Hirsutism in Women: How to Identify and Treat It, According to Derms

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While it's completely normal to have body and facial hair—even for those assigned female at birth—some people are naturally hairier than others. For some, that may mean having a little more peach fuzz on their cheeks than their friends, but for others, it could mean a handful of thick chin hair. If this sounds like you, what you may be seeing is hirsutism on your face.

It can feel isolating and frustrating to have any type of skin condition, especially when they go against what outdated societal beauty standards for women are, but please know that hirsutism, for one, is quite common. In fact, this endocrine disorder affects roughly 10 percent of women of reproductive age. So to better understand hirsutism, how it manifests on the face and body, what causes it, and how to treat it, we asked four board-certified dermatologists to weigh in. Discover insights from Dr. Alexis Stephens, Dr. Adeline Kikam, Dr. Orit Markowitz, and Dr. Scott Paviol, ahead.

Meet the Expert

What Is Hirsutism?

“Hirsutism is a hair disorder that results in an increased number of terminal hairs in women with a male pattern of distribution, such as the cheeks, chin, upper lip area, chest, upper back, abdomen, and groin,” explains Dr. Alexis Stephens, a board-certified dermatologist and the founder of Parkland Dermatology & Cosmetic Surgery in Florida. “These are body locations where high levels of the hormone androgen are required for hair growth.”

Signs and Symptoms of Hirsutism

Hirsutism is characterized by coarse, terminal hair growth in women in areas more commonly associated with men. Dr. Adeline Kikam, a board-certified dermatologist and the founder of @brownskinderm, says that most often, these areas include the upper lip, beard area (chin and sideburn, included), chest, lower abdomen, upper back, inner thighs, and groin. "Men have higher levels of androgen hormones during and after puberty, which are responsible for terminal hairs in the aforementioned sex-specific areas of the body, and, as such, when there is an excess amount of this ‘male hormone’ in women, we see excessive hair growth in these areas as well," she explains.

The Causes

While hirsutism is most commonly associated with hormonal imbalance—particularly the presence of elevated androgen hormones—Dr. Kikam says that it’s possible for women who have normal androgen levels to also develop hirsutism. Either way, she says that the most common cause of hirsutism is polycystic ovarian syndrome (PCOS). Of course, that’s not the only cause. She says that hirsutism can also be caused by medication, thyroid dysfunction, adrenal tumors, and unknown factors—which is why she recommends getting a full workup if you’re concerned that hirsutism may be at play. 

Markowitz adds to this, noting that menopause-related hormone changes can also be a contributing factor to excess hair growth. Given the many potential causes, getting a doctor’s opinion can prove to be very helpful in treating your symptoms of hirsutism. 

Hirsutism Treatment

01 of 07

Identify Where the Excess Hair Is Growing

Since hirsutism presents itself in areas more commonly associated with male hair growth, assessing your body to see where your hair is growing is the first step in determining if you may have hirsutism.

As Dr. Kikam reminds us, hirsutism is commonly associated with excess hair growth in areas that are not typical high-density areas for women. “This is just a clue,” she adds, noting that an additional workup should be done to differentiate it from hypertrichosis—excessive hair growth anywhere on the body—which can affect anyone.

If you don’t notice excess dark hair growth (because remember, the key to hirsutism is coarse, dark hair), North Carolina-based board-certified dermatologist Dr. Scott Paviol says that you might be confusing normal female hair growth with a more severe disorder.

“Women can have increased fine vellus hairs [also known as peach fuzz] on their face and that is not associated with androgen excess,” he explains, noting that it’s a very normal occurrence. (Of course, if you’re still not satisfied with peach fuzz, you can use a dermaplaning device like the Dermaflash Luxe+ Anti-Aging, Exfoliation + Peach Fuzz Removal Set, $199.) 

02 of 07

Determine the Density of the Hair

It’s not just about the area of growth but the density, too. With that in mind, Dr. Markowitz explains that there are three levels of hirsutism.

"Hirsutism can be measured by elevated androgen levels using the Ferriman-Gallwey score, which determines the level of hirsutism someone has by checking nine areas of the body for hair growth," she shares. "A normal level would score less than eight; a mild level scores between eight and 15; and anyone with a score higher than 15 has a severe case."

03 of 07

Treat and Prevent Ingrown Hairs

“Excessive unwanted facial hair can lead to pseudofolliculitis—also known as ingrown hairs—which, on darker skin, can lead to post-inflammatory hyperpigmentation and scarring,” Dr. Stephens says.

Plus, apart from the more serious complications mentioned above, dealing with ingrown hairs can be uncomfortable and painful. To keep ingrown hairs at bay, develop a consistent exfoliation routine (physical and chemical) and balance it out with soothing moisturizers.

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Look For Other Signs of Hirsutism

While excessive hair growth is the most obvious symptom of hirsutism, the Cleveland Clinic states that people living with this condition may also experience acne, decreased breast size, increased sex drive, a deeper voice, clitoris enlargement, and increased muscle size.

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Take Care of Your Mental Health

“Excessive hair growth—especially on very visible areas like the face, which is so intricately linked to identity, self-awareness, and what it means to be feminine in society—can be a cause for decreased self-esteem, stress, anxiety, and even depression in many with this condition,” says Dr. Kikam.

If this sounds familiar, take time to prioritize self-care. That can come in the form of an at-home spa day, spending time with people who make you feel beautiful, finding a sense of community with others who have hirsutism, and watching your favorite feel-good movies, amongst other things.

06 of 07

Consult a Doctor

Hirsutism isn’t always a cut-and-dry disorder. That’s because excessive hair growth might not be immediately alarming. According to Dr. Stephens, it can be seen alongside other signs such as amenorrhea (lack of periods) and male pattern alopecia. As such, if you notice any of these signs, she recommends consulting a physician to discuss the next steps and potential hirsutism treatment options.

Another thing to note is that, according to Dr. Kikam, sudden changes in hair growth patterns aren’t associated with normal developmental milestones—especially in adult women. So, if you’re thinking that maybe this sudden surge of thick, coarse hair is just a phase, she says to head to a doctor before lingering further on that thought. After all, even if you’re open to embracing your excessive facial and body hair, it helps to know what medical issues are churning within your body.

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Consider Treatment Options

Once you’ve consulted with your doctor, they’ll likely point you in the direction of what they believe to be the best hirsutism treatment for you. According to Dr. Stephens, hirsutism can be treated with a combination of therapies, including laser hair removal, spironolactone, birth control pills, or Vaniqa (a topical prescription).

However, since effective treatment depends on the underlying cause of the hirsutism, Dr. Kikam says it’s better to work with a doctor than try to self-diagnose at home with hirsutism treatments.

Article Sources
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  1. Mihailidis J, Dermesropian R, Taxel P, Luthra P, Grant-Kels JM. Endocrine Evaluation of HirsutismInt J Womens Dermatol. 2017;3(1 Suppl):S6-S10. doi:10.1016/j.ijwd.2017.02.007

  2. Cleveland Clinic. Excessive Hair Growth (Hirsutism). Updated January 13, 2018.

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