Excessive hair growth and what it can say about your health

Hirsutism is a medical condition that occurs in women which is characterised by thick, dark hair across the body.

Whilst it’s common for some women to naturally have this condition of hair, hirsutism usually affects specific parts of the body where women don’t typically have thick hair, areas known as ‘male-pattern’ or ‘androgen-dependent’ sites.

Symptoms of hirsutism include excessive hair growth on the:

• face (particularly the upper lip)
• neck
• chest
• stomach
• lower back
• buttocks
• inner thighs
• toes
• pubic hair

Hair growth is typically evaluated using the Ferriman-Gallwey visual scale, which evaluates whether a woman's hair growth is natural or caused by hirsutism.

A similar condition can cause excessive hair growth, which is known as hypertrichosis. The key distinction, however, is that hirsutism only affects women in areas of male-pattern hair growth. Hypertrichosis can affect the whole body in both men and women.

There are several different types of hirsutism that all have different underlying biological causes, of which there are two main types.

The most common type is known as hyperandrogenic hirsutism. This is due to your body overproducing male hormones (androgens) which are responsible for most of the body’s hair growth. They play an important role in puberty, as they turn the thin, fuzzy hairs (vellus hair follicles) into the thicker, longer hairs (terminal hair follicles) that we grow across our face and body.

The next most common type of hirsutism is non-hyperandrogenic hirsutism. These are causes that are not related to androgen production in the body including other conditions, medications and other hormonal imbalances.

However, in about 10% of severe cases and 50% of mild cases, there is no clear cause. This is a phenomenon known as idiopathic hirsutism and researchers are still debating what causes these cases.

We’re going to be discussing some of the most common causes of hirsutism in women and their symptoms.

Polycystic ovary syndrome (PCOS) is by far the most common cause of hirsutism in women. Research estimates that up to 78% of hirsute women have PCOS. PCOS is a condition characterised by small, benign ovarian cysts that can cause infertility and irregular or absent menstrual periods.

It is caused by an imbalance of hormones. In particular, women with PCOS have high levels of androgens and lower levels of oestrogen (female hormone) which is what causes excess hair growth on the face, chest, back and stomach. This is also what causes acne in women with PCOS.

Symptoms normally occur after puberty and, as well as hirsutism, include:

• oily skin or acne
• weight gain
• absent or irregular periods
• thinning hair or hair loss
• ovulation difficulties and difficulties getting pregnant

However, everyone’s experience with PCOS is different and not everyone will get these symptoms. Although experts aren’t sure what causes PCOS, it has been linked to genetics, lifestyle and insulin resistance.

A specific type of hirsutism is linked to postmenopausal women. This is because during the menopause, your adrenal glands and ovaries stop producing female hormones such as estrogen but continue to produce testosterone and other androgens. This results in increased facial hair growth, particularly on the upper lip and the chin. However, unlike other causes of hirsutism, the hair growth will appear fine and light in colour.

Another interesting phenomenon relating to hair growth occurs during pregnancy. It is not caused by an increase in male hormones, however. Your body goes through many hormonal fluctuations whilst you are pregnant, but there is a particular increase in oestrogen and prolactin (breast milk production). This results in thicker, darker hair all across the body but particularly on the stomach.

One cause of non-hyperandrogenic hirsutism is the medications you take. This could be hormonal medications but it could also be certain other medications, including:

• corticosteroids - used to treat inflammation and swelling in autoimmune conditions (e.g rheumatoid arthritis, asthma and allergies)
• anabolic steroids - used to build muscle mass (often misused)
• minoxidil- used to treat hair loss
• cyclosporine - suppresses the immune system
• danazol - used to treat endometriosis
• diazoxide - for chronic low blood sugar
• phenytoin - for epilepsy
• penicillamine - for severe liver problems and severe rheumatoid arthritis

Just because you take one of these medications doesn’t mean you will develop hirsutism. However, it’s important to know the side effects of your medicines. If you’re not sure, check the patient information leaflet or consult a healthcare professional.

