Excess hair (hirsutism) in women often appears in the places where men have body hair, such as the upper lip and chin, the chest (including around the nipples), the tops of the shoulders and the lower abdomen. The excess hair is usually coarse and dark (different from the fine hair that some women have on their upper lip, chin, breasts and stomach). The hairs also grow longer than normal so, for example, hairs on the upper lip may grow to 1 cm long instead of remaining short, fine and fair.
Reasons for Excess Hair
Extra-responsiveness to hormones. Women often worry that hairiness means that they have male hormones and are not fully female. In fact, all women have a small amount of the ‘male’ hormone, testosterone, circulating in their bodies. It is produced mainly by the adrenal glands, which are situated over the kidneys. If the skin is extra-responsive to it, testosterone encourages hair growth on the upper lip, chin, chest, lower abdomen. The hormone levels are normal; the problem is that the skin is too responsive to testosterone. Women with this problem gradually develop more body hair from puberty until the menopause, after which the amount of body hair slowly lessens – except for facial hair, which continues to increase.
There are many reasons for this extra-responsiveness to normal amounts of testosterone.
- Often, it is inherited; your mother or aunts may have had the same problem.
- Some drugs can be responsible, particularly phenobarbitone and phenytoin taken to control epilepsy. Long-term steroids (taken for conditions such as arthritis or inflammatory bowel disease) and ciclosporin (taken for psoriasis, dermatitis or arthritis) can also cause extra hair growth.
Polycystic ovary syndrome is the cause of hairiness in some women. This syndrome is usually caused by an imbalance between the pituitary and adrenal glands with cysts on the ovary. As a result, the level of male hormone rises. It usually develops in the late teens or early 20s and there are usually other symptoms as well as excess hair. Polycystic ovary syndrome sometimes runs in families. It is diagnosed by blood tests and, usually, an ultrasound scan of the ovaries. It can be treated with medication. Women with polycystic ovary syndrome are often obese, and the hirsutism (hairiness) improves if they lose weight.
Symptoms of polycystic ovary syndrome
- Excess hair
- Scanty or irregular periods, or periods stop altogether (but periods may be normal)
- Acne and greasy hair
- Difficulty in getting pregnant
- Obesity (usually)
Tumour. Very occasionally, a tumour of the ovaries or an adrenal gland can be responsible for the excess male hormones, but this is very rare.
What You Can Do
Do nothing. Women often feel a social pressure to be hairless on the body but there is growing acceptance and choice to how women wish to manage body hair.
Lose weight if you are overweight. This may greatly improve the problem.
Bleaching is a good way of disguising upper lip hairs or ‘sideburns’ unless your skin is dark. Hydrogen peroxide cream for bleaching is available from pharmacists, but it can cause severe skin irritation.
Depilatories (hair-removing creams) do not leave stubble but can irritate the skin. Test beforehand by applying a small amount to the inside of your wrist. If there is no reaction the next day, it is probably safe to use the cream. Weaker creams for use on the face are available.
Plucking, waxing, sugaring or threading will deal with the problem temporarily. These all work by pulling out the hairs. If you pull out a hair, a new hair immediately starts to grow in that follicle. (If you shave a hair, it may be in its resting phase and will not grow for some time.) So plucking, waxing and sugaring may have to be repeated quite frequently.
Plucking can be used to remove a few long hairs on the chin, but in general it is not a good idea for the face because it can easily cause scarring. Never pluck hairs on the nipple or the surrounding pink area (areola), or on a mole. In waxing, strips of hot wax are placed over the hairy area and pulled off, taking the hairs with them. This is painful, and difficult to use on the face. Sugaring is similar, but uses a special sugar paste obtainable from pharmacies. A private prescription of eflornithine is also an option.
Shaving will need to be done every day. In spite of the old wives’ tale, it does not make the hairs grow back more quickly (British Medical Journal 2007;335:1289). However, shaved hairs will be stubbly, so they may be noticeable if shaving is not repeated daily and can also cause ingrown hair, particularly in ethnic skin or in people with a curly hair type.
Laser treatment is quicker and less painful than electrolysis. It works best on dark hair with pale skin, because the dark pigment helps to transmit the laser energy down the hair shaft to the bottom of the hair follicle, where it damages the lining of the follicle so the hair cannot grow properly. The results can be very good, but there are also a few problems.
