Hirsutism is a condition characterised by excessive hair growth in specific areas of the face and body, typically resulting from elevated levels of male sex hormones called androgens. It frequently manifests in individuals diagnosed with polycystic ovary syndrome (PCOS), a condition marked by ovaries producing an excess of androgens. Additionally, other medical conditions and certain medications can contribute to the development of hirsutism.

 

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According to a 2018 study issued in the Indian Journal of Clinical And Experimental Dermatology, 38 per cent of Indian women suffer from excessive facial hair growth. The good news is that there are treatments out there to remove unwanted facial hair or minimise the regrowth of hair.

 

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Role of Male Hormones In Women

Genetics exert a significant influence on hair colour, thickness, and distribution. For instance, individuals hailing from regions like the Mediterranean, Middle East, and the Indian subcontinent commonly exhibit dark body and facial hair. Familial hirsutism, wherein excess hair is inherited within families, is considered a normal variation and is not indicative of any underlying medical condition.

 

As per a 2010 study issued in the Indian Journal of Dermatology, the female sex hormone oestrogen typically contributes to the development of fine and soft body hair. In contrast, androgens, which encompass male sex hormones like testosterone, are responsible for the manifestation of masculine traits such as facial hair growth and the presence of coarse body hair. Women naturally produce a modest amount of androgens via their ovaries and adrenal glands.

 

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Symptoms of Hirsutism

Women who have hirsutism commonly exhibit heightened growth of hair in specific regions such as the sides of the face, upper lip, chin, upper back, shoulders, sternum, and upper abdomen. The characteristic feature of hirsutism is the presence of dark, coarse hair in areas where women typically have lighter or finer hair, or no hair at all.

 

Causes of Hirsutism

In females, male hormones are produced by the ovaries and adrenal glands. Elevated levels of androgens in women can stimulate hair follicles to produce thicker hair.

Polycystic ovary syndrome (PCOS)

According to a 2023 study issued in the StatPearls, the primary hormonal condition associated with hirsutism, accounts for approximately 75 per cent of cases. It affects 5 to 10 per cent of women during their reproductive years and 20 to 25 per cent of adolescent girls. PCOS is characterised by hormonal imbalances and irregular menstrual cycles, often resulting in ovarian cysts. This condition is marked by the termination of follicular maturation, leading to the accumulation of small follicles beneath the ovarian cortex and hyperplasia of the ovarian stroma.

 

Androgen-Secreting Tumour

Hyperandrogenism resulting from ovarian or adrenal tumours is infrequent, contributing to only 0.2 per cent of all hirsutism cases. These tumours, which secrete androgens autonomously, are not regulated by the hypothalamic-pituitary axis. Approximately 50 per cent of these tumours are malignant, leading to markedly elevated plasma androgen levels. They often present with rapid-onset virilisation, hirsutism, and the presence of a pelvic or abdominal mass.

 

Medications

According to a 2023 study issued in the StatPearls, certain medications, such as acetazolamide, phenytoin, latanoprost, streptomycin, psoralen, minoxidil, cyclosporine, and diazoxide, have been associated with the development of hypertrichosis, a condition characterised by excessive hair growth beyond what is considered normal for the individual.

 

Adrenal Disorders

Adrenal disorders, including Cushing's syndrome and congenital adrenal hyperplasia, involve abnormalities in the adrenal glands, leading to an overproduction of androgens. This excess of male hormones can induce hirsutism, indicated by excessive hair growth in women. Cushing's syndrome arises from elevated cortisol levels, either due to adrenal tumours or prolonged corticosteroid use. Congenital adrenal hyperplasia, on the other hand, results from genetic enzyme deficiencies affecting cortisol synthesis, leading to androgen excess. 

 

Hormonal Changes

Hormonal fluctuations during significant life events such as pregnancy or menopause can precipitate hirsutism in certain individuals. These periods of hormonal transition can disrupt the delicate balance of hormones in the body, leading to an increase in androgen levels. As a result, excess androgens can stimulate hair follicles to produce thicker and darker hair in regions typically associated with male-pattern hair growth.

 

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Diagnosis of Hirsutism

Hirsutism is typically diagnosed through a combination of medical history assessment, physical examination, and laboratory tests. The diagnostic process may involve the following steps:

Medical History

The healthcare provider will inquire about the patient's medical history, including menstrual patterns, family history of hirsutism or hormonal disorders, medication use, and any other relevant symptoms.

 

Physical Examination

A thorough physical examination will be conducted to assess the distribution, pattern, and severity of hair growth, as well as to identify any other signs of underlying conditions associated with hirsutism.

