The Bottom Line

Hirsutism — the growth of coarse, dark hair in areas where women typically have fine or no hair (face, chest, back) — affects 5-10% of women. The most common cause is polycystic ovary syndrome (PCOS), which increases androgen hormones. Treatment combines medical therapy (spironolactone, oral contraceptives) with hair removal methods (laser, electrolysis). Evaluation by a doctor is important to identify the underlying cause.

What Is Hirsutism?

Hirsutism is the growth of terminal (thick, dark) hair in androgen-dependent areas of a woman's body — areas where men typically grow hair but women normally don't. These include the upper lip, chin, jawline, chest, abdomen (linea alba), lower back, and inner thighs.

It's important to distinguish hirsutism from hypertrichosis, which is excessive hair growth anywhere on the body (not limited to androgen-dependent areas) and has different causes.

Severity is measured using the modified Ferriman-Gallwey score, which grades hair growth in 9 body areas on a scale of 0-4. A score of 8 or higher is generally considered hirsutism.

Common Causes

  • PCOS (most common, 70-80% of cases): Polycystic ovary syndrome causes elevated androgens. Associated symptoms include irregular periods, acne, weight gain, and ovarian cysts.
  • Idiopathic hirsutism (5-15%): Normal androgen levels but increased skin sensitivity to androgens, or increased peripheral conversion of testosterone to DHT. Often familial.
  • Congenital adrenal hyperplasia: Genetic condition causing excess adrenal androgens. Late-onset form can present in adulthood.
  • Medications: Anabolic steroids, danazol, minoxidil, cyclosporine, and some progestins.
  • Cushing syndrome: Excess cortisol production, which increases adrenal androgens.
  • Androgen-secreting tumors: Rare but important to rule out when hirsutism develops rapidly or severely.

Diagnosis

Your doctor will likely order:

  • Total and free testosterone levels
  • DHEA-S (adrenal androgen marker)
  • 17-hydroxyprogesterone (screens for congenital adrenal hyperplasia)
  • Thyroid function tests
  • Prolactin level
  • Pelvic ultrasound if PCOS is suspected

Treatment Options

Medical therapy (reduces new hair growth — takes 6-12 months):

  • Combined oral contraceptives: Reduce ovarian androgen production. Pills containing anti-androgenic progestins (drospirenone, cyproterone acetate) are preferred.
  • Spironolactone (50-200mg daily): Anti-androgen that blocks testosterone receptors. The most commonly prescribed anti-androgen for hirsutism in the US. Must use contraception (can feminize a male fetus).
  • Eflornithine cream (Vaniqa): Applied to the face twice daily. Slows facial hair growth in about 60% of women. Results stop when you stop using it.
  • Finasteride (off-label): Blocks conversion of testosterone to DHT. Used when spironolactone isn't tolerated.

Hair removal methods (removes existing hair):

  • Laser hair removal: Most effective long-term option. Works best on dark hair/lighter skin. 6-8 sessions reduce hair by 60-80%. Nd:YAG laser is safe for darker skin tones.
  • Electrolysis: Permanent destruction of individual follicles. Works on all hair colors/skin types but is time-consuming and expensive for large areas.
  • Shaving, waxing, threading: Temporary solutions. Shaving does NOT make hair grow back thicker (this is a myth).

Frequently Asked Questions

Will the hair go away if I treat the underlying cause?

Medical treatment prevents new terminal hairs from developing and may slow existing growth, but it usually doesn't reverse established terminal hair. This is why combining medical therapy (to stop new growth) with physical removal (laser/electrolysis for existing hair) gives the best results.

Is hirsutism dangerous?

Hirsutism itself is not dangerous, but the underlying cause may need treatment. PCOS, for example, increases risks of diabetes, heart disease, and endometrial cancer if untreated. Rapid-onset severe hirsutism needs urgent evaluation to rule out androgen-secreting tumors.

How long before treatment works?

Medical therapy takes 6-12 months for noticeable reduction because hair growth cycles are slow. Laser hair removal shows results after 3-4 sessions (spaced 4-6 weeks apart). Patience and consistency are essential.

  1. Martin KA, et al. "Evaluation and treatment of hirsutism in premenopausal women: an Endocrine Society clinical practice guideline." Journal of Clinical Endocrinology & Metabolism. 2018;103(4):1233-1257.
  2. Azziz R, et al. "Polycystic ovary syndrome." Nature Reviews Disease Primers. 2016;2:16057.
  3. Blume-Peytavi U, Hahn S. "Medical treatment of hirsutism." Dermatologic Therapy. 2008;21(5):329-339.