If you have a high BMI (a BMI of 25 or higher), you may be more at risk of developing hirsutism. Research has found that adipose tissue, otherwise known as body fat, is partly responsible for the production and circulation of male hormones around the body. Therefore, excess body fat could mean excess androgen production which can ultimately result in excess body hair.

Being overweight can also result in insulin resistance (metabolic syndrome). Insulin resistance happens when your blood sugar levels are too high that your body needs more insulin to convert it into energy. However, because of the high levels of insulin, your body becomes resistant to it. To counteract this, your body then produces even more insulin to combat the resistance as well as rising blood sugar levels, eventually resulting in prediabetes then type 2 diabetes.

Insulin resistance isn’t just a problem in obesity though. It also affects up to 75% of women who have PCOS but are not overweight. Researchers have linked insulin resistance to increased testosterone secretion from the ovaries, which could contribute to hirsutism in many women.

There are other conditions that affect hormone levels which have also been linked to hirsutism. However, prevalence of hirsutism in the following conditions is low:

• cushing’s syndrome - high levels of cortisol (stress hormone)
• hyperthyroidism - overactive thyroid gland
• hypothyroidism - underactive thyroid gland
• hyperprolactinemia - high prolactin levels in non-pregnant women
• acromegaly (gigantism) - a condition where your pituitary gland produces too much growth hormone during adulthood, often caused by a benign tumour

In rare cases of hyperandrogenic hirsutism, women may have an adrenal tumor on the ovaries that is over-producing androgens such as testosterone. So as well as hirsutism, women may experience acne, deepening of the voice and ambiguous genitalia. Whilst it can be serious, these tumours occur in 2 in every million people so if you have hirsutism, it is unlikely to be caused by a tumor. Regardless, you should still speak to your doctor if you experience any sudden excessive hair growth.

There are also a group of genetic conditions that affect the adrenal glands which can lead to hirsutism (as well as hypertrichosis in both genders). This is known as adrenal hyperplasia, where your adrenal glands lack the enzymes to make key hormones including androgens. This results in very early pubic hair growth as well as facial hair and body hair. These genetic conditions are also incredibly rare and are likely to be diagnosed when you’re younger.

Treatment options for hirsutism depend on how severe your condition is. Some women may only require hair removal techniques, whilst others may need prescription medication.

Hair removal methods

There are many different options for hair removal that you can do yourself such as plucking, waxing, bleaching, hair removal creams (chemical depilatories) and shaving. You can buy the tools for these methods at most pharmacies and cosmetic shops to do yourself, but some spas and beauty salons will offer this.

Alternatively, you can also seek specialist hair removal services such as laser hair removal and electrolysis hair removal. These are typically longer-lasting compared to methods you can do yourself.

Prescription medications

Before you’re prescribed anything, your doctor may want to do a blood test to check your hormone levels. This will help determine a potential cause for your hirsutism.

For instance for those with PCOS, you may need to take birth control such as the combined contraceptive pill or other hormonal medication like Dianette to adjust your hormone levels. For women with menopause, you may be recommedned to start HRT (hormone replacement therapy) to control your menopause symptoms as the best HRT can reduce facial hair growth. Your doctor may give you some advice on how to lose weight if applicable, as this may help your insulin levels as well as improve your health overall.

Some interesting research has even found that finasteride, typically used for male pattern baldness, can help with hirsutism in women with PCOS when taken with other medications. However, it’s not licensed for this purpose and you should always seek advice from your doctor.

There is also a specific prescription cream available for women who have hirsutism on their face. It is known as eflornithine cream, typically sold under the brand name Vaniqa, and it is applied to the particular areas of excessive hair growth on the face. You can purchase Vaniqa here from euroClinix! All you have to do is fill out a quick consultation form and then you’ll receive your prescription with free next-day delivery.