Hirsutism is a condition where a woman has excess thick, dark hair which grows in a male-type pattern. (1, 2)

The hair may appear on the:

• upper lip
• the chin
• the chest
• the stomach – from the belly button to the pubic hair
• the lower back
• the anal and genital area
• the arms
• the legs – in particular the front of the thighs (1, 3, 7)

There may also be other symptoms including:

• Oily skin and acne
• Abnormal periods, these may be irregular, heavy or even absent
• Infertility
• Deep voice
• Decreased breast size
• Enlarged clitoris
• High blood pressure
• Abnormal cholesterol levels
• Baldness
• Enlarged ovaries and adrenal glands
• Social and self-esteem issues (3, 4)

Causes of hirsutism

Hirsutism is often caused by high levels of androgens, which are male sex hormones. It may also be caused by an increased sensitivity to androgens. (5, 6) Androgens are carried in the blood and hair follicles may be exposed to them. (2)

The exposure of hair follicles to androgens causes the hair fibers to increase in size and diameter. Small, non-pigmented hairs may turn into large, pigmented hairs called terminal hairs. (18)

An increased level of androgens may be caused by:

• Polycystic ovary syndrome
• Congenital adrenal hyperplasia (CAH), which is due to a defect of the 21-hydroxylase enzyme
• Ovarian tumors
• Adrenal tumors
• ACTH secreting tumors
• Pregnancy luteomas, which are benign tumors of the ovary, which may be caused by the hormonal effects of pregnancy
• Some types of Cushing’s syndrome
• Acromegaly, or excess growth hormone
• Exposure to certain drugs, including: (3, 8, 9, 10, 11, 17)
  • Oral contraceptives
  • Progestin-containing medications
  • Anabolic steroids
  • Minoxidil
  • Cyclosporine
  • Phenytoin
  • Diazoxide

Hirsutism and Polycystic Ovary Syndrome (PCOS)

Hirsutism is a symptom of Polycystic ovary syndrome (PCOS), but just because someone has hirsutism it does not mean that they also have PCOS. (12, 13) Furthermore, there may be no obvious cause for hirsutism. In this case it is labelled idiopathic hirsutism. (18)

The symptoms of hirsutism and PCOS are quite similar. They are both associated with excessive hair growth, acne, unusual periods, balding and so forth. (13)

Figures vary as to how many women PCOS affects, but estimates suggest between 5-10% of women. (13, 14) There are three basic features of PCOS: cysts on the ovaries; failed ovulation (that is the release of eggs from the ovaries); and high levels of male hormones. (12)

PCOS does not have a specific cure and so therapy tends to focus on controlling the symptoms. Patients may also be advised to concentrate on maintaining an ideal weight, as someone who is overweight is at a higher risk of developing the symptoms of PCOS. (13, 15)

How many people does hirsutism affect?

Statistics also vary as to how many women hirsutism itself affects. According to Bupa, around one in ten women are affected by hirsutism. (16) Researchers at Medical University of South Carolina in 2003, however, stated that the affected number of people was less than this – up to 8% of people. (14)

These variances may be due to hirsutism being subjective. This is because what is considered “excessive” hair growth depends on what you consider “normal”. The latter may be affected by culture and race. (17)

Diagnosing hirsutism

Hirsutism is generally a very subjective condition. It can, however, be formally diagnosed using the Ferriman-Gallwey system. This system consists of rating nine areas with a number between 0 and 4, based on the level of hair (where 0 refers to no hair and 4 means heavy hair growth). (17)

The scores are then combined to produce an overall score. Moderate hirsutism is diagnosed as a score between 8 and 15 and severe hirsutism is diagnosed for a score above 15. (18)

The nine areas rated in the system are:-

• Upper lip
• Chin
• Chest
• Upper back
• Lower back
• Upper abdomen
• Lower abdomen
• Upper arms
• Thighs (17)

Treatment of hirsutism

The treatment for hirsutism varies depending on what is causing the symptoms. There are some general strategies one can try to try to cope with the symptoms of hirsutism.

The first option is to lose weight if you are overweight. This is because being overweight increases your risk of displaying the symptoms of hirsutism. (5)

Another option is to try hair-removal techniques. These include:

• Shaving
• Depilating through the use of creams
• Bleaching
• Plucking
• Waxing
• Threading (16)

Laser treatment is also another option for the removal of hair. For patients to have laser treatment on the NHS, however, the hirsutism must be facial and it must be deemed “severe”. This means that the hirsuitsm is so serious that it is necessary for the patient to shave every day. (19)

Some patients may require medications to treat their condition. These include:

• Anti-androgen medications which block the action of androgen hormones. There are several different specific medicines that may be given including:
  • Oral contraceptive pills
  • Cyproterone acetate
  • Spironolactone
  • Finasteride (also known as Propecia and Proscar)
  • Flutamide
• Metformin (also known as Glucophage) may be given if your hirsutism is being caused by PCOS.
• Eflornithine (also known as Vaniqa) may be given to rub into the skin to slow hair growth. (11, 16)

Hirsutism and excessive hair growth in men

It is possible for men to get hirsutism, however, it is important to distinguish hirsutism from excessive hair growth in general. Hypertrichosis is the medical term given to denote excessive hair growth. (20)

The distinguishing feature between hirsuitsm and hypertrichosis is that the latter refers to excessive hair growth in a nonsexual pattern. Furthermore, hypertrichosis is not caused by excess androgens. (21)