Hirsutism Explained: Get the Expert-Backed Insights You Need

Throughout history, body hair has played a vital role in our survival, helping regulate body temperature and protect against ultraviolet damage. However, evolving societal norms regarding beauty have led to the promotion of various services and treatments as more people embrace smooth, hairless skin.

Our bodies naturally exhibit various hair types, ranging from delicate, light 'peach fuzz' to thicker, darker hair. While societal pressure may influence our approach to body hair, how we manage it ultimately remains personal.

But, it's crucial to distinguish unwanted hair from a medical condition called hirsutism, which affects women. 

Hirsutism is when women experience excessive, thick, dark, and coarse hair growth in areas where they typically have lighter, finer hair (like peach fuzz), such as the face, chest, abdomen, back, and thighs. While some hair growth in these areas is normal, hirsutism symptoms can be characterised by more than usual thickness, darkness, or abundance of hair. 

Dr Anurag Lila, M.D. (Medicine), D.M. (Endocrinology) from Dr L.H Hiranandani Hospital, Powai, Mumbai, explains hirsutism as hair growth in locations on a woman's body where it wouldn't normally be expected. This often occurs after puberty when there is an imbalance of hormones, particularly androgens. Affecting approximately 5-10% of women, hirsutism is a frequent concern among patients seeking cosmetic consultations in dermatology clinics.

Many women have to deal with facial hair, which can be challenging. Sometimes, the imbalance of hormones involves androgens, typically found in both males and females, as well as female hormones like estrogens and progestins. Dr Anurag explains, "In hirsutism, there are too many androgens or increased sensitivity to these hormones, causing thicker, darker, coarser hair growth. The hair follicles, especially in areas like the face and chest, become more responsive to even small amounts of these hormones.” 

While androgens are a big factor, other hormonal issues like insulin resistance and individual and ethnic differences may also contribute to hirsutism. Many women find social situations and relationships more challenging due to hirsutism. It's crucial to understand that having facial hair as a woman is normal. Still, societal norms can make it difficult for them. 

Hirsutism, characterised by excessive thick, dark hair growth, can manifest on various body parts. This includes the face, with prominent areas like the upper lip, chin, sideburns, and chest, particularly around the nipples and lower abdomen. The back, encompassing the upper back, shoulders, and stomach, may also be affected. Furthermore, hirsutism can extend to other regions, such as the tummy, lower back, buttocks, and thighs, leading to a noticeable change in hair thickness and colour.

Studies have shown that hirsutism can be present with additional symptoms beyond excessive hair growth. These can include oily skin and acne, hair loss on the scalp resembling male pattern baldness, a deepening of the voice, an increase in muscle mass, a reduction in breast size, and irregular menstrual cycles. In some instances, individuals may also exhibit more masculine traits, such as an enlarged clitoris.

Dr Anurag explains that the causes of hirsutism are various and not limited to only one condition. He further explains the leading causes- 

Often, hirsutism is caused by an imbalance in hormones, notably higher levels of androgens (male hormones) such as testosterone. The ovaries and adrenal glands secrete androgens into circulation. Hair follicles react to androgens by growing thick hair and producing sebum. Once activated, hair follicles can convert circulating weak androgens into stronger ones. Several different conditions can lead to hirsutism. Pre-existing conditions such as polycystic ovary syndrome (PCOS) frequently lead to such imbalances.

Genetics is a crucial factor. If your mother, sisters, or other female relatives have had hirsutism, your chances of getting it are higher. Why? It's all in the genes. Certain genes can affect how your body handles hormones, including those that affect hair growth. If your family has a history of hirsutism, it could mean you're more likely to experience it, too.

According to Dr Anurag, hirsutism can be related to conditions such as -

• Congenital Adrenal Hyperplasia (CAH): This is a group of genetic disorders that impact the adrenal glands, creating hormone imbalances and causing more androgens to be produced.

• Cushing's Syndrome: This happens when your body makes too much cortisol, a stress hormone. It throws your hormones out of whack and can lead to higher androgen levels and hirsutism.

• Ovarian Tumours: In rare cases, tumours in the ovaries can pump out too many androgens, which can lead to hirsutism.

Insulin resistance, often associated with conditions like PCOS, can contribute to higher androgen levels, leading to hirsutism. Insulin resistance can result in elevated insulin levels in the blood. These high insulin levels can stimulate the ovaries to produce more androgens, further contributing to the hormonal imbalance observed in hirsutism.

Increased androgen levels are a common thread linking 70-80% of women with PCOS to experiencing hirsutism. As emphasised by Dr Anurag Lila, having hirsutism doesn't always mean you have PCOS. Importantly, you can have hirsutism without PCOS and PCOS without hirsutism. However, it's more likely to experience hirsutism if you have PCOS, but not a guaranteed symptom. 

While hirsutism itself doesn't directly impact fertility, Dr Anurag Lila underscores that the underlying hormonal imbalances that often cause it, especially those related to PCOS, can affect fertility in some women. These imbalances can lead to irregular or even anovulation, making natural conception more challenging. Also, the quality of the eggs might be affected, further impacting their fertilisation ability. 

Hirsutism, while not typically a physical health concern, can greatly impact individuals in different ways. It may signal an underlying medical issue.

For many, the unwanted hair growth linked to hirsutism can be emotionally distressing, leading to anxiety and depression, especially if societal beauty standards play a significant role in self-esteem.

Dr Anurag Lila explains regular body hair and hirsutism differ in colour, density, and texture. Research indicates that individuals from different racial backgrounds may have varying levels of androgen and, as a result, different patterns of body and facial hair growth. But when this hair turns thicker or dense, it could be hirsutism. 

The amount of body hair you have can depend on your genetics, where your ancestors came from, and so many other factors! For example, women with Southern Asian, Middle Eastern, or Mediterranean heritage often tend to have naturally thicker body hair.

Dr Anurag says you should consult a doctor when you notice a change in naturally existing hair, when it changes texture or thickness, or when you observe abnormal hair growth.

While currently, there's no definitive cure for hirsutism, several treatment options can manage its symptoms and reduce unwanted hair growth. Correcting the underlying hormonal changes with appropriate medications forms the cornerstone of hirsutism therapy.

The meaning of hirsutism is not just excess hair growth in women; it is often a result of hormonal imbalances, genetics, or medical conditions. With the correct diagnosis and treatment, it is manageable. Seeking medical advice and exploring treatment options can significantly improve comfort and confidence.

Medically Reviewed By:
Dr Aasim Maldar: SCE in Endocrinology & Diabetes (Royal College UK), DNB (Endocrinology), MD (Gen Medicine)