Excess hair growth (hirsutism)

About hirsutism

The amount of hair you have on your body, and how noticeable it is, varies from person to person. When you develop hirsutism, hair starts to become more noticeable on the parts of your body where you wouldn’t usually expect to see it, such as your face and chest. This hair is called terminal hair, or sometimes sexual hair, and it’s usually long, dark and coarse. This is different from the fine, often pale hair (vellus hair) that covers most of your skin. It can be very obvious and you may feel embarrassed or distressed by it.

Hirsutism affects about one in 10 women of childbearing age. If you have dark skin, hirsutism is more noticeable because your hair is usually darker.

Hirsutism can start around puberty and may get worse as you get older. Hirsutism can develop if you put on weight or as a result of hormonal changes.

Symptoms of hirsutism

The main symptom of hirsutism is coarse, dark hair appearing on your body. This may develop on your face and neck, abdomen, chest and upper back, as well as on your arms, legs and buttocks. Where and how much hair grows is different for every woman.

You may find hirsutism very upsetting. It can affect your confidence and self-esteem, particularly if it’s on parts of your body that are on show, such as your face. You may find it hard to do some of the things you enjoy, such as swimming, because you feel uncomfortable or embarrassed. It's important to talk to your GP if you feel this way.

Depending on the cause of your hirsutism, you may have other symptoms as well. These may include having a deeper voice, hair loss on your scalp or increased muscle size. If you have any of these symptoms, or if hirsutism develops very quickly, you should see your GP.

Causes of hirsutism

For around half of women there is no known cause for their hirsutism. This is called idiopathic hirsutism.

Hirsutism is linked to male sex hormones called androgens. Hormones are natural chemicals produced by your body that make things grow or change. All women produce some androgens, for example testosterone, though usually in small amounts. However, if you have hirsutism you may produce more androgens, or your hair follicles may be more sensitive to them than normal.

Hirsutism is linked to some medical conditions. If you have Cushing syndrome, polycystic ovary syndrome (PCOS) or other conditions that affect the balance of hormones your body produces, you may develop hirsutism. You can also develop hirsutism as a side-effect of taking some medicines, such as anabolic steroids or the oral contraceptive pill.

Hirsutism can run in families and may not necessarily be associated with an excess of androgens or other health conditions.

Diagnosis of hirsutism

Your GP will ask about your symptoms and examine you. He or she may also ask you about your medical history.

Your GP may ask you to have blood tests to check the level of hormones in your blood. Depending on these results, your GP may refer you to a specialist for further tests or treatment.

Treatment of hirsutism

If you have mild hirsutism and your periods are regular, it’s unlikely that you have an underlying medical condition and you may not need any treatment.

There is no cure for hirsutism, but there are a number of treatments that can help to remove the excess hair or make it less noticeable. If you have severe hirsutism, you may need to use several different types of treatment at the same time.

Self-help

If you’re overweight or obese, it's a good idea to lose excess weight, as this can reduce the level of androgens that your body produces. Eating a healthy, balanced diet and taking regular exercise will help you lose excess weight.

There are also a number of methods of hair removal or treatment that you can try.

  • Shaving. You can try shaving every day or twice a day. This is quick and easy, but it can irritate your skin. Shaving won’t make your hair grow back thicker or darker but does make the cut end of the hair appear as stubble, which can be uncomfortable and more noticeable.
  • Depilation. This removes hair by using a cream that dissolves it. This doesn’t leave any stubble. However, it can irritate your skin, so test any depilatory cream on a small area of your skin before you start using it.
  • Bleaching. If you have light coloured skin, bleaching the hairs makes them less noticeable, but it can irritate your skin. Don’t use bleaching creams if you have dark or black skin.
  • Plucking and waxing. This can be very effective. However, you can develop scars or an infection in the hair follicles. Plucking and waxing can also make electrolysis less effective.
  • Threading. This is where you wind a fine cotton thread around the hair follicle, which can then be pulled out.

Electrolysis

Electrolysis is a way of removing your hair using an electric current. This is passed down into the root of your hair follicle using a needle, which damages it permanently. It’s an effective treatment but it can be painful, time consuming and expensive. Electrolysis can cause changes to the colour of your skin and scarring.