 

Laboratory Tests

Blood tests may be performed to measure hormone levels, including testosterone, dehydroepiandrosterone sulphate (DHEAS), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and thyroid-stimulating hormone (TSH). Elevated levels of androgens or abnormalities in other hormone levels may indicate underlying causes of hirsutism, such as polycystic ovary syndrome (PCOS) or adrenal disorders.

 

Imaging Studies

In some cases, imaging studies such as ultrasound or MRI may be recommended to evaluate the ovaries or adrenal glands for abnormalities, such as cysts or tumours, which could be contributing to hirsutism.

 

Individuals seeking assistance with hair removal or management due to conditions like hirsutism or polycystic ovary syndrome (PCOS) may benefit from consulting a dermatologist.  They can provide various treatment options for unwanted hair growth, including laser hair removal, prescription medications, or topical treatments, tailored to the individual's needs and preferences. By consulting the appropriate medical specialists—gynaecologists for gynaecological concerns, endocrinologists for insulin resistance, and dermatologists for hair removal or management—individuals can receive comprehensive care and guidance specific to their respective health issues.

 

Treatment of Hirsutism

Hirsutism often requires long-term management, and the effectiveness of treatment varies depending on the chosen approach. For individuals who either do not require or cannot tolerate medication, or for those seeking additional measures alongside medical treatment, there are several at-home strategies to help minimise the appearance of hair growth and cope with the condition. 

 

These include:

• Shaving: Regular shaving can help temporarily remove unwanted hair, although it may need to be repeated frequently.
• Tweezing: Tweezing can be used to pluck individual hairs, providing a more precise method of hair removal.
• Waxing: Waxing can remove hair from larger areas of the body and typically results in smoother skin for a longer duration compared to shaving.
• Bleaching: Bleaching products can lighten the colour of hair, making it less noticeable, although this method does not remove the hair itself.
• Depilatory creams, lotions, and gels: These products contain chemicals that dissolve hair follicles, providing an alternative method of hair removal.

If self-care methods of hair removal have proven ineffective in managing hirsutism, consulting with a healthcare provider about pharmacological treatments may be beneficial. These medications typically require up to six months, which is the average life cycle of a hair follicle, before significant differences in hair growth are observed.

 

Treatment options include:

• Oral Contraceptives: Birth control pills or other hormonal contraceptives containing oestrogen and progestin can address hirsutism resulting from androgen production. They are commonly prescribed for women seeking contraception who also wish to manage hirsutism. Possible side effects may include nausea and headaches.
• Anti-Androgens: These medications work by blocking the action of androgens in the body. They are often recommended if oral contraceptives alone are not sufficiently effective. Spironolactone (Aldactone, CaroSpir) is a commonly prescribed anti-androgen for hirsutism treatment, but the results are modest and may take at least six months to become noticeable. Menstrual irregularities may occur, and due to the risk of birth defects, contraception should be used while taking these medications.
• Topical Cream: Eflornithine (Vaniqa) is a prescription cream specifically designed for excessive facial hair in women. It is applied directly to the affected area twice a day to slow down new hair growth, although it does not eliminate existing hair. It can be used alongside laser therapy to enhance treatment response.

 

Procedures that offer longer-lasting results compared to self-care methods, and can be combined with medical therapy, include:

• Laser Therapy: This involves using a concentrated beam of light to damage hair follicles, preventing hair regrowth (photoepilation). Multiple treatments may be required. Laser therapy is generally more effective for individuals with black, brown, or auburn hair compared to electrolysis. However, people with tanned or darkly pigmented skin should discuss potential risks and benefits with their healthcare provider, as certain lasers may cause adverse effects such as changes in skin tone, blistering, or inflammation.
• Electrolysis: This procedure involves inserting a tiny needle into each hair follicle and delivering an electric current to damage and eventually destroy the follicle. Multiple sessions may be needed. Electrolysis is particularly suitable for individuals with naturally blond or white hair. While effective, it can be uncomfortable, and the use of a numbing cream beforehand may help alleviate discomfort.

 

Discussing these treatment options with a healthcare provider can help determine the most suitable approach based on individual needs and preferences, while also considering potential risks and benefits.

 

Hirsutism itself cannot be prevented, but individuals affected by the condition can focus on managing and minimising unwanted hair growth through treatment methods such as medication. While hirsutism can affect anyone, certain factors may increase the likelihood of its development. Genetic predisposition appears to play a significant role, as studies indicate that hirsutism often runs in families. This suggests that individuals with hirsutism frequently have a family member, such as a parent or sibling, who also experiences the condition.

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