What Is Hirsutism?
Hirsutism is a condition in women and people assigned female at birth (AFAB) that causes a lot of hair growth. The hair typically grows in areas where it usually appears in men or people assigned male at birth (AMAB).
It can also affect men, but the condition is often harder to identify. In men, hirsutism may look like typical hair growth.
The hair is often dark and coarse instead of the light, fine “peach fuzz” that covers most of the body.
About 5%-10% of women in the U.S. have hirsutism.
Hirsutism pronunciation
Hirsutism is pronounced hur-soo-tiz-uhm.
Hypertrichosis
Hypertrichosis also causes excess hair growth, but it’s different from hirsutism. With hypertrichosis, excess hair can grow anywhere on your body. On the other hand, people with hirsutism have a lot of hair growth on specific areas that depend on male hormones, such as the face, chest, back, and stomach.
Hirsutism Symptoms
With hirsutism, extra hair will grow on your:
- Face
- Chest
- Lower stomach
- Inner thighs
- Back
Virilization
Virilization is a process in which women and people AFAB develop male traits. It can happen when people with hirsutism have high hormone levels. Signs of virilization include:
- A deep voice
- Balding
- Acne
- More muscle mass
- Smaller breasts
- An enlarged clitoris
Causes of Hirsutism
Having high levels of male hormones (called androgens) can cause hirsutism. It's normal for women's bodies to make androgens, and low levels don't cause excess hair growth. But when these amounts are too high, they can cause hirsutism and other things, such as acne, a deep voice, and small breasts.
Sometimes, a person’s androgen levels may be normal, but their hair follicles are overly sensitive to male hormones. This is called follicle sensitivity and can lead to hirsutism.
Some possible reasons for high levels of androgens include:
- Polycystic ovary syndrome (PCOS). It causes small cysts, or fluid-filled sacs, to form on your ovaries.
- Cushing's syndrome. You get this when you have high levels of the stress hormone cortisol for long periods.
- Tumors in your adrenal glands (which make hormones such as cortisol) or your ovaries.
- Medication. Some drugs can change the hormone levels in your system, causing unwanted hair to grow on your face or body. This can happen with drugs that have hormones (such as anabolic steroids ), those that spur hair growth (like minoxidil [Rogaine]), and a drug called danazol (Danocrine) that can help with endometriosis (when the tissue that lines the uterus grows outside the womb).
- High insulin levels. Insulin can trigger the ovaries to produce androgens.
- Congenital adrenal hyperplasia. It's an inherited condition that can cause your adrenal glands to make too much androgen.
- Menopause. Hormonal changes can happen after menopause.
Some women and people AFAB have idiopathic hirsutism, which means there’s no known cause.
Hirsutism and PCOS
PCOS is the most common cause of hirsutism. But hirsutism, by itself, doesn’t mean you have PCOS. Extra hair growth is simply a symptom of PCOS that affects up to 70% of women and people AFAB with the condition.
Other signs of PCOS are:
- Irregular menstrual cycles
- Weight gain
- Thinning hair
- Acne
- Darkening of skin or skin tags
Risk Factors for Hirsutism
Women and people AFAB are most likely to develop hirsutism. A few other things can make hirsutism more likely, including:
- Family history. Some conditions that run in families and affect your hormones can cause hirsutism.
- Ancestry. People of Mediterranean, Hispanic, South Asian, or Middle Eastern descent are more likely to have extra body hair.
- Obesity. Being overweight causes your body to make more male hormones, which can make hirsutism worse.
Hirsutism Diagnosis
Your doctor will look at your hair growth and check for any other signs of hirsutism, such as acne. They might rule out other conditions with tests such as:
- Blood tests to check your hormone levels
- Ultrasound to look at your ovaries and uterus
- X-ray or CT scan to examine your adrenal glands
- MRI of the brain
- Pelvic exam to look at your ovaries for any tumors or cysts (abnormal fluid sacs)
Once a diagnosis is made, your doctor might use the Ferriman-Gallwey scale. This tool helps them determine the severity of your condition by looking at hair growth in nine areas of your body. To calculate the Ferriman-Gallwey score, health providers use a scale that ranges from 0 to 4 for each body location. A lower score means your hirsutism is mild, while a higher score indicates a more severe condition.
