Bonnie Hayflick of Florida, went to a dermatologist when she was 30 to see about having spider veins in her legs removed. While she was there, she asked about the coarse blonde hair around her mouth and eyebrows. The doctor recorded a diagnosis of
, defined as excessive growth of facial and body hair. She was stunned.
The Causes of Hirsutism
What the doctor didn't tell Hayflick is that hirsutism in women is often a symptom of excessive androgen, or male sexual hormones. Most cases of excess hair growth in women result from genetic factors that cause a mild increase in androgen production along with an increased sensitivity of hair follicles to androgens. Women of Mediterranean or East Indian descent tend to exhibit these characteristics more often than Asian and Nordic women. This kind of androgen-dependent hirsutism produces course hair associated with puberty.
More severe hirsutism is usually associated with an underlying disorder, most commonly
polycystic ovary syndrome
(PCOS), also known as persistent anovulation or Stein-Leventhal Syndrome. Hirsutism can also be a side effect of certain medications, and in very rare cases, it can be a manifestation of congenital endocrine problems or tumors of the ovaries or adrenal glands.
Some women may have idiopathic hirsutism, in which the cause is unknown. A nonandrogen form of hirsutism (familial hypertrichosis) is associated with the growth of finer hair, and does not respond to medicines that interfere with androgen production.
Where Is the Hair?
Most cases of hirsutism involve unwanted hair above the lip or on the chin. It can also appear on the chest or on the stomach or thighs as an extension of pubic hair areas where men normally exhibit androgen-dependent hair growth. It may also grow more thickly than normal on the arms and legs.
Too Embarrassed to Ask for Help
Many women with hirsutism don't mention the condition to their doctors, or may hide it by removing the hair before they go to the doctor.
"Even if it really bothers them, they may not ask about it," says Carol Wheeler, MD, associate professor at Brown Medical School and reproductive endocrinologist at Women & Infants Hospital in Providence, Rhode Island. "They don't realize it can be a sign of an underlying problem that has other health implications beyond the hair. It's important to address those together."
The Emotional Impact
Besides the underlying health conditions that hirsutism can signal, the condition can have a tremendous emotional impact on women.
"We come from a society where women aren't supposed to have unwanted hair," says Evelina Weidman Sterling, a health education specialist and co-author of the book,
Living with PCOS
. "A lot of women feel they don't want to get intimate. They don't want to have people see them with that much hair, shaving, plucking or tweezing, or see them wearing bathing suits."
Hayflick says that her facial hair is so blonde that no one else notices, but it still bothers her.
"The texture is probably as coarse as any man's beard," she says. "That's what I notice most and it's starting to be most upsetting. I'm an attractive, fit, healthy female, but this is a real personal 'me' thing. I'm habitually touching the areas where I have the hair, and pulling them out. I'm hoping that once I can discover what can handle the hair growth, that behavior will stop as well."
Since many cases of hirsutism result from a hormonal condition, your doctor may refer you to an endocrinologist. There are several ways to control hirsutism, including:
These treatments include over-the-counter methods of hair removal include shaving, bleaching, depilatorizing, tweezing, waxing, and using pumice stones.
For cases associated with excessive androgen production, anti-androgenic medications and
can be effective.
13.9% (Vaniqa) cream, the first topical treatment approved by the Food and Drug Administration (FDA) for the treatment of unwanted facial hair, can effectively treat hirsutism regardless of the cause. It is designed for use on the face and chin only. It can produce a rash at the application site, but does not appear to have the systemic effects sometimes associated with oral medications. Hair growth will resume if a woman stops using these medications.
Permanent Hair Removal Treatments
Electrolysis and laser treatments are interventions that do not involve medication. Electrolysis destroys each hair follicle with a small electrical discharge. Because it is time-consuming and sometimes painful, it can only be used to treat a small area at a time. Risks include scarring of the skin, local electric shock, and infection if the technician is unskilled. Laser therapy is faster than electrolysis, but the hair usually returns in 3-6 months. Risks include scarring around the treated area.
Researchers are also looking into combining treatment options for patients diagnosed with hirsutism. A study published in the
Journal of American Academy of Dermatology
found that elfornithine 13.9% cream in addition to laser treatments further reduces unwanted facial hair for up to six months.
Living with PCOS
. Addicus Books; 2000.
Updated Treatment section on 11/1/2007 according to the following study, as cited by
DynaMed's Systematic Literature Surveillance
: Hamzavi I, Tan E, Shapiro J, Lui H. A randomized bilateral vehicle-controlled study of eflornithine cream combined with laser treatment versus laser treatment alone for facial hirsutism in women.
J Am Acad Dermatol.
2007;57:54-59. Epub 2007 Jan 30.
Please be aware that this information is provided to supplement the care
provided by your physician. It is neither intended nor implied to be a
substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER
IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the
advice of your physician or other qualified health provider prior to
starting any new treatment or with any questions you may have regarding a