Hirsutism

Hirsutism is a condition of unwanted, male-pattern hair growth in women. Hirsutism results in excessive amounts of dark, coarse hair on body areas where men typically grow hair — face, chest and back.

The amount of body hair you have is largely determined by your genetic makeup. There's a wide range of normal hair distribution, thickness and color due to differences in heredity. However, hirsutism is a medical condition that can arise from excess male hormones called androgens, primarily testosterone. It can also be due to a family trait.

A combination of self-care and medical therapies provides treatment for many women with hirsutism.

Symptoms

Hirsutism is stiff and dark body hair, appearing on the body where women don't commonly have hair — primarily the face, chest and back. What's considered excessive can vary depending on ethnicity and culture.

When excessively high androgen levels cause hirsutism, other signs might develop over time, a process called virilization. Signs of virilization might include:

Deepening voice
Balding
Acne
Decreased breast size
Increased muscle mass
Enlargement of the clitoris

Common Causes of Hirsutism

Polycystic Ovary Syndrome (PCOS) — the most common cause of hirsutism, characterized by hormonal imbalance and ovarian cysts
Congenital Adrenal Hyperplasia — a genetic condition affecting adrenal hormone production
Cushing's Syndrome — excess cortisol production leading to hormonal imbalances
Adrenal or Ovarian Tumors — rare but serious causes of excess androgen production
Medications — certain drugs like anabolic steroids or danazol can cause hirsutism
Idiopathic Hirsutism — when no identifiable cause is found, but there may be increased sensitivity to normal androgen levels

When Should You Seek Evaluation?

Consider consulting a specialist if you experience:

Sudden or rapid onset of excessive hair growth
Hair growth accompanied by other signs of virilization (deepening voice, balding, acne, decreased breast size)
Irregular menstrual periods
Difficulty managing weight or sudden weight gain
Hirsutism that significantly affects your quality of life or self-esteem

Diagnosis & Treatment

A thorough evaluation includes a detailed medical history, physical examination, and specialized tests. Diagnosis typically involves hormonal blood tests to measure levels of testosterone, DHEA-S, and other androgens. Imaging studies like ultrasound may be performed to evaluate the ovaries and adrenal glands.

Treatment options depend on the underlying cause and may include:

Lifestyle modifications — weight loss and exercise can help reduce androgen levels in women with PCOS
Hormonal contraceptives — birth control pills can help regulate hormones and reduce hair growth
Anti-androgen medications — such as spironolactone to block androgen effects
Topical treatments — creams that slow hair growth
Hair removal methods — laser hair removal, electrolysis, or other cosmetic approaches

As an endocrinologist, my focus is on identifying and treating the hormonal root causes of hirsutism, working closely with patients to develop personalized treatment plans that address both the medical condition and its impact on quality of life.