- In general, it is not very suitable for black skin, because the pigment (melanin) in the skin will pick up the laser energy, causing scarring and loss of pigment. People with Mediterranean or pale Asian skin tones might be able to risk the treatment. However, new long-wavelength lasers that can be used on dark skin are now available.
- In general, red, grey or blonde hair, and hair that is very fine is unlikely to respond well. However, some new types of laser are able to treat pale hair.
- It is slightly uncomfortable – like having rubber bands flicked over the skin. Your skin may tingle for several hours afterwards.
- It takes time. Although an area 9 cm in diameter takes only 1 or 2 minutes to treat with the newest fast lasers, most people will need two or three treatments at intervals of a few months. This is because laser treatment works best on hair that is in the growing phase – at any time, only a proportion of hairs are in this phase. Also, at the first visit, the therapist should treat just a small area and wait at least 8 weeks before starting the full treatment.
- Complete and permanent removal of the hair is unlikely. The hair usually disappears for 2–3 months, and then slowly regrows (but the new hair is less dense and less coarse). Six months after the treatment, you would probably have about half the amount of hair you had originally.
- It is still a fairly new treatment, so no one knows if there are any bad effects in the long term.
- Almost anyone can get hold of the equipment and set themselves up as a therapist. It may be difficult to be sure that a therapist is properly trained. Find out who will actually be doing the procedure, and their qualifications. They should be a doctor (plastic surgeon or dermatologist). In the UK, check that the doctor is a member of the British Association of Plastic Surgeons or the British Dermatology Association.
- It is expensive. Before embarking on it, ask the price of a complete treatment, and how large an area will be treated in each session.
Electrolysis is probably the best method of getting rid of the unwanted hair long term (possibly permanently). Electrolysis is a slow process, because each hair is dealt with separately and it may take months or years of treatment before all the unwanted hairs disappear.
A fine needle is inserted into the hair root, which is then destroyed by a chemical reaction and by heat.
- Electrolysis treatment can be uncomfortable. It is important that you use a qualified practitioner, registered with the Institute of Electrolysis.
- Treatments are given 2 weeks apart (to allow the skin to recover), and the whole process may take 6–9 months.
- Check that the practitioner uses new, disposable (not simply re-sterilized) needles.
- If it is too expensive for you, contact your local college of further education – they may have training courses for beauticians where you could be treated by trainees who will be supervised and have good equipment.
- Home kits for electrolysis are not a good idea; the current used is too low to destroy the hair root, so the effect is similar to plucking.
- Electrolysis is unsuitable for anyone with a heart pacemaker.
Try spearmint tea. A research study has suggested that drinking 2 cups of spearmint tea daily can reduce levels of testosterone in women and might reduce hairiness (British Medical Journal 2007;334:482). This research involved only a small number of women, so its results need to be confirmed.
How Your Doctor Can Help
See your doctor if any of the following apply:
- you have any of the symptoms of polycystic ovary syndrome, such as periods becoming irregular or stopping altogether
- you are taking any medications that might be responsible (check the information leaflet in the packet)
- excess hair starts to appear suddenly in adult life
- no one else in your family has excess hair
- if, at the same time, you are losing hair from your scalp, especially at the sides of your forehead
- you are having to spend a lot of money on electrolysis
- you are depressed and worried by your appearance.
Polycystic ovary syndrome. If this is a possibility, your doctor will refer you to an endocrinologist (hormone specialist). The endocrinologist will check for other problems, such as diabetes, that can sometimes accompany polycystic ovary syndrome. The medication used to treat polycystic ovary syndrome is effective, especially if you also lose weight; greasy skin and acne clear up in about 6 weeks, but it can take 12–18 months for maximum improvement in the hirsutism (hairiness).
No hormone abnormality. If there is no hormone abnormality, and the hirsutism (hairiness) happens simply because your skin is especially responsive to testosterone, your doctor may prescribe the combined oral contraceptive pill containing the progestogens desogestrel, gestodene or norgestimate. Both the oestrogen and progestogen in the combined pill have an effect, so the progesterone-only pill would not be as effective in reducing hair. About 1 in 10 women will see an improvement, but it may take 12–18 months.
If this does not help, your doctor may decide to try a combination of ethinyloestradiol and cyproterone acetate