Managing Hirsutism: Causes, Symptoms & Treatment Options for Women

Let's be honest: Our relationship with body hair is complicated. What was once purely functional has become deeply personal, influenced by everything from family genetics to social media feeds. But when hair growth goes beyond personal preference and enters medical territory, it's time to have a different conversation entirely.

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. 

Why understanding hirsutism matters

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 shows up as unexpectedly thick, dark hair in places where you'd normally have fine, barely-there fuzz. 

Dr Anurag Lila, MD (Medicine), DM (Endocrinology) from Dr LH 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 oestrogens and progestins. Dr Lila 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.

Common hirsutism symptoms

Hirsutism typically shows up in predictable places — think upper lip, chin, chest, and back — but the hair is noticeably different from what you're used to. 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.

Causes of hirsutism: What’s behind unexpected hair growth

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

1. Hormonal imbalance

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. Think of hair follicles as being hypersensitive to certain hormones — even small amounts can trigger them to produce thicker, darker hair than usual. Several different conditions can lead to hirsutism.

2. Family history

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.

3. Medical conditions

According to Dr Lila, 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.

4. Insulin resistance

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.

Hirsutism & PCOS: Understanding the link

Here's what many women don't realise: 70%-80% of women with PCOS experience hirsutism due to elevated androgen levels. But as Dr Lila emphasises, it's not a one-to-one relationship. You can have hirsutism without PCOS and PCOS without hirsutism. However, if you're dealing with hirsutism alongside irregular periods, weight changes, or difficulty conceiving, PCOS might be worth investigating with your healthcare provider.

Will hirsutism affect my fertility?

While hirsutism itself doesn't directly impact fertility, Dr Lila underscores that the underlying hormonal imbalances that often cause it, especially those related to PCOS, can affect fertility in some women. These hormonal shifts can disrupt ovulation and make conception more challenging. Also, the quality of the eggs might be affected, further impacting their fertilisation ability. 

Is hirsutism a health concern?

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.

How much hair is a sign of hirsutism?

Dr 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 South Asian, Middle Eastern, or Mediterranean heritage often tend to have naturally thicker body hair.

Dr Lila 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.

Hirsutism treatment options 

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.

Symptoms of related hirsutism conditions

Hirsutism conditions are usually hormonal in nature and may come with other noticeable symptoms. Recognising these associated signs can help in early diagnosis and management.

Common symptoms of related hirsutism conditions include:

• Oily skin and acne due to elevated androgen levels

• Weight gain or difficulty losing weight, particularly around the abdomen

• Deepening of the voice

• Increased muscle mass or changes in body shape

• Enlargement of the clitoris (in rare cases with severe hormonal imbalance)

• Fertility issues

• Darkened skin patches, particularly around the neck or armpits

Complications & risk factors for hirsutism: When to be concerned

Hirsutism is not usually dangerous in itself, but it can be a symptom of an underlying health issue and may lead to several complications. One of the most significant concerns is the emotional and psychological impact, with many women experiencing anxiety, low self-esteem, or depression due to the appearance of unwanted hair. 

Risk factors for hirsutism include a family history of the condition and obesity, which can exacerbate hormonal imbalances. Additionally, insulin resistance, which often accompanies obesity or PCOS, can further increase androgen production, worsening the symptoms of hirsutism. 

Taking control: What you can do

While hirsutism can’t always be prevented, especially when caused by genetic or medical conditions, there are several lifestyle choices and self-care strategies that can help manage symptoms and reduce their severity. 

Lifestyle tips

• Maintain a healthy weight: Losing excess weight can help lower androgen levels, improve hormonal balance, and help manage hirsutism.

• Follow a balanced diet: A low-glycaemic diet, rich in whole grains, vegetables, lean proteins, and healthy fats, supports insulin sensitivity.

• Exercise regularly: Moderate physical activity can help with weight control and improve insulin function.

• Consider hair removal methods: Methods such as waxing, threading, laser hair removal, or prescription creams, based on personal preference and skin type, can help manage hirsutism.

• Manage stress: Practise yoga, meditation, and other such relaxation techniques, as chronic stress can impact hormonal health.

• Quit smoking: Smoking may increase androgen levels and worsen symptoms.

The final takeaway

Hirsutism in women can be a distressing condition, but understanding its causes and treatment options can significantly reduce anxiety and improve quality of life. While it may be triggered by hormonal imbalances, genetics, or underlying health conditions, a tailored approach involving medical support, lifestyle changes, and cosmetic solutions can be highly effective. Early diagnosis and intervention are key to managing symptoms and addressing any root causes.

Frequently Asked Questions

1. What is hirsutism?

Hirsutism is excessive hair growth in women in areas where men typically grow hair, such as the face, chest, and back, often due to elevated male hormones.

2. What causes hirsutism in women?

It can be caused by polycystic ovary syndrome (PCOS), certain medications, adrenal disorders, or be hereditary in nature.

3. Does weight affect hirsutism?

Yes, being overweight can worsen hormonal imbalances, particularly in PCOS, and contribute to excess hair growth.