Unwanted Hair Growth in Women

Hirsutism is the condition of excessive unwanted hair growth which occurs due to hormonal imbalances in both men and women, although in men it is difficult to decipher. Hirsutism is often the sign of androgen levels produced excessively. While there are various causes of hirsutism, polycystic ovarian syndrome and idiopathic hyperandrogenism are the most prominent, accounting for more than 85% of cases.

The other less common causes include idiopathic hirsutism, nonclassic congenital adrenal hyperplasia, androgen-secreting tumors, medications, etc. It is common for the endocrinologists to subject women suffering abnormal hirsutism for evaluation of elevated androgen levels as rapid onset of hirsutism could be due to an underlying androgen-secreting tumor.

The condition of hirsutism can be treated with pharmacologic agents and in cases of extreme conditions, hair removal options can be sorted. The common pharmacologic therapies include combination of oral contraceptives, 5-alpha reductase inhibitors, mineralocorticoid receptor antagonists, etc. which are to be adhered at least for a period of 6 months as it coincides with the hair growth cycle.

Types of Unwanted Hair Growth

Hirsutism: Women suffering from hirsutism display significant amounts of hair growth among those usual areas where hair growth is common in the male such as the face, chest, back, and stomach. Often dark and coarse hair is produced instead of the light, fine “peach fuzz” that covers most of the body.
Hypertrichosis: In patients suffering from hypertrichosis, excessive hair growth is seen anywhere on the body. On the other hand, people with hirsutism have a lot of hair growth in specific areas that depend on male hormones, such as the face, chest, back, and stomach.

Symptoms of Unwanted Hair Growth

Hirsutism symptoms in women could be:

Excessive facial or body hair: Hair growth on the chin, upper lip, chest, abdomen, and back.
Acne or oily skin: Due to excess androgen production.
Menstrual irregularities: Hormonal imbalances often affect the menstrual cycle.
Deepening of voice and balding: Severe cases of hirsutism may result in masculinization symptoms.

In men, excessive hair growth can occur, but this content is focused on the hormonal aspects in women.

Hirsutism causes

The primary cause of unwanted hair growth in women is androgen excess. Common conditions include:

PCOS: This is a common hormonal disorder that affects 5–10% of women. In this hormonal disorder the ovaries overproduce androgens causing unwanted hair growth in women.
Unexplained Hirsutism: In few cases, the hair follicles in women attain higher sensitivity to androgens, causing unwanted hair growth. This type of disorder is clearly genetic.
Non-classical Adrenal Hyperplasia: In few cases even abnormalities in the adrenal glands can cause unwanted hair growth. The most common of them include non-classical adrenal hyperplasia (NCAH), an inherited disorder that causes the adrenal glands to overproduce androgens resulting in irregular menstrual cycles and unwanted hair growth.
HAIR-AN Syndrome (Hyperandrogenism, Insulin Resistance, Acanthosis Nigricans): Insulin controls blood sugar levels. In insulin resistance, the ability of insulin to control blood sugar levels decreases. In few women who were born with insulin resistance, the pancreas produces more insulin as a form of compensation. High levels of insulin can stimulate the ovaries to overproduce androgens, leading to unwanted hair growth, acne, and irregular ovulation.
Cushing Syndrome: The overproduction of cortisol by the adrenal glands can also cause unwanted hair growth but it may not be the primary feature. Women suffering from Cushing syndrome often are obese with a flushed and rounded face, muscle weakness, diabetes, and irregular menstrual cycle.
Ovarian or Adrenal Tumors: extremely high levels of androgen production can also be seen in tumors developing in the ovaries or adrenal glands. This causes symptoms, such as unwanted hair growth, which progress quickly. It can also cause male-like balding, deepening of the voice, etc.
Menopause: During menopause, the ovaries stop producing estrogen but continue to produce androgens. The imbalance of estrogen levels may allow the androgens to have a greater impact, leading to an increase in the number of dark terminal hairs, especially on the face. For this reason, many menopausal women complain of new facial hair (moustache and whiskers) and mild balding.
Medication Side Effects: Drugs such as anabolic steroids are used to increase muscle mass, especially in chronically ill and debilitated people. They can increase unwanted hair growth. Other medications include danazol, phenytoin, minoxidil, etc.

When to See a Doctor?

Consult a doctor if you notice sudden, rapid hair growth or if hirsutism is accompanied by symptoms like irregular menstrual cycles, acne, or deepening of the voice. These could indicate a serious underlying health condition such as PCOS or adrenal disorders. It’s important to seek medical advice to identify the root cause and manage it effectively

Risk Factors of Unwanted Hair Growth

Several factors increase the likelihood of developing hirsutism:

Family History: Genetic predisposition can lead to hirsutism, especially if women in your family have similar symptoms.
Obesity: Being overweight can influence hormone production and worsen hirsutism.
Ethnicity: Women of Mediterranean, Middle Eastern, and South Asian descent are more prone to excessive hair growth.
Underlying Medical Conditions: Disorders like PCOS and Cushing’s syndrome are major risk factors.

Hirsutism Complications

Hirsutism can lead to emotional distress, anxiety, and a decrease in self-esteem, impacting social and personal relationships. If untreated, the underlying conditions, such as PCOS, can lead to complications like infertility, type 2 diabetes, and cardiovascular issues.

Hirsutism Prevention

Prevention involves managing risk factors such as weight, hormonal balance, and early intervention through regular medical check-ups.

Hirsutism Diagnosis & Tests

To diagnose hirsutism, healthcare providers will review the patient’s medical history, perform a physical examination, and other hirsutism tests such as:

Blood Tests: To check hormone levels, particularly androgens and cortisol.
Ultrasound: Used to examine the ovaries and detect cysts, which may indicate PCOS.
CT Scan or MRI: Imaging tests may be required to evaluate adrenal or pituitary gland abnormalities.

Hirsutism treatment types

Hirsutism management is dependent on the underlying cause:

Medications: Anti-androgens like spironolactone can reduce androgen levels and slow hair growth. Oral contraceptives may also be prescribed to regulate hormones.
Hair Removal Techniques: Laser hair removal, electrolysis, or depilatory creams can help manage excessive hair.
Surgery: In rare cases, surgery may be needed to address adrenal or ovarian tumors contributing to hirsutism.

Do's and Don'ts

Do's:

Do maintain a healthy weight. Weight loss can help regulate hormone levels and reduce hirsutism.
Do seek professional treatment early. Early diagnosis can prevent complications from underlying conditions like PCOS.
Do explore long-term hair removal options. Laser hair removal or electrolysis can provide more permanent solutions than shaving or waxing.

Don'ts:

Don’t ignore sudden or severe hair growth. It may be a sign of a serious medical issue.
Don’t use unproven treatments. Over-the-counter products may not effectively address the root cause of hirsutism.
Don’t self-diagnose. Consult a healthcare provider to accurately diagnose and treat the condition.

Care at Dr. Prudwiraj Sanamandra Endocrinology Clinic

At Dr. Prudwiraj Sanamandra Endocrinology Clinic, we specialize in treating hormonal conditions that lead to unwanted hair growth in women. Our comprehensive approach includes accurate diagnosis, personalized treatment plans, and the latest hair removal techniques to manage symptoms effectively. With a focus on patient care, we ensure privacy and compassion in every step of your treatment journey.