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Understanding excessive hair
Excessive or unwanted hair that grows on a woman’s body and face is the result of a condition called hirsutism. All women have facial and body hair, but the hair is usually very fine and light in color.
The main difference between typical hair on a woman’s body and face (often called “peach fuzz”) and hair caused by hirsutism is the texture. Excessive or unwanted hair that grows on a woman’s face, arms, back, or chest is usually coarse and dark. The growth pattern of hirsutism in women is associated with virilization. Women with this condition have characteristics that are commonly associated with male hormones.
Hirsutism is not the same as hypertrichosis, which refers to excess hair in areas that aren’t dependent on androgens (male hormones). Hirsutism is excess hair in areas where it’s typically seen in men, such as the face and lower abdomen. Hypertrichosis, on the other hand, can increase hair anywhere on the body.
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The presence of excess body hair can lead to feelings of self-consciousness, but it isn’t dangerous. However, the hormonal imbalance that can lead to it may compromise a woman’s health.
Women develop excessive body or facial hair due to higher-than-normal levels of androgens, including testosterone. All females produce androgens, but the levels typically remain low. Certain medical conditions can cause a woman to produce too many androgens. This can cause male-pattern hair growth and other male characteristics, such as a deep voice.
Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) is one common cause of hirsutism. It accounts for three out of every four hirsutism cases, according to American Family Physician. Benign cysts that form on the ovaries can affect hormone production, leading to irregular menstrual cycles and decreased fertility. The Office of Women’s Health states that women with PCOS often have moderate-to-severe acne and tend to be overweight. Additional symptoms can include:
Adrenal gland disorders
Other forms of hormonal imbalance that cause excessive hair growth include these adrenal gland disorders:
The adrenal glands, located just above your kidneys, are responsible for hormone production. People with congenital adrenal hyperplasia are born without an enzyme that’s necessary for hormone production. Those with Cushing’s disease have higher-than-normal levels of cortisol. Cortisol is sometimes called the “stress hormone.” All of these conditions can affect the way your body produces androgens.
Symptoms of adrenal gland disorders include:
- high blood pressure
- bone and muscle weakness
- excess weight in the upper body
- high or low blood sugar levels
Excessive body or facial hair growth can also result from taking any of the following medications:
- Minoxidil, which is used to stimulate hair growth
- anabolic steroids, which are synthetic variations of testosterone
- testosterone, which can be taken in case of a testosterone deficiency
- cyclosporine, which is an immunosuppressant drug that’s often used before organ transplants
In some cases, women may experience idiopathic hirsutism, which means that there’s no detectable cause for why the hirsutism developed. It’s usually chronic and may be harder to treat.
Your doctor will take a detailed medical history when diagnosing hirsutism. Discuss your medication use with your doctor to help them determine the cause of your condition. Your doctor will likely order blood tests to measure your hormone levels. In some cases, your doctor may also order blood work to make sure you don’t have diabetes.
If you’re overweight, your doctor will probably suggest that you lose weight to reduce your hair growth. Obesity can change the way your body produces and processes hormones. Maintaining a healthy weight may correct your level of androgens without the use of medication.
You may need medical treatment if excessive hair growth is a symptom of PCOS or adrenal disorders. Drug therapy in the form of birth control pills and antiandrogen medications can help balance your hormone levels.
Antiandrogen medications: Steroidal androgens and nonsteroidal (or pure) antiandrogens can block androgen receptors and reduce androgen production from the adrenal glands, ovaries, and pituitary glands.
Combination birth control pills: These pills, which have both estrogen and progesterone, may help shrink the cysts from PCOS. The estrogen can also help reduce excess hair. These drugs are usually a long-term solution for hirsutism. You will most likely notice improvement after three to six months of drug therapy.
Your doctor may prescribe the cream eflornithine to reduce the growth of facial hair. Your facial hair growth should slow after one to two months. Side effects of eflornithine include skin rash and irritation.
Hair removal techniques are a nonmedical way to manage excessive or unwanted hair. These are the same hair removal methods that many women use to keep their legs, bikini line, and underarms free of hair.
Waxing, shaving, and depilatories: If you have hirsutism, you may need to be more proactive about waxing, shaving, and using depilatories (chemical foams). These are all pretty affordable and take effect immediately, but they require continual treatment. Shop for depilatories.
Laser hair removal: Laser hair removal involves using concentrated light rays to damage your hair follicles. Damaged follicles can’t produce hair, and the hair that’s present falls out. With sufficient treatments, laser hair removal can provide permanent or near-permanent results.
Electrolysis: Electrolysis is the removal of hair using an electric current. It treats each hair follicle individually, so the sessions can take longer.
Both laser hair removal and electrolysis can be expensive and require multiple sessions to achieve the desired results. Some patients find these treatments uncomfortable or slightly painful.
Excessive or unwanted body and facial hair is a long-term challenge. Most women with diagnosed hormonal imbalances respond well to treatment, but the hair can grow back if your hormone levels become out of sync again. If the condition makes you self-conscious, counseling and support from friends and family can help you to cope.
Depending on the underlying cause and your choice of treatment, treating hirsutism may or may not be a lifelong commitment. Laser hair removal or electrolysis can provide more permanent results than shaving, waxing, or depilatories. Conditions that cause hirsutism, such as PCOS or adrenal gland disorders, may require lifelong treatment.
What is the Ferriman-Gallwey score?
The Ferriman-Gallwey index is a method to score the degree of male pattern body hair growth in women. It consists of pictures of hair distribution on the upper lip, chin, chest, back, abdomen, arm, forearm, thigh, and lower leg. Each area is scored from 0 to 4, with 4 being heavy hair growth. After each area is scored, the numbers are added together for a total score. Most experts agree that a total of 8 indicates hirsutism.
The Ferriman-Gallwey score is a simple, inexpensive, and reliable diagnostic tool for hirsutism. However, there are more elaborate and expensive methods to determine the extent of excess hair growth that may be more precise. These include photographic measures, computerized assessment of photographs, and microscopic measurement and counting of hair shafts.Deborah Weatherspoon, PhD, RN, CRNA, COIAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.