Understanding hirsutism and how to treat it

Many women take pride in their hair whether it’s styled, natural or covered. But even something so normal can feel deeply abnormal when it starts appearing in unwanted places like the face, chin, chest, arms or shin.

When hair grows where it “shouldn’t,” it goes beyond surface appearance and often signals a hormonal imbalance. This is hirsutism

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What is Hirsutism?

Hirsutism is the medical term for excessive, male-pattern hair growth in women. It shows up in places where women usually grow minimal or no terminal hair; face, upper lip, chin, chest, arms, abdomen, back, buttocks, or thighs.

In women, most body hair is soft, fine, and lightly pigmented (called vellus hair).² But when certain hormone levels shift, androgens (male hormones like testosterone), those fine hairs can transform into coarse, dark, terminal hairs in places typically associated with masculinity. 

Hirsutism is not the same as hypertrichosis, which is the generalized excessive hair growth that can occur anywhere on the body, regardless of pattern, gender, or hormonal status. Hypertrichosis can be congenital (from birth) or acquired (due to medications, malnutrition, or metabolic conditions) and is not limited to androgen-sensitive areas. 

Who Can Have Hirsutism?

Hirsutism is quite common, affecting around 5 to 10% of women  of reproductive age globally.¹ It occurs frequently among women of Mediterranean, South Asian, and Middle Eastern backgrounds, due to naturally higher levels of androgens in these populations.

Hirsutism is often under-recognized or misdiagnosed in black women due to natural variations in hair patterns across ethnicities, delayed diagnoses of underlying causes like PCOS, or the tendency to dismiss symptoms as purely cosmetic instead of medical.

Hirsutism runs in families. If your mother, sister, or aunt has it, there’s a good chance you’d have it as well. 

Classifications Of Hirsutism

Clinicians often classify hirsutism based on severity and cause.

The severity of hirsutism is often assessed using the Ferriman-Gallwey Scoring System,⁷ which scores hair growth in 9 areas from 0 (no hair) to 4 (frankly virile).

• Mild: Light hair growth in a few areas (e.g., chin, upper lip).
• Moderate: Noticeable hair in multiple areas, like the lower abdomen and chest.
• Severe: Dense, male-pattern hair across the face, chest, and thighs.

Hirsutism isn’t always severe but its milder forms can impact confidence and have longer-term effects on one's health if left unchecked. 

What Causes Hirsutism? 

Hirsutism is usually driven by androgens, a class of “male” hormones like testosterone that everyone has, just in different amounts. Too much of these hormones, or increased sensitivity to them at the hair follicle level, facilitates your hair growth in all the wrong places.

Why does this happen? Let’s walk through the common causes.

 Polycystic Ovarian Syndrome (PCOS)

Studies show that 70% to 80% of women with hirsutism have PCOS at the root of it. PCOS is a complex hormonal disorder where the ovaries produce excess androgens, often due to insulin resistance.

Congenital Adrenal Hyperplasia (CAH) 

CAH is a rare genetic disorder that affects how your adrenal glands make hormones. In some forms, the body overproduces androgens from early life, resulting in severe hirsutism that may begin during childhood or adolescence.

Though uncommon, this condition can be mistaken for PCOS (unless tested specifically for elevated 17-hydroxyprogesterone levels).

Androgen-Secreting Tumors

In rare cases, a tumor in the ovaries or adrenal glands can churn out large amounts of testosterone or other androgens. These cases often present with sudden, dramatic changes including, rapid hair growth, deepening of the voice, male-pattern baldness, or even clitoral enlargement. Hirsutism appearing quickly and aggressively can be a potential medical emergency.

