What is Hirsutism? Causes and Treatment of Excessive Hair Growth in Women

Hirsutism is a condition characterised by male-pattern hair growth in women, resulting from the overproduction of male hormones called androgens or the hair follicles becoming overly sensitive to these hormones. It usually manifests as the growth of thick, coarse, and dark hair in areas such as the face, chin, chest, abdomen, and back. This condition does not merely create an aesthetic concern; it is also considered a warning sign of an underlying hormonal or metabolic imbalance.

• In brief:
• It is a problem of male-pattern, coarse, and dark hair growth in women.
• The most common cause is Polycystic Ovary Syndrome (PCOS).
• Hormone tests performed on the 3rd day of menstruation are of great importance for diagnosis.
• Treatment involves a combination of medical drugs, laser hair removal, and weight management.
• Cosmetic procedures alone do not provide lasting results without resolving the underlying cause.

What is Hirsutism?

The clearest answer to the question of what hirsutism is, is the transformation of fine, weak, and colourless peach fuzz (vellus hair) normally found on a woman's body into thick, coarse, and dark terminal hairs due to hormonal influences. It is completely normal for women to have a certain amount of androgens (male hormones). However, when the ovaries or adrenal glands produce more of these hormones than necessary, hair follicles are stimulated, and male-pattern hair growth begins.

Particularly common in Mediterranean and Middle Eastern populations due to genetic predisposition, this condition can appear at any age starting from puberty. Affecting approximately 10 percent of women in society, this clinical picture can lead to a serious loss of self-confidence, social isolation, and emotional stress. Hirsutism is not just a skin or cosmetic problem; it is a medical condition involving the endocrine (hormonal) system. Therefore, the underlying main source must be found, and the treatment process should be planned accordingly.

Causes of Excessive Hair Growth in Women

When examining the causes of hirsutism, hormonal imbalances play the leading role in the vast majority of cases. The secretion of androgen hormones above normal levels or the hair follicles overreacting even to normal hormone levels leads to this condition.

Polycystic Ovary Syndrome (PCOS)

Accounting for approximately 75 percent of all hirsutism cases, Polycystic Ovary Syndrome is the first disease that comes to mind when mentioning hair growth problems in women. Starting in adolescence, this syndrome is characterised by the accumulation of small cysts in the ovaries, menstrual irregularities, weight gain, and insulin resistance. In addition to the hair growth problem, polycystic ovaries also pave the way for other androgenic symptoms such as acne and hair loss.

Other Diseases and Medications

Other medical conditions and factors that cause excessive hair growth include:

• Cushing's Syndrome: Develops as a result of the adrenal glands producing excessive cortisol.
• Congenital Adrenal Hyperplasia: An inherited disorder that affects the production of steroid hormones by the adrenal glands.
• Thyroid Diseases: Hormonal balance can be disrupted in cases of hypothyroidism or hyperthyroidism.
• Hyperprolactinaemia: The excessive secretion of prolactin, the milk hormone.
• Tumours: Rare androgen-secreting tumours that develop in the ovaries or adrenal glands.
• Medication Use: Testosterone-containing drugs, certain immunosuppressants, and specific steroid derivatives can trigger hair growth.

Idiopathic Hirsutism

In some women, the menstrual cycle is completely regular, the ovaries appear normal, and androgen hormone levels in the blood are within normal limits. Yet, male-pattern hair growth is still observed. This is called idiopathic (of unknown cause) hirsutism. It is usually related to genetic predisposition, and other women in the family often have similar complaints. It is thought to stem from the hair follicles being overly sensitive to normal levels of androgens.

Symptoms of Hirsutism

The symptoms of hirsutism vary depending on the severity of the hair growth and the underlying cause. The most fundamental symptom is the growth of thick and dark hair in androgen-sensitive areas such as above the lip (moustache area), chin, neck, between the breasts, nipples, the abdominal line, back, and inner thighs.

If the hair growth is accompanied by a very severe increase in androgen levels, more advanced symptoms called virilisation (masculinisation) may emerge. In this case, deepening of the voice, male-pattern hair loss (receding hairline at the temples), an increase in muscle mass, enlargement of the clitoris, and a decrease in breast size may be seen. Additionally, due to insulin resistance, darkening and thickening of the skin in the neck, armpits, and groin areas (acanthosis nigricans) are among other notable findings.

How is it Diagnosed?

The diagnosis of hirsutism begins with the physician taking a detailed medical history and performing a physical examination. Questions are asked about when the hair growth started, how fast it progressed, menstrual regularity, and whether there are similar cases in the family. The physician uses a special scoring system that evaluates nine different areas of the body to determine the severity of the hair growth.

To confirm the diagnosis and find the underlying cause, certain hormone tests are usually requested on the 3rd day of menstruation, in the morning, on an empty stomach. The main tests requested for diagnosis are as follows:

• Total testosterone and free testosterone
• Dehydroepiandrosterone sulfate (DHEAS)
• Luteinising hormone (LH) and Follicle-stimulating hormone (FSH)
• 17-hydroxyprogesterone (17-OHP)
• Sex hormone-binding globulin (SHBG)
• Thyroid-stimulating hormone (TSH) and Prolactin (PRL)

In addition to blood tests, pelvic ultrasonography may be used to examine cysts in the ovaries, and computed tomography (CT) or magnetic resonance (MR) imaging methods may be utilised to evaluate the adrenal glands.

