Part of Excess facial hair in women guide
Excessive Facial Hair in Women (Hirsutism): Causes and Options
Thick, dark hair on a woman's face, chest or tummy is called hirsutism. PCOS is the most common cause. Here is how it is assessed and the treatment options.
The short answer
Hirsutism means thick, dark hair growing in a male pattern in women, such as the upper lip, chin, chest, tummy or back. It is usually linked to androgen hormones, and the most common cause is polycystic ovary syndrome (PCOS). Treatment combines finding and managing the cause, hair removal methods such as laser, and, where needed, prescription medicines that slow hair growth over six to twelve months.
On this page 7 sections
Excessive facial or body hair in women, called hirsutism, means thick, dark hair growing in a male pattern on areas such as the upper lip, chin, chest, tummy, lower back or thighs, and it is usually linked to androgen hormones. The most common cause is polycystic ovary syndrome (PCOS), so the first step is a medical check of your periods, skin and hormones, followed by a combination of hair removal and, where needed, prescription treatment that slows hair growth over months.
Unwanted facial hair is one of the most common, and most hidden, concerns among Indian women. Many spend years threading, waxing and bleaching without anyone checking why the hair is there. This guide explains what is normal, what is not, and what can help.
What counts as hirsutism?
The NHS describes hirsutism as thick, dark hair on a woman’s face, neck, chest, tummy, lower back, buttocks or thighs. DermNet explains that it is a male pattern of hair growth, often starting in the moustache and beard areas.
What is not hirsutism:
- Fine, light, soft hair on the face or body. The NHS notes most women get more of this type of hair with age, especially after menopause.
- Hair that runs in the family. DermNet notes that what counts as hirsute varies with culture and ethnic background, and that a hairier pattern is often genetic, with male and female relatives also having more hair than average.
Doctors sometimes use the Ferriman Gallwey score, which rates hair growth in nine body areas, to judge how severe hirsutism is.
What causes hirsutism?
The NHS explains that hirsutism is usually linked to androgens, sometimes called “male” hormones. It can happen when these hormone levels rise, or when hair follicles become more sensitive to them.
Polycystic ovary syndrome (PCOS)
PCOS is the most common cause. The World Health Organization (WHO) estimates that PCOS affects 10 to 13 percent of women of reproductive age, and that up to 70 percent of affected women do not know they have it. The NHS now uses the name polyendocrine metabolic ovarian syndrome (PMOS) for the same condition, but PCOS remains the familiar term in India.
Other features of PCOS can include:
- Irregular or infrequent periods
- Acne and oily skin
- Thinning hair on the scalp
- Weight gain or difficulty losing weight
- Difficulty getting pregnant
- Dark, velvety patches on the neck or underarms (acanthosis nigricans)
Importantly, the WHO notes that you do not need cysts on your ovaries to have PCOS. Our complete guide to PCOS skin and hair symptoms and our article on hormonal acne and PCOS explain more.
Other causes
- No obvious cause. The NHS notes that sometimes no cause is found.
- Medicines, including some epilepsy medicines and steroids, including anabolic steroids.
- Other hormone conditions, such as Cushing syndrome, congenital adrenal hyperplasia and acromegaly.
- Rarely, a tumour of the ovary or adrenal gland that produces hormones.
- Pregnancy, which DermNet notes can cause mild hirsutism.
When is excess hair growth urgent?
The NHS advises asking for an urgent doctor’s appointment if you are a woman and:
- New thick, dark hair suddenly starts growing on your face and body
- Your voice is getting deeper
- Your muscles are getting bigger
DermNet lists other signs of very high androgen levels, called virilisation, such as balding at the temples, a decrease in breast size and enlargement of the clitoris. Rapid onset of these signs needs prompt assessment because it can rarely signal a hormone producing tumour.
How is hirsutism assessed?
A dermatologist, gynaecologist or endocrinologist will usually:
- Ask about your history: when the hair started, your periods, acne, weight changes, medicines, and family history.
- Examine you: the pattern of hair, and clues such as acanthosis nigricans, which suggests insulin resistance, or stretch marks and easy bruising, which can suggest Cushing syndrome.
- Arrange tests if needed. DermNet lists blood tests for testosterone and other androgens, and, depending on symptoms, prolactin, LH and FSH, thyroid function, glucose and lipids. An ultrasound of the ovaries may be done.