Medications

Several medications have excess hair growth as a side effect. Some of these include

• Minoxidil (used for scalp hair growth, ironically)
  
• Phenytoin (anti-seizure drug)
  
• Cyclosporine (an immunosuppressant)
  
• Danazol (used to treat endometriosis)
  
• Anabolic steroids or testosterone therapy

Excessive Cortisol

This is known as Cushing's Syndrome, a hormonal condition where your body is exposed to high cortisol levels, either from internal overproduction or prolonged corticosteroid use. It is associated with central weight gain, round face, easy bruising, acne, menstrual irregularities, and hirsutism.

Insulin Resistance

Insulin, the blood sugar hormone, can stimulate androgen production in the ovaries, especially in women with insulin resistance, obesity, or type 2 diabetes. These women may not have full-blown PCOS, but the elevated insulin levels still lead to hirsutism.

Idiopathic Hirsutism: When All Tests Look “Normal”

In some women, everything checks out—no PCOS, no tumors, normal hormone levels, but the hair growth is still persistent. This is known as idiopathic hirsutism. The cause? Most likely increased sensitivity of hair follicles to even low-normal levels of androgens.

How to Treat Hirsutism

1. Treat the root cause

Understanding what's causing your hirsutism is the first step toward the right treatment and desired results. If the hair growth is being driven by a hormonal imbalance, as is often the case, removing the hair will only offer temporary relief. 

So, before plucking the hairs out, or trying any cream or pill, it’s important for your doctor to figure out why the hair is growing in this way and the best way to treat it.

2. Medical Treatments 

If a hormonal disorder like PCOS is behind the hirsutism, medication can help control both the hormone imbalance and the hair growth.

• Oral contraceptive pills (OCPs): Birth control pills are often the first line of treatment for women who are not trying to conceive. They regulate menstrual cycles and reduce the production of androgens (male hormones), which helps reduce hair growth over time. Studies show that combination pills containing ethinyl estradiol and cyproterone acetate or drospirenone are especially effective.

• Anti-androgen medications: These drugs block the effects of male hormones at the hair follicle level. They are, however, not safe in pregnancy, so you'll also need reliable contraception while taking them.

• Spironolactone is the most commonly used and helps slow the growth of new hair. It usually takes 6 to 12 months to see visible results.
• Flutamide and Finasteride are alternatives but may have more side effects and are less commonly used.

• Insulin sensitizers: For women with insulin resistance, drugs like metformin can be helpful. They don’t directly reduce hair but improve insulin sensitivity, which in turn can help regulate hormone levels.

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3. Creams and lotions 

Prescription creams like Vaniqa (eflornithine) can slow down how fast hair grows. It's most effective when used along with other treatments like laser or OCPs.

4. Hair Removal Methods  

While medications work behind the scenes, you may consider removing visible hair. Here are your best options:

• Shaving and waxing: These are the most accessible options. They’re affordable and effective for short-term results, but frequent regrowth and skin irritation can be drawbacks.
• Depilatory creams: These creams, e.g Veet® Hair Removal Cream, work by breaking down the structure of the hair, making it easy to wipe off. They're pain-free, quick, and affordable, but not a permanent solution.

• Laser hair removal: This is one of the best long-term fixes for unwanted hair. It uses heat to destroy hair from the root and works best for people with light skin and dark hair (but newer lasers work for all skin tones). It requires multiple sessions, but hair grows back finer, slower, or not at all.

• Electrolysis: This method uses tiny electric currents to destroy individual hairs permanently. It’s great for small areas like the chin or upper lip, but it takes time and can be a bit uncomfortable.

5. Lifestyle Changes

When it comes to treating hirsutism, especially in women with PCOS, lifestyle modification is often the first and most important step before any medical intervention.

• Lose a little weight—a 5-10%  body weight loss can help regulate hormones and possibly lessen hair growth.
• A balanced diet with high fiber, lean proteins, healthy fats and less carbs can reduce insulin resistance and help lower excess androgens that fuel hirsutism.‍
• Regular exercise, especially a mix of cardio and strength training improves hormone levels, restores ovulation, and reduces symptoms linked to PCOS.

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