Hirsutism in Women: Causes, Symptoms & Treatments

Hirsutism is a medical condition in women that leads to excessive hair growth in areas typically associated with male pattern hair, such as the face, chest, and back. It can significantly affect self esteem, mental health, and quality of life. This comprehensive guide supported by insights from a trusted intermediary organization like Istanbul Care explores the causes, symptoms, diagnosis, and treatment options for hirsutism in women.

What is Hirsutism?

Hirsutism refers to unwanted, male-pattern hair growth in women. The condition results from an excess of male hormones (androgens) or increased sensitivity of hair follicles to these hormones. It should be distinguished from hypertrichosis, which is excessive hair growth unrelated to androgens.

Pathophysiology of Hirsutism and Hypertrichosis

Hirsutism involves the conversion of vellus (fine) hairs into terminal (coarse) hairs in androgen sensitive areas. Hypertrichosis affects non androgenic areas and often involves genetic or medication-related factors.

Table: Comparison Between Hirsutism and Hypertrichosis

What are the Symptoms of Hirsutism?

• Coarse, dark hair on the upper lip, chin, chest, abdomen, or back
• Irregular menstrual cycles
• Deepening of the voice (in severe cases)
• Acne or oily skin
• Enlargement of the clitoris (in extreme androgen excess)

Who Does Hirsutism Affect?

Hirsutism most commonly affects:

• Women with a family history of hirsutism or PCOS
• Postmenopausal women
• Women from Mediterranean, Middle Eastern, or South Asian backgrounds

How Does Hirsutism Affect My Body?

Beyond cosmetic concerns, hirsutism may point to underlying hormonal imbalances or endocrine disorders. It can be a symptom of:

• PCOS
• Cushing’s syndrome
• Adrenal gland disorders
• Insulin resistance

Hairiness Is Not the Same as Hirsutism

Not all body hair is abnormal. Hirsutism is defined by hair growth in a male pattern distribution. Increased body hair in women not caused by androgens is referred to as hypertrichosis.

When to See a Doctor

You should seek medical attention if:

• Hair growth is sudden or rapidly increasing
• Menstrual irregularities accompany hair growth
• There are signs of virilization (deep voice, muscle mass increase)

Hirsutism May Be Caused By:

1. Certain Medicines

• Minoxidil
• Phenytoin
• Cyclosporine

2. Using Anabolic Steroids

May increase testosterone levels leading to hirsutism.

3. Polycystic Ovary Syndrome (PCOS)

The most common cause of hirsutism due to excess androgen production.

4. Cushing Syndrome

Elevated cortisol levels can increase androgen secretion.

5. Congenital Adrenal Hyperplasia

Genetic condition leading to adrenal hormone imbalance.

6. Tumors

Ovarian or adrenal tumors can cause sudden-onset hirsutism.

7. Medications

Other drugs like danazol or testosterone replacement therapies.

8. Increase in Circulating Androgen Levels

Caused by hormonal imbalances or gland dysfunction.

9. Enhanced End Organ Response to Androgens

Hair follicles may become more sensitive to normal androgen levels.

Symptoms of Hirsutism in Women

• Male-pattern facial and body hair
• Acne and oily skin
• Irregular periods or amenorrhea
• Weight gain or obesity
• Mood swings or depression due to appearance concerns

What Is the Cause of Hirsutism in Women?

1. The Natural Production of Androgens

Produced by adrenal glands and ovaries.

2. Polycystic Ovarian Syndrome (PCOS)

Accounts for 70–80% of hirsutism cases.

3. Postmenopause

Estrogen levels drop, increasing relative androgen activity.

4. Cushing’s Syndrome

Due to prolonged exposure to high cortisol.

5. Other Conditions

Adrenal or ovarian tumors, thyroid dysfunction.

6. Medications

Including certain antidepressants, anticonvulsants, and immunosuppressants.

