Hirsutism

Hirsutism can be caused by an increased androgen (male hormone) production, increased skin sensitivity to androgens, or both. Androgens are often thought of as exclusively 'male hormones' but, in fact, both men and women produce them, although men usually in greater amounts than women.

In premenopausal women, the most common cause of hirsutism is polycystic ovary syndrome (PCOS). However, in 5-20% of affected women no apparent underlying cause is found. It is common for women to develop more facial or body hair gradually as they get older, especially after the menopause.

Rarely, hirsutism can be caused by medications such as steroids or hormonal disorders. Extremely rarely, hirsutism can be caused by tumours that secrete androgens. In such cases the hirsutism will be severe and appear over a few years.

The dermatologist may request some hormone tests, possibly an ultrasound of the pelvis (to investigate the potential diagnosis of PCOS) and may refer you to an endocrinologist (specialist in hormonal disorders).

It is important to see a doctor if hirsutism is associated with any of the following: 

• Developing quickly (over 1-2 years), or before puberty.
• Accompanied by menstrual problems.
• Associated with features suggesting an increase in androgens such as thinning of the scalp hair, baldness, or deepening of the voice.
• Accompanied by obesity or diabetes.

Is hirsutism hereditary?

No, although some cases can run in families.

In the rare cases where there is an underlying hormonal disorder, the doctor may suggest treating this first. Treatments for hirsutism where there is no underlying cause or in association with PCOS include:

Physical treatments

Medical treatments 

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• Shaving. Some people believe that shaving encourages more hair growth, but this is not true. However, the stubble that follows regrowth may be undesirable. Frequent shaving can irritate your skin.
• Waxing is effective for some people, but can irritate the skin and should be used with caution on the face. Pseudofolliculitis, also known as ‘shaving bumps’, or ‘razor bumps’, may occur with both shaving and waxing and is caused by hairs being trapped beneath the skin surface which become inflamed. It may result in discolouration of the skin or scarring.
• Depilatories (creams that remove hair) chemically dissolve hair shafts thereby leaving no stubble, but may also irritate the skin. Before using depilatories, a skin test should be carried out to check they can tolerated. Please follow the manufacturer’s instructions for testing and product applications.
• Bleaching creams are designed to make the dark hairs pale. Such creams can irritate the skin and may temporarily lighten darker skin tones.