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Home > Skin & Beauty > Skin Conditions > Unwanted Facial Hair (Hirsutism): Causes, Symptoms, and Treatment

Unwanted Facial Hair (Hirsutism): Causes, Symptoms, and Treatment

December 15, 2020 - Updated on August 16, 2021
5 min read
By Akanksha Shah Sanghvi, MD, Clinical Dermatology

In this article:

  • Hirsutism and Testosterone
  • Causes of Unwanted Facial Hair (Hirsutism)
  • Symptoms That May Accompany Hirsutism
  • Medical Treatment for Unwanted Facial Hair (Hirsutism)
  • Diagnosing Hirsutism
  • Risk Factors Associated With Unwanted Facial Hair
  • Complications of Untreated Hirsutism
  • When to See a Doctor
  • Final Word

Many women suffer from excessive hair growth on areas such as the face, back, thighs, and pubic areas. The condition in women characterized by dark coarse hair in male-like pattern is medically known as hirsutism.

unwanted facial hair (hirsutism)

Hirsutism is a common presentation in dermatological settings mainly for cosmetic reasons. It often causes emotional stress, anxiety, and depression in women as it is an unwanted cosmetic issue.

Hirsutism is the most prevalent endocrine disorder among women in the United States and affects around 10% women in most populations. (1)

Hirsutism and Testosterone

The most common reason of hirsutism in women is increased testosterone levels, which may result from problems in the ovaries or adrenals, the glands that secrete the majority of testosterone in women. (2)

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Increased levels of active testosterone, known as dihydrotestosterone, lead to the production of longer, thicker, coarser hair, different from the normal female hair.

Causes of Unwanted Facial Hair (Hirsutism)

what causes unwanted facial hair (hirsutism)?

Hirsutism can be a result of various reasons, including:

1. Increase in androgen levels

The most common cause of hirsutism is the increased production of androgens, which may result from:

  • Polycystic ovary syndrome
  • Tumors in the ovary or adrenal glands
  • Non-classical congenital adrenal hyperplasia

2. Endocrinological problems

While not very common, endocrine disorders such as hypothyroidism, hyperthyroidism, Cushing’s syndrome, hyperprolactinemia, and acromegaly can cause hirsutism, among other symptoms.

3. Medications

Hirsutism is a common side effect of estrogen antagonists, cyclosporine, diazoxide, androgens, danazol, interferon, and phenytoin. (2)

However, in many cases, these drugs may cause hypertrichosis, which results in excessive hair growth in patches or all over the body in both men and women, as opposed to hirsutism, which is male-pattern hair growth in females.

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4. Menopause

Discontinuation of ovarian estrogen production post menopause can result in mild hirsutism. (3)

5. Pregnancy

Prolactin secretion during pregnancy can also cause mild hirsutism. (4)

6. Idiopathic hirsutism

Idiopathic hirsutism refers to cases with an unknown cause. Idiopathic causes make up to 10% of the total cases of hirsutism.

Symptoms That May Accompany Hirsutism

Hirsutism is most commonly characterized by hair growth on the upper lip, upper back, chin, sides of the face, shoulders, upper abdomen, and sternum. However, depending on the cause, it may be accompanied by other symptoms, including:

  • Dyslipidemia
  • Acne
  • Obesity
  • Acanthosis nigricans
  • Oligomenorrhea 
  • Cancer
  • Deepened voice
  • Alopecia
  • Decreased breast size
  • Infertility
  • Increased muscle mass
  • Abdominal discomfort
  • Amenorrhea

Medical Treatment for Unwanted Facial Hair (Hirsutism)

treatment options for unwanted facial hair (hirsutism)

Most cases of hirsutism can be managed with medical treatment, including: (5)

  • Anti-androgens: These medications help prevent the production of hormones and include spironolactone, finasteride, and flutamide. Anti-androgens should only be taken upon consulting your doctor.
  • Electrolysis: Electrical current is used to damage hair follicles, thus preventing hair growth. However, it is an expensive treatment that may cause redness, swelling, and scarring of skin.
  • Birth control pills: These medications help reduce the concentration of androgens. Consult your doctor on the use of birth control pills for hirsutism as combination oral contraceptives are disproved by the FDA.
  • Depilatory creams: These may be effective in controlling hair growth but may cause irritation.
  • Prescription creams: Creams such as eflornithine help retard facial hair growth but may produce side effects such as stinging or skin rash.
  • Laser and intense pulsed light (IPL): These treatments help destroy hair roots, thus preventing hair growth.
  • Insulin sensitizers: These are helpful for women who are affected by hyperandrogenism, insulin resistance, and hirsutism. (5)
  • Cancer treatment: Hirsutism caused by tumors may be improved with the use of radiation therapy or surgery.