Treatment of Hirsutism in Women

The best treatment depends on the underlying cause and severity. A combination of lifestyle changes, medications, and cosmetic therapies is typically recommended.

How Is Hirsutism Diagnosed?

Diagnosis begins with a thorough history and physical examination. The Ferriman Gallwey scoring system may be used to quantify hair growth in different body regions.

What Tests Will Be Done to Diagnose Hirsutism?

• Blood tests (testosterone, DHEA-S, LH, FSH)
• Pelvic ultrasound to evaluate ovaries
• CT or MRI for adrenal gland abnormalities

Table: Diagnostic Markers for Hirsutism

Risk Factors

1. Family History

Genetics play a significant role.

2. Ancestry

More common in Mediterranean, Middle Eastern, and South Asian women.

3. Obesity

Increases insulin resistance and androgen levels.

What Are the Treatment Options for Hirsutism?

1. Weight Loss

Losing weight can help lower androgen levels and improve symptoms, especially in women with PCOS.

2. Medications
3. Birth Control Pills

Combined oral contraceptives are often first line therapy. They regulate menstruation and reduce androgen production.

1. Androgen-Suppressing Medications

• Spironolactone: Blocks androgen receptors
• Flutamide: An anti androgen agent used under close supervision

1. Low-Dose Steroid Medications

• Useful for congenital adrenal hyperplasia

1. Insulin-Lowering Medications

• Metformin: Improves insulin resistance and decreases androgen levels

1. Gonadotropin-Releasing Hormone (GnRH) Agonists

• Reduce ovarian androgen production

1. Eflornithine Skin Cream

• Slows facial hair growth when applied topically

3. Hair Removal Options
4. Electrolysis

Destroys hair roots with electrical current; permanent but time-consuming.

1. Laser Hair Removal

Targets pigmented hair; requires multiple sessions but yields long-term reduction.

4. Home Remedies
5. Shaving

Quick and safe but requires regular upkeep.

1. Bleaching

Lightens hair color; suitable for facial hair.

1. Waxing and Plucking

Removes hair from the root but may irritate the skin.

Table: Medical vs Cosmetic Treatment Options

Longer Lasting Hair Removal

Laser treatments and electrolysis provide more permanent results compared to topical creams or shaving. Consultation with a certified specialist from an intermediary organization ensures safety and effectiveness.

What Does Hirsutism Look Like?

Women may notice coarse, dark hair on areas typically hair-free, such as:

• Upper lip
• Chin
• Chest and nipples
• Lower abdomen
• Back and shoulders

How Soon After Treatment Will I Feel Better?

• Medical treatments: May take 3–6 months for visible changes
• Laser hair removal: Results start showing after 2–3 sessions
• Eflornithine cream: Works after 6–8 weeks of regular use

How Can I Reduce My Risk of Developing Hirsutism?

• Maintain a healthy weight
• Monitor blood sugar levels
• Avoid anabolic steroids
• Manage underlying hormonal disorders early

Suggestions for Preventing or Managing Hirsutism

• Regular physical activity
• Balanced diet with low glycemic index foods
• Routine hormone check-ups
• Avoid overuse of over-the-counter steroid creams

Common Misconceptions About Hirsutism

• “Hirsutism is only cosmetic”: False. It may signal serious hormonal conditions.
• “Only overweight women get hirsutism”: Not true. Even lean women with PCOS may develop it.
• “Shaving worsens hair growth”: Myth. Shaving doesn’t affect follicle depth or hormone levels.

Risk Factors for Hirsutism

• Family history of PCOS or hirsutism
• Obesity and insulin resistance
• Certain ethnic backgrounds

Hirsutism Prevention

While not all cases can be prevented, adopting a proactive lifestyle can significantly reduce risk. Maintaining hormonal balance through regular check ups, a nutritious diet, and physical activity is key. Early identification of hormonal imbalances or underlying disorders also plays a major role in minimizing the onset or progression of hirsutism.