Hirsutism Treatment Methods

The treatment of excessive hair growth requires a multidisciplinary approach. Merely removing the hair on the surface does not provide a permanent solution; the underlying hormonal imbalance must also be brought under control. The treatment process requires patience because the hair cycle lasts an average of six months, and it may take this long for the applied treatments to yield visible results.

Medical Treatments

The most frequently used method to achieve hormonal balance is birth control pills. These medications, containing oestrogen and progestin, suppress androgen production from the ovaries and regulate the menstrual cycle. If birth control pills alone are not sufficient, anti-androgen drugs are added to the treatment. These drugs stop new hair formation by preventing androgens from binding to the receptors in the hair follicles. Medical treatment must be continued under a physician's supervision, and liver functions should be monitored regularly.

Cosmetic Solutions

While medical treatment prevents the growth of new hair, it does not shed existing coarse hairs. For this reason, cosmetic methods must be added to the medical treatment. Laser hair removal targets the melanin in the roots of dark hairs, destroying the hair follicles, and is highly effective over large areas. For light-coloured, red, or white hairs, electrolysis (needle epilation) is preferred. In the electrolysis method, an electric current is delivered to each hair follicle with a fine needle, permanently destroying the root.

Lifestyle Changes

Especially in cases of PCOS-induced hirsutism, losing weight is one of the most critical steps in treatment. Losing even 5 to 10 percent of body weight helps break insulin resistance and lower androgen levels. A healthy diet and regular exercise are essential for re-establishing hormonal balance. While maintaining weight control, psychological factors should not be ignored; as stress and distraction can trigger binge eating behaviour, which can complicate the treatment process.

Complications and Risk Groups

When left untreated, hirsutism does not remain merely an aesthetic problem; it leads to serious psychological and metabolic complications. The constant need for hair removal increases the risk of social isolation, anxiety, and depression in women.

Furthermore, diseases that cause hirsutism, such as PCOS, bring along the risk of metabolic syndrome. If insulin resistance is not controlled, serious health problems such as Type 2 diabetes, high blood pressure, high cholesterol, and fatty liver disease can develop. In addition, chronic menstrual irregularity can increase the risk of long-term infertility and endometrial (uterine lining) cancer. Women with a family history of PCOS, diabetes, or adrenal gland disease constitute the highest risk group.

When to See a Doctor?

If you notice a gradual increase in the amount of hair on your body, it would be beneficial to consult an endocrinology or gynaecology specialist. However, some situations require an urgent medical evaluation. You should see a doctor without delay if you experience any of the following symptoms:

• Hair growth starting suddenly and severely over a very short period, such as a few months.
• Signs of masculinisation such as deepening of the voice, hair loss, or a sudden increase in muscle mass.
• Severe menstrual irregularity or the complete cessation of menstrual bleeding.
• Severe pain in the abdomen or groin area and a palpable mass sensation.

In particular, sudden-onset severe virilisation symptoms may be a sign of an androgen-secreting tumour in the ovary or adrenal gland, which may require urgent intervention.

The Hirsutism Process at BHT CLINIC

At BHT CLINIC İstanbul Tema Hastanesi, a multidisciplinary diagnosis and treatment process is carried out for our patients presenting with complaints of hirsutism. Through the collaborative work of our Endocrinology, Gynaecology, and Dermatology departments, the underlying cause is identified, and the most appropriate treatment plan is created for you.

Especially during the evaluation of digestive system and metabolism issues such as PCOS-related metabolic syndrome, insulin resistance, and fatty liver, our Gastroenterology department is also included in the process to safeguard your comprehensive health. In our advanced technology laboratories, your hormone tests are concluded rapidly. To take a step towards a healthy life and evaluate personalised treatment options, you can book an appointment at our hospital 24/7.

Frequently Asked Questions

Can hirsutism be completely cured?

Hirsutism can be largely brought under control when the underlying hormonal cause is correctly identified and treated. While new hair growth is stopped with medical treatment, existing hair can be permanently removed with cosmetic methods. However, complaints may recur if the treatment is discontinued or weight is gained.

Is laser hair removal effective in treating hirsutism?

Yes, laser hair removal is one of the most effective cosmetic methods for destroying existing coarse and dark hairs. However, if the underlying hormonal disorder is not treated with medical drugs, it is likely that new hair will grow even after laser hair removal. Therefore, both treatments should be carried out simultaneously.

Which department should I visit for hirsutism?

It is recommended that women with hair growth complaints first consult the Endocrinology and Metabolic Diseases department. When necessary, Obstetrics and Gynaecology, as well as Dermatology specialists, are also involved in the treatment process.

Does everyone with polycystic ovary syndrome experience excessive hair growth?

No, severe hair growth may not be seen in every woman diagnosed with PCOS. The symptoms of the disease vary from person to person; while menstrual irregularity or weight gain may be prominent in some patients, hirsutism or acne may be more pronounced in others.

Does using tweezers or waxing at home increase hair growth?

Because methods like tweezing or waxing pluck the hair from the root, they can increase blood flow to the hair follicle. If there is a hormonal imbalance, this situation can cause peach fuzz to grow coarser over time. Therefore, permanent hair removal methods should be preferred under a physician's supervision.

This article is for informational purposes only; please consult your doctor for diagnosis and treatment.