Diagnosing Hirsutism

To determine the cause of hirsutism, the doctor will study your medical history and perform a physical exam. Furthermore, you may be required to undergo tests such as:

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  • Serum androgen level
  • Serum DHEA-sulfate test
  • ACTH stimulation test
  • Pelvic ultrasound
  • 17-hydroxyprogesterone blood test
  • CT scan or MRI

The degree of hirsutism can be determined using the Ferriman-Gallwey scale. (6) Besides the physical presentations, it is also important to understand the mental impact of hirsutism in a woman for a wholesome treatment, as this disorder can affect a person’s self-image.

Risk Factors Associated With Unwanted Facial Hair

The following factors can predispose you to hirsutism:

  • Racial ethnicity (7)
  • Genetics
  • Obesity (8)
  • Gestational diabetes (8) 
  • Menopause

Complications of Untreated Hirsutism

When left untreated, the underlying problem can cause following complications:

  • Infertility
  • Cancer
  • Anxiety
  • Depression
  • Social isolation
  • Osteoporosis
  • Obesity

When to See a Doctor

when to consult a doctor regarding hirsutism?

It is essential to consult a doctor if you suspect hirsutism, especially when accompanied by:

  • Irregular menstrual cycle
  • Receding scalp line
  • Male-pattern hair
  • Darkening of the neck, groin, and armpits
  • Enlarged clitoris
  • Breast milk leakage when not breastfeeding
  • Deepened voice
What you may ask your doctor
  • What medication do I need to take and how long will I take it?
  • What are side effects of the recommended treatment?
  • How can I adjust with the excessive hair?
  • Can any lifestyle changes help balance my hormone levels?
What your doctor may ask you
  • When did you first develop the symptoms?
  • Have you gained weight recently?
  • Are you menstrual periods irregular?
  • Do you have any metabolic disorder?

Final Word

Women develop very fine hair on the lips, chin, chest abdomen, or back. However, some women may grow darker, coarser hair in these areas, which is more common among men.

This condition is known as hirsutism, which generally results from excessive androgens in the body. Medical treatment and cosmetic attention can help manage most cases of hirsutism over time.

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Continue Reading Continue ReadingHow to Deal With Unwanted Facial Hair (Hirsutism)
References
  1. H.F. Escobar-Morreale, E. Carmina, D. Dewailly, A. Gambineri, F. Kelestimur, P. Moghetti, M. Pugeat, J. Qiao, C.N. Wijeyaratne, S.F. Witchel. Epidemiology, diagnosis and management of hirsutism: a consensus statement by the Androgen Excess and Polycystic Ovary Syndrome Society. https://academic.oup.com/humupd/article/18/2/146/618266. Published 2012.
  2. Sachdeva S. Hirsutism: evaluation and treatment. Indian journal of dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856356/. Published 2010.
  3. Dolinko AV, Ginsburg ES. Hyperandrogenism in menopause: a case report and literature review. Fertility research and practice. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5424333/. Published May 19, 2015.
  4. Majumdar A, Mangal NS. Hyperprolactinemia. Journal of human reproductive sciences. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853872/. Published July 2013.
  5. S; B-PUH. Medical treatment of hirsutism. Dermatologic therapy. https://pubmed.ncbi.nlm.nih.gov/18844711/. Published 2008.
  6. Mihailidis J, Dermesropian R, Taxel P, Luthra P, Grant-Kels JM. Endocrine evaluation of hirsutism. International journal of women’s dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419053/. Published February 16, 2017.
  7. Afifi L, Saeed L, Pasch LA, et al. Association of ethnicity, Fitzpatrick skin type, and hirsutism: A retrospective cross-sectional study of women with polycystic ovarian syndrome. International journal of women’s dermatology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5419030/. Published March 13, 2017.
  8. Sirmans SM, Pate KA. Epidemiology, diagnosis, and management of polycystic ovary syndrome. Clinical epidemiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872139/. Published December 18, 2013.
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