What Is Hirsutism In Women?

Image by Ryan McGuire from Pixabay 

The popular media shows women as hair-free beings. So much so that the models appearing in the TV commercials for chemical depilatory products or epilators are shown using these products on smooth hairless skin. Hope you got the joke there! Anyway, coming to the point, body hair growth is normal in women. The problem arises when the texture, frequency, and area of sex-hormone dependent hair growth changes. This condition is called hirsutism, i.e., the growth of coarse and dark hair in places where women generally have fine or no hair. It usually affects the upper lips, chin, chest, stomach, and back. The primary reason for hirsutism is an increase in male hormones called androgens. Although women’s bodies produce androgens, their quantity is negligible. 

Hirsutism as a manifestation of rising androgen levels in women is not a serious condition. However, it shows that an underlying condition needs treatment. Further, hirsutism affects women’s self-esteem. It makes women conscious about their looks and decreases body image satisfaction. What more should you know about this seemingly harmless health issue? Continue reading to find out.

What Are The Causes of Hirsutism?

Hirsutism has several causes. However, polycystic ovary syndrome (PCOS) and polycystic ovarian disorder remain the most common causes of the condition. The gynecologist conducts a physical examination, some blood tests and considers your family/medical history to diagnose these conditions. Some tell-tale signs of polycystic ovary syndrome include irregular menstrual cycles, weight gain, acne, male pattern baldness, and sometimes hoarse voice. Untreated or poorly managed PCOS/PCOD may cause serious health concerns such as infertility, diabetes, depression, anxiety, heart problems, and sleep apnea. Treating PCOS/PCOD in women comprises lowering the androgen levels to address hirsutism. However, medications for PCOS/PCOD alone won’t help eliminate hirsutism. 

A few other causes of excessive hair growth in women include:

• Cushing Syndrome: Chronic stress makes your adrenal glands overproduce cortisol, a hormone that regulates your body’s response to stress. 
• Androgen-secreting tumor growth
• Congenital Adrenal Hyperplasia. It is a hereditary condition characterized by excess production of steroid hormones, including androgens and cortisol, by your adrenal glands.
• Some medications can trigger hirsutism. These include anabolic steroids, minoxidil (Minoxidil, Rogaine); testosterone (Androgel, Testim); danazol (for treating endometriosis); cyclosporine, glucocorticoids, dehydroepiandrosterone (DHEA), phenytoin.
• Skin-to-skin contact with someone topically using products that increase androgenic function.
• Idiopathic hirsutism, i.e., hairiness without any identifiable reason.

How Is Hirsutism Treated?

Seeking medical remedies for hirsutism is a personal choice. It is because what’s ‘normal’ in terms of body hair growth not only depends on hormonal make-up but race and ethnicity too. For example, South Asian, Mediterranean, and Middle Eastern women may have more body hair than Native American and East Asian women. Also, some women choose to embrace this change in their appearance. However, contact your healthcare provider about treatment options if too many body hair makes you feel depressed, anxious, or embarrassed. Here’s a list of standard hair removal or elimination alternatives you might want to consider. 

1. Birth control pills: They contain estrogen and progestin, female sex hormones that help bring androgen levels down. Birth control pills are usually the first-line treatment for hirsutism, and it works well for a significant number of women with hirsutism.
2. Hair removal creams: These chemical products break your hair’s keratin structure and remove them superficially. 
3. Shaving: Feminine razor works well for vellus and terminal hair. However, you may get ingrown hair or a 5 o’clock shadow after using a razor to remove thick hair. 
4. Waxing: Wax is an emulsion made of sugar, beeswax, or rosin. It helps uproot hair from the follicle, and the results last 25-40 days.
5. Hair Retardants: Creams or sprays containing Eflornithine Hydrochloride may help slow unwanted facial hair growth in women. Noticeable results take about two months. However, the hair returns to pre-treatment levels if you discontinue using the cream. Eflornithine Hydrochloride causes redness or irritation in some cases; therefore, a patch test is recommended.
6. Laser hair removal: Although costly, laser hair removal is less painful, faster, and an effective option to reduce body hair growth permanently. It particularly suits patients with fair skin and dark hair. Achieving satisfactory results from this procedure requires multiple sessions, depending on the area to be treated. You may also need to go for maintenance sessions every six to twelve months, especially if you have hormonal issues. Some YouTube testimonials advise against laser hair removal on the face as it may trigger more hair growth in some cases. So, discuss with your dermatologist if laser hair removal is the right option for you.
7. Electrolysis: It is the only FDA-approved hair removal technique that can help remove hair permanently. However, electrolysis is painful and time-consuming. Full-body hair removal using electrolysis may take up to four years. The process involves a licensed electrologist damaging each hair follicle by transferring electrical current through a very fine needle. Electrolysis is a good choice if safety and side effects are your concerns. The side effects are mild and go away within 3-5 days.
8. Antiandrogens: It is a class of drugs that directly lowers androgen production or inhibits androgen activity on hair follicles. However, antiandrogens may cause congenital disabilities, and it is generally not recommended for women planning to get pregnant. Some commonly prescribed antiandrogen medications include spironolactone, cyproterone acetate, and finasteride. 
9. Combination Therapy: Many women find that a comprehensive treatment plan may produce a maximal reduction in hair growth. It includes suppressing androgen production with estrogen-progestin birth control pills, hair removal techniques with long-term benefits  (laser, electrolysis), and blocking androgen activity with an antiandrogen (spironolactone). Remember to be on the birth control pill to prevent hair regrowth when choosing laser hair removal. You may use women’s health-tracking apps with a pill-reminder feature to avoid misses.
10. Weight Loss: Shedding extra weight lowers androgen activity by at least 5% and helps decrease unwanted hair growth.

The physical effect of hirsutism has no harmful effects, but it may become a reason for depression, anxiety, and social isolation for some women. If you find excessive body hair bothersome, contact a gynecologist and a dermatologist now.