What is Hirsutism?

Hirsutism is the excessive growth of thick hair, particularly on areas of the body not commonly seen in women. The hair growth in hirsutism is typical of male hair growth patterns, affecting the face (moustache/mustache or beard), chest, abdomen or back. While most women may have fine hair on these parts of the body, in hirsutism, the type of hair growth is usually associated with androgenic hair growth (hair as a result of high levels of male hormones, androgens).

Excessive Body Hair in Women & Men

Hair growth and distribution may vary among different ethnic groups but thick female facial hair, the presence of a visible mustache or beard in women, are considered to be uncharacteristic of the female gender. Hair growth is primarily dependent on the sex hormones, androgens and estrogen. Androgens, like testosterone are usually responsible for thicker hair while the female sex hormones like estrogen are responsible for fine hair.

The presence and distribution of body hair is usually noted at puberty and continues to grow till early adulthood. This type of hair, after the onset of puberty,  is known as terminal hair compared to the fine downy hair (vellus hair) present in early childhood. Hirsutism should be differentiated from hypertrichosis which is excessive hair growth throughout the body (generalized) or isolated to specific areas (localized). Hirsutism refers to androgenic hair growth patterns and can affect both men and women. Usually hirsutism is not noticed or considered a problem in men since it corresponds to normal body hair growth patterns associated with adult males.

Causes of Thick Hair Growth in Females

Male sex hormones (androgens) are present in females at significantly lower levels than it would be present in males. However any condition that increases the levels of androgens in females will likely contribute to terminal hair growth on parts of the body similar to males. Other causes of hirsutism are due to the increased sensitivity of hair follicles to androgens. The increased levels of androgens may also result in hair loss in both men and women.

  • Polycystic ovarian syndrome (PCOS) is the most common cause of hirsutism. The growth of thick female facial and body hair occurs due to the increased production of androgens by the ovaries. Multiple cysts are usually detected on the ovaries, either one sided or on both sides and other symptoms may include obesity,  irregular menstrual cycle, menstrual and lower abdominal pain, impaired glucose tolerance, premenstrual syndrome (PMS) and infertility.
  • Adrenal disorders may cause the adrenal cortex to increase its production of androgens (male sex hormones). These disorders include adrenal tumors, congenital adrenal hyperplasia, Addison’s disease or Cushing’s syndrome.
  • Familial hirsutism is usually a result of increased sensitivity of the hair follicles to androgens. Genetic factors which may also be responsible for excessive hair growth in certain ethnic groups, results in female facial hair growth, as well as terminal hair on the arms, abdomen and thighs.
  • Certain drugs may increase androgen levels in the blood, particularly anabolic steroids used by athletes and body builders, high progesterone contraceptives, drugs for endometriosis and certain hormone replacement therapies.
  • Hormone changes in menopause and pregnancy may result in hirsutism.
  • Hormone production due to tumors, sometimes outside of the sex glands, can cause the production of hormones or hormone like substances that may stimulate thick hair growth.
  • Disorders of the endocrine glands, affecting the pituitary gland, thyroid gland and pancreas affect androgen levels thereby resulting in hirsutism.

Female Facial Hair Removal

The presence of terminal hair especially on the face of women can be disturbing due to the cosmetic implications.  In most cases of hirsutism, facial hair growth does not progress beyond a fine, visible mustache similar to a young teen male. A facial beard may only involve the growth of a few strands of hair and does not develop into a complete or extensive beard as is present in adult males.

Treatment of hirsutism should focus on the cause of the thick hair growth, however in idiopathic hirsutism (hirsutism due to no known cause), most women may have to employ hair removal (epilation) or masking techniques throughout life. These techniques may include :

  • Plucking or ‘tweezing’ with hair tweezers
  • Waxing
  • Hair removal or depilatory creams
  • Bleaching to blend the color of the hair with the natural skin pigmentation
  • Shaving, although this technique is avoided in facial hair growth due to the possibility of stimulating thick hair growth.
  • Electrolysis
  • Laser hair removal

None of these hair removal or masking techniques are permanent and may have to be repeated at regular intervals. Unconfirmed reports advocate waxing, electrolysis and laser hair removal procedures as it may reduce the thickness of the terminal hairs on the target areas when the hair grows again. Any hair removal technique should be undertaken carefully as it can result in folliculitis and complicate into skin infections like a staph skin infection.


References

1. Causes of Hirsutism. Mayo Clinic

2. Hirsutism. WrongDiagnosis

3. Hirsutism (Excess Hair). FamilyDoctor.org


Article reviewed by Dr. Greg. Last updated on April 12, 2011