healthcare provider about how to reduce your risk.

What can I expect if I have hirsutism?

Hirsutism requires ongoing treatment. None of the treatments make the hair go away completely, but they help make your hair grow more slowly and decrease the amount of unwanted hair. Most people are happy with their results once they find an effective treatment regimen that works for them. Once you find an effective treatment, you may use it long-term.

When should I see my healthcare provider?

It’s a good idea to see your healthcare provider as soon as you notice unusual hair growth. Hirsutism may be a symptom of PCOS, Cushing’s syndrome or other conditions.

What questions should I ask my healthcare provider?

• How can you tell that I have hirsutism?
• If I don’t have hirsutism, what’s causing my hair growth?
• What medications or treatments do you recommend?
• What’s the complete list of side effects for the medications and treatments?
• Should I see a dermatologist?

A note from Cleveland Clinic

Hirsutism is a common condition that mainly affects women and people assigned female at birth (AFAB). It doesn’t cause any pain, but it may be a symptom of another condition, including polycystic ovarian syndrome, Cushing’s syndrome, an adrenal gland disorder or an ovary disorder. Unwanted hair can also make you feel embarrassed, which can affect your mental health.

It’s a good idea to reach out to your healthcare provider as soon as you notice signs of hirsutism, especially if it causes stress, anxiety or depression. Medications and treatments are available to limit your unwanted hair growth.