Not everyone with mild hirsutism and regular periods needs extensive testing. Your doctor will decide based on your symptoms.
What are the treatment options?
Treatment usually has three parts: managing the cause, removing existing hair, and slowing new growth.
Lifestyle
The NHS notes that losing weight, if you are overweight, can help control hormone levels. DermNet adds that reducing insulin resistance through weight loss and diet may help.
Hair removal methods
| Method | How long results last | Points to know |
|---|---|---|
| Shaving | A day or two | Does not make hair thicker |
| Threading or plucking | A few weeks | Can cause folliculitis and dark marks |
| Waxing | About six weeks | Can irritate or cause folliculitis |
| Bleaching | Until hair grows out | Makes hair less visible, can irritate |
| Hair removal creams | A few days | Can irritate and cause dermatitis |
| Laser hair reduction | Long lasting, not usually permanent | Multiple sessions, works best on dark hair |
| Electrolysis | Can be permanent | Slow, hair by hair, risk of scarring if unskilled |
DermNet notes that folliculitis, inflamed and sometimes painful hair follicles, is a risk of plucking, shaving and waxing. On brown skin this often leaves dark marks. Our guide to ingrown hairs and razor bumps covers how to reduce this.
Laser hair reduction is the most popular longer lasting option. DermNet explains that dark hair on brown skin can be treated by experienced centres, with multiple sessions over months. The NHS cautions that results are not the same for everyone and that it is not usually permanent. Our laser hair reduction guide explains what to expect on Indian skin.
Prescription treatments
Your doctor may consider, depending on your age, symptoms, pregnancy plans and medical history:
- A prescription cream that slows facial hair growth (eflornithine), where available
- Combined oral contraceptive pills, which the WHO and NHS note can help regulate periods and reduce excess hair and acne
- Anti-androgen medicines, such as spironolactone, which block the effect of androgens on hair follicles
- Metformin, sometimes used in women with PCOS who have insulin resistance or are overweight
DermNet notes that hormonal treatments take six to twelve months to make a noticeable difference and often need to be continued for several years. Many of these medicines are not safe in pregnancy, so they must be prescribed and monitored by a doctor. Please do not start hormone pills or anti-androgens on your own or on a friend’s advice.
How does hirsutism affect wellbeing?
The WHO notes that unwanted hair growth, like other PCOS symptoms, is subject to social stigma and can affect mental health, relationships and confidence. DermNet also notes the considerable time and expense women spend removing hair. If facial hair is making you anxious or low, that is a valid reason to seek treatment, not vanity.
When to see a dermatologist
See a dermatologist if:
- You have thick, dark hair on your face, chest, tummy or back
- Hair growth comes with irregular periods, acne, scalp hair thinning or dark patches on the neck
- Threading or waxing is leaving you with bumps, ingrown hairs or dark marks
- You are considering laser and want to know if it suits your skin and hair
- The hair is affecting your confidence or daily life
Seek an urgent appointment if hair growth is sudden, or your voice is deepening or muscles are getting bigger. For routine concerns, Dr. Maria offers online consultations to talk through possible causes, tests and a treatment plan that fits your needs.
Questions people ask
Is facial hair in women always a sign of PCOS?
No. Fine, light facial hair is normal, and the amount of hair varies with family and ethnic background. Thick, dark hair in a male pattern, especially with irregular periods or acne, is more likely to be linked to PCOS, which is the most common cause of hirsutism.
Does shaving or threading make facial hair grow back thicker?
Shaving does not make hair grow more thickly. Plucking, shaving and waxing can sometimes cause inflamed hair follicles (folliculitis), which may take weeks to settle.
What tests are done for hirsutism?
Your doctor will look at your hair pattern and other signs, and may arrange blood tests for hormone levels, thyroid function, blood sugar and lipids, and sometimes an ultrasound of the ovaries.
How long do medicines for hirsutism take to work?
Hormonal treatments usually take six to twelve months to make a noticeable difference, and often need to be continued for years. Hair removal is usually still needed alongside them.
When is excess hair growth urgent?
Ask for an urgent doctor's appointment if thick, dark hair starts growing suddenly, your voice is getting deeper or your muscles are getting bigger, as these can rarely signal a hormone producing tumour.
Sources
This article is for general education and does not replace a consultation with a qualified dermatologist. Do not start, stop or change any medicine based on this page. Read the full medical disclaimer.
