Hirsutism

Overview

Hirsutism (say: HER-suh-tizm) is when a woman grows dark, thick, coarse hair in places where men usually grow hair — mainly the face, chest, tummy and back. It is different from the soft, fine 'peach fuzz' hair that almost everyone has. Hirsutism is usually caused by hormones called androgens (male-type hormones that everyone has, in different amounts), or by hair follicles being extra sensitive to them. It is a common and treatable condition, not a sign that something is wrong with you as a person.

Yes. Hirsutism is common — roughly 1 in 10 to 1 in 20 women of reproductive age have it to some degree. Mild facial hair, especially around the upper lip and chin, is very normal and becomes more common as women get older.

Hirsutism mainly affects women and people assigned female at birth, usually starting around puberty or in the late teens and twenties. It is more common in women with PCOS, in women with a family history of excess hair growth, and in some ethnic groups, including women of South Asian, Middle Eastern and Mediterranean background. It can also appear or worsen around the menopause, when hormone levels shift.

Symptoms

Common symptoms

• Thick, dark, coarse hair on the upper lip, chin, cheeks or neck
• Coarse hair on the chest, between the breasts, or on the upper or lower tummy
• Coarse hair on the back, bottom or inner thighs
• Hair on the face or body that is darker or thicker than before
• Thinning hair on the scalp, or a receding hairline
• Acne or oily skin, especially along the jaw and chin
• Irregular, infrequent or absent periods (often linked to PCOS)
• Hair removal that feels like a constant battle because it grows back quickly
• Skin irritation, ingrown hairs or dark marks from shaving, plucking or waxing

Symptoms in children

• Coarse, dark pubic or underarm hair, acne or body odour before age 8 in girls — this is called early puberty and should be checked by a doctor
• Rapid growth spurt or a growth spurt that starts very early
• Excess hair on the face or body in a young child — this is unusual before puberty and needs medical review
• Note: fine, dark hair over the forehead, back and shoulders is very common in newborn babies and normally fades on its own

Symptoms in older adults

• New or increasing facial hair after the menopause, which is often due to normal hormone changes
• Hair growth that starts suddenly, or gets much worse over a few months, which needs checking
• Hair growth linked to a new medicine — ask your doctor or pharmacist to review your medicines
• A deepened voice, balding scalp or enlarged clitoris at any age — see a doctor promptly

Causes

Main causes

• Polycystic ovary syndrome (PCOS) — the most common cause; the ovaries and adrenal glands make slightly higher levels of male-type hormones, and periods may be irregular
• Idiopathic hirsutism — excess hair growth with normal hormone levels; the hair follicles are simply more sensitive to hormones. This is very common
• Higher androgen levels (male-type hormones) from the adrenal glands or ovaries, which can run in families
• A rare hormone-producing growth on an ovary or adrenal gland — this usually causes fast-worsening symptoms and needs prompt checking
• A rare inherited enzyme problem called congenital adrenal hyperplasia, which affects hormone production
• Medicines — some steroids, some treatments for blood pressure and certain other drugs can worsen hair growth
• Natural hormone changes around puberty, pregnancy and the menopause
• Insulin resistance (when the body responds poorly to insulin, a hormone that controls blood sugar) and being overweight, which can raise androgen levels

Risk factors

• Having PCOS or a related hormone condition
• A family history of excess hair growth, PCOS or diabetes
• Being of South Asian, Middle Eastern or Mediterranean background, where hirsutism is more common
• Being overweight — fat tissue can raise androgen levels
• Insulin resistance or type 2 diabetes
• Taking certain medicines that affect hormones
• The years around puberty or the menopause, when hormone levels naturally shift

When to see a doctor

See a doctor urgently if:

• Hair growth that has come on suddenly and is getting worse fast
• A deepening voice, scalp balding, an enlarged clitoris or severe new acne
• Missed periods for several months, or periods that stop altogether
• Very heavy periods, bleeding between periods, or bleeding after the menopause
• Sudden severe pelvic pain with feeling faint or unwell — call your local emergency number

Book a routine appointment if:

• You are bothered by facial or body hair and want advice on options
• The hair growth has been slowly increasing over months or years
• You also have irregular periods, acne, or trouble getting pregnant
• Hair removal is causing ingrown hairs, scarring or skin darkening
• The hair growth is affecting your confidence, mood or daily life
• You want to review whether a medicine you take could be contributing

Diagnosis

Your doctor will usually start by talking with you — when the hair growth began, how fast it changed, your periods, your medicines, and whether anyone in your family has similar hair growth or PCOS. They will look at where the hair is and how coarse it is, check your skin and scalp, and may check your weight and blood pressure. If your periods are irregular, the hair growth is fast, or your doctor suspects a hormone problem, they will arrange blood tests. Often the diagnosis is made from your story and examination alone.

Tests that may be done

• Blood tests for male-type hormones such as testosterone, and for a hormone called DHEAS that comes from the adrenal glands
• A blood test for prolactin (a hormone from the pituitary gland in the brain)
• Thyroid function tests
• A blood test for blood sugar or insulin resistance, such as fasting glucose or HbA1c
• An ultrasound scan of the ovaries, usually done through the tummy or the vagina, to look for signs of PCOS
• In some cases, a short test using a medicine to check how the adrenal glands respond
• A pelvic or adrenal scan if a hormone-producing growth is suspected — this is uncommon

What to expect at your appointment

Most of the tests are simple blood tests, and you may be asked to have them at a certain point in your menstrual cycle. Results usually take a few days to a couple of weeks. Your doctor will explain what each result means and whether anything needs treating. If everything comes back normal, that is a common and reassuring result — it means the hair growth is not caused by a health problem, and you can focus on management and cosmetic options.

