Excess hair growth in women · Androgen excess · PCOS
Unwanted hair growth, treated at the source.
Hirsutism is coarse, dark hair growing in a male pattern on the face, chest, abdomen or back. It affects 5 to 10 percent of women and is almost always a hormone story, most often PCOS, occasionally something that needs to be found promptly. Removing the hair treats the symptom; lowering the androgen signal is what stops new growth. Dr. Hasan is experienced in evaluating and treating hirsutism in women of all ages.
Why it happens
Hair follicles in androgen-sensitive areas respond to testosterone and its more potent form, DHT. Excess hair comes from higher androgen levels, more sensitive follicles, or both. Polycystic ovary syndrome accounts for 70 to 80 percent of cases; idiopathic hirsutism (normal hormones, sensitive follicles) for most of the rest. Less common causes include non-classic congenital adrenal hyperplasia, Cushing's syndrome, high prolactin, thyroid disease, medications such as anabolic steroids, testosterone gel exposure and some seizure drugs, and rarely an androgen-producing tumor of the ovary or adrenal gland.
Rapid onset over months, virilization (deep voice, clitoral enlargement, muscle gain) or a testosterone over 150 ng/dL prompts an urgent search for a tumor.
Signs to note
Where androgen excess shows
- 1Coarse hair on the upper lip, chin and sideburns; acne
- 2Thinning at the crown or temples (female-pattern hair loss)
- 3Hair between or around the breasts
- 4Hair from the navel downward; central weight gain and insulin resistance
- 5Irregular or absent periods; difficulty conceiving
- 6Dark, velvety skin (acanthosis nigricans) as a marker of insulin resistance
- 7Hair on the upper back and shoulders
The modified Ferriman-Gallwey score rates nine body areas; a total of 8 or more defines hirsutism in most populations.
Treatment
- Combined oral contraceptives are first-line when pregnancy is not desired: they lower ovarian androgen production and raise the protein that binds testosterone. Improvement takes 6 months, the length of a hair growth cycle.
- Anti-androgens (spironolactone 100 to 200 mg daily, or finasteride) are added after 6 months if needed, always with reliable contraception.
- Insulin sensitizers and weight management in PCOS: metformin, GLP-1 therapy and a 5 to 10 percent weight reduction lower androgens and restore cycles.
- Hair removal is used alongside: laser or electrolysis for lasting reduction, eflornithine cream to slow facial regrowth, shaving or threading in the meantime.
- Treat the specific cause when it is not PCOS: glucocorticoids for non-classic CAH when fertility is the goal, surgery for tumors, correction of thyroid or prolactin problems.
Dr. Hasan is experienced in evaluating hirsutism and androgen excess in women, including PCOS, non-classic CAH and rarer causes, and in combining hormonal treatment with practical hair-reduction strategies.
Common questions
How long until I see results?
Hair follicles cycle over about 6 months, so medication changes the hair that grows next, not the hair already there. Expect visible slowing by 6 months and the full effect by 9 to 12 months.
Can I take spironolactone alone?
Only with reliable contraception, because it can affect a male fetus. Most women take it with a combined pill, which also treats the underlying hormonal pattern.
Is laser hair removal permanent?
Laser gives long-term reduction, especially on dark hair against lighter skin, but new follicles can be recruited if androgens stay high. Treating the hormones first makes laser results last.
Does hirsutism mean I have PCOS?
Most often, but not always. PCOS requires two of three features: androgen excess, irregular ovulation and polycystic ovaries on ultrasound, after other causes are excluded.
Related conditions
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