If you decide to have electrolysis, make sure that the practitioner who treats you is fully trained and registered with the British Institute and Association of Electrolysis.

Laser and intense pulsed light (IPL) treatment

These treatments use laser light to damage your hair at the root. Both treatments destroy your hair and can be very effective. Because this type of treatment works on your hair during a growing phase, it needs to be done over a few months. This treatment is not usually permanent although it can be long lasting.

While you’re having treatment you shouldn’t use any other type of hair removal treatment, apart from shaving. You won’t be able to sunbathe or use fake tan while you’re having treatment. Laser treatment and IPL can cause changes to the colour of your skin, and cause scarring.

Make sure that you choose a practitioner who is registered with the Healthcare Commission or the British Medical Laser Association. If possible, ask your GP to refer you.

Medicines

There are a number of medicines that can treat hirsutism. You will probably need to keep taking any medicines for them to keep working and stop hirsutism coming back.

Your doctor may suggest eflornithine cream. You rub the cream onto your skin and it slows down the growth of your hair, making it finer and less noticeable. Eflornithine usually takes six to eight weeks to start to work. You should stop using it if it hasn’t worked after four months. Eflornithine cream can cause side-effects, including a burning or stinging sensation and acne.

Anti-androgens block the action of the hormones that cause hirsutism. They work by slowing down the growth of your hair and making it thinner so that it becomes less noticeable. You’re unlikely to see any effect from these medicines for between four and six months. Anti-androgen medicines include oral contraceptive pills that contain cyproterone acetate. Anti-androgens can affect the development of unborn male babies, so you should take effective contraception while you’re taking them.

Metformin is a medicine usually used to treat diabetes, but it may occasionally be used for hirsutism.

Can men get hirsutism?

Answer

No, only women can get hirsutism. There is a condition called hypertrichosis, which can cause excessive hair growth in both men and women. However, this is very rare.

Explanation

Hirsutism is a condition where excessive, thick hair grows on a woman. This is usually on parts of the body where men would be more likely to have hair. Men don’t get hirsutism.

There is a condition called hypertrichosis that causes excessive hair growth over and above what is considered normal for both men and women. Hypertrichosis can develop all over your body or it can grow in small patches. It can be present when you’re born or it can develop later in life.

Hypertrichosis that you’re born with (congenital) is very rare. Before you’re born, you’re covered with a layer of fine, soft hair called lanugo hair. In most people, this falls out before birth, and the usual hair that you have on your head and body grows. Extremely rarely, this doesn't happen and hair carries on growing after you’re born and throughout your life. This is called congenital hypertrichosis.

Hypertrichosis that develops later in life can develop because of an illness such as cancer or anorexia nervosa. Some medicines, for example steroid creams and ointments, can also cause hypertrichosis.

If you’re worried about excessive hair, see your GP.

My GP has said that I should stop taking anti-androgen medicines if I want to try to get pregnant. Why is this?

Answer

If you’re taking anti-androgen medicines and you become pregnant, they can affect your baby if it’s a boy. If you’re planning on becoming pregnant, speak to your GP about other ways of treating your hirsutism.

Explanation

Anti-androgen medicines are used to treat hirsutism because they reduce the amount of male sex hormones (androgens) in your body. If you become pregnant, these medicines can cross the placenta and affect your unborn child. This can be particularly dangerous if your unborn baby is a boy, because he needs male hormones to develop his sexual organs and physical characteristics.

If you’re taking anti-androgens while you’re pregnant, it can cause your baby’s sexual organs not to grow and develop properly, and he may not develop male characteristics.

Speak to your GP if you’re taking anti-androgen medicines and want to get pregnant. He or she may be able to suggest alternative treatments for hirsutism that you can take instead.

Are there any complementary therapies that can be used to treat hirsutism?

Answer

Some people use herbal medicines, such as spearmint, to treat their hirsutism. However, there is little medical research to show that it is an effective treatment.

Explanation

Spearmint is used by some people to treat mild hirsutism. However, there has been little research on it and there is no evidence to show that it is effective in treating hirsutism.

Herbal medicines can contain active ingredients that sometimes affect how other treatments and medicines work. Always speak to your GP before trying any complementary therapies.