Treatment

There is no single 'cure', but hirsutism can almost always be managed well. Treatment has two strands: dealing with the hair you already have (removal and slowing hair growth), and — if a hormone condition such as PCOS is found — treating that underlying cause. Many women combine both. It can take three to six months to see the full effect of hormone treatment, because hair grows slowly, so patience helps.

Self-care at home

• Choose a hair removal method that suits your skin and budget: shaving, plucking, waxing, sugaring, threading or hair-removal creams
• Shaving does not make hair grow back thicker — that is a myth, though the blunt tip can feel stubbly at first
• Test any cream or wax on a small area first, and follow the instructions carefully to avoid burns or irritation
• Use a gentle, fragrance-free moisturiser and avoid harsh scrubs on areas you remove hair from, to reduce ingrown hairs
• Exfoliate gently and regularly if you are prone to ingrown hairs
• Consider laser or electrolysis for longer-lasting results — ask about patch tests, costs and how many sessions you may need, and use a trained, regulated practitioner
• If you are overweight, losing a modest amount of weight can lower androgen levels and improve symptoms
• Use sun protection on any area with dark marks or scarring from hair removal

Medical treatments

If a hormone cause is found, your doctor may suggest treatment to lower or block the effect of male-type hormones. For women who are not trying to get pregnant, options include combined hormonal contraception (such as the pill or a patch), which can lower androgen levels and also help acne and irregular periods; anti-androgen tablets, which block the effect of male-type hormones on the hair follicle; and medicines that improve insulin resistance, which can help if PCOS is the cause. A prescription cream can be applied to the face to slow hair growth in some women. All of these need to be prescribed and monitored by a qualified healthcare professional, and some are not safe in pregnancy, so discuss contraception with your doctor. Because hair grows slowly, expect three to six months before you notice a real difference, and hair removal may still be needed alongside treatment. You may be referred to a specialist (an endocrinologist for hormones, a gynaecologist, or a dermatologist for skin and hair) if the cause is unclear or treatment is not working.

When is surgery considered?

Surgery is rarely needed. It may be offered if tests show a hormone-producing growth on an ovary or an adrenal gland — this is uncommon and is usually suspected because symptoms appear suddenly and worsen quickly. Otherwise, treatment is medical and cosmetic rather than surgical.

Living with this condition

Many women settle into a routine that keeps hair growth manageable — a combination of regular removal, a skincare plan, and sometimes hormone treatment. It can help to book removal sessions in advance, keep a small kit for touch-ups, and avoid last-minute panics before social occasions. Try to be kind to yourself: visible hair is common and says nothing about your femininity or worth.

Lifestyle tips

• Keep a simple, gentle skincare routine, especially on the face
• Plan hair removal around your week so it feels less of a burden
• Notice which methods suit your skin — some cause less irritation than others
• Get regular sleep and manage stress, which can help hormone balance and how you feel overall
• Talk to someone you trust about how you feel — carrying it alone makes it heavier

Diet and exercise

There is no special diet that cures hirsutism, but if you have PCOS or insulin resistance, eating a balanced diet and staying active can genuinely help. Aim for regular meals with plenty of vegetables, whole grains, beans and lean protein, and limit sugary drinks and highly processed snacks. Moving your body in a way you enjoy — walking, swimming, cycling, dancing — for around 150 minutes a week is a good target, and it also lifts mood. If you want to lose weight, a modest, steady loss of around 5 to 10 percent of your body weight can improve hormone levels. Ask your doctor or a dietitian for personalised advice.

Mental health and emotional wellbeing

Hirsutism can affect far more than skin. Many women describe feeling self-conscious, embarrassed or less feminine, and some avoid social situations, intimacy or photographs. Anxiety and low mood are common and completely understandable. These feelings are valid, and they are treatable. Talking therapies, peer support and, where needed, help from a mental health professional can make a real difference. If you ever have thoughts of harming yourself, please reach out to your local crisis service or emergency number straight away — you deserve support.

Prevention

Hirsutism cannot always be prevented, especially where it runs in families or is linked to PCOS. But some things can lower your chances or keep it milder: staying at a healthy weight, being active, eating a balanced diet to help insulin resistance, and reviewing medicines with your doctor if you notice hair growth after starting a new drug. If you have PCOS, getting it diagnosed and managed early can reduce long-term symptoms.

Screening programmes

There is no national screening programme for hirsutism. However, if you have PCOS, your doctor may check your blood pressure, blood sugar and cholesterol from time to time, because PCOS slightly raises the risk of type 2 diabetes and heart problems. Regular check-ups are a good chance to raise any concerns about hair growth, periods or skin.

Complications

If left untreated

• The hair growth may become more widespread and coarser over time
• Skin problems such as ingrown hairs, folliculitis (inflamed hair follicles), scarring and dark patches from repeated removal
• An underlying condition such as PCOS may go undiagnosed, along with its effects on periods and fertility
• Higher long-term risk of type 2 diabetes and heart problems if PCOS or insulin resistance is present and unmanaged
• Ongoing distress, low confidence, anxiety and low mood
• Difficulty with intimacy or social situations for some women

Long-term outlook

The outlook is good. Hirsutism is not dangerous in itself, and most women find a combination of hair removal and, where needed, medical treatment that keeps it manageable. If a cause such as PCOS is found, treating it can improve hair growth, skin and periods together. Results take a few months, so give yourself time and keep talking to your doctor about what is and is not working — there is usually something else to try.

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