Hirsutism Treatment
If you have more facial or body hair than you want, there are several ways you can remove it:
Weight loss. If you’re not at a healthy weight and drop pounds, your body may make fewer male hormones.
Shaving. You can remove unwanted hair easily with a razor or electric shaver. You may need to shave daily to avoid stubble growth. Some people get razor burn from shaving too often, but a soothing cream may help.
Tweezing or threading. There are different ways to pluck hair from the root. You can use tweezers, or you can have areas threaded, which involves using a long, tight strand to loop around and remove each unwanted hair. These methods can cause pain and redness.
Waxing. A quick way to remove lots of unwanted hair from the root is with melted wax. Often, you get this done in a salon. Wax is applied to the skin and then removed quickly. It can cause pain and redness.
Creams. Some creams have strong chemicals called depilatories. You apply the cream and let it sit for a while, and when you wipe it off, the hair goes with it. They can irritate sensitive skin, so test a small spot before you use one on a large area.
Electrolysis. You can remove hair for good with electrolysis, which zaps hair at the root with an electric current. After you repeat the process several times, hair should stop growing in treated areas.
Laser hair removal. The heat from lasers removes hair from the root, but you need to repeat the process several times, and it sometimes grows back.
Medication. Doctors can prescribe drugs that change the way your body grows hair. But when you stop using it, your hair will grow back.
Birth control pills make the body produce fewer male hormones. With regular use, you should have less hair on your face or body.
Anti-androgens help your body make and use fewer male hormones.
Eflornithine (Vaniqa) is a face cream that slows hair growth when applied to the skin.
Bleaching products can lighten the hair on your body.
Low-dose steroids may be prescribed if your adrenal glands are overactive.
Gonadotropin-releasing hormone (GnRH) agonists lower the amount of androgen produced in the ovaries. They are injected and can be expensive.
Insulin-lowering drugs, such as metformin or pioglitazone (Actos), can also lower androgen levels in the blood; however, they usually aren’t used as a standard treatment option because they can cause side effects.
Complications of Hirsutism
Hirsutism can cause emotional distress. People with the condition can have a poor self-image due to the unwanted hair. You may even have symptoms of depression or anxiety.
Hirsutism Prevention
You may be able to lessen your chances of getting hirsutism, depending on the cause. If you have PCOS, here are some ways to lower your risk:
- Eat a healthy, low-calorie diet.
- Lose weight.
- Exercise regularly.
Talk to your doctor if you take medicines that can cause hirsutism. You may be able to adjust some of these drugs.
Takeaways
Hirsutism causes excessive hair growth, mainly in women and people AFAB. Though the symptoms of this condition can feel embarrassing, there are treatments available if you want to lessen the amount of facial and body hair. Talk to your doctor if you think you might have hirsutism.
Hirsutism FAQs
How do you get rid of hirsutism?
There are treatments to help slow down your hair growth and lessen unwanted hair. But no therapies will make the hair completely go away. You will need continuing treatment if you want to address your symptoms. Most people find an effective therapy that they can use as a long-term fix.
At what age does hirsutism start?
Hirsutism can start at any age, but most people start having symptoms during puberty.
What makes hirsutism worse?
Having obesity can make your body produce more androgen, which could make hirsutism worse.
What happens if hirsutism is left untreated?
If left untreated, hirsutism can contribute to mental health problems like depression, anxiety, low self-esteem, poor body image, and more. Because hirsutism could be due to underlying health conditions like polycystic ovary syndrome and Cushing’s syndrome, not treating it may cause your symptoms to worsen and increase your risk of complications like heart disease, type 2 diabetes, fertility problems, and high blood pressure.
How do you fix hirsutism naturally?
You can manage hirsutism naturally by making lifestyle and diet changes that may help reduce your androgen levels. For example, you can eat more antioxidant-rich foods like blueberries, tomatoes, bell peppers, lean meat, and foods cooked with healthy oils like olive oil, reduce your intake of refined foods and red meat, exercise regularly, and sleep well. You can also talk to your doctor about supplements or herbs that might help with hirsutism symptoms like saw palmetto, spearmint tea, and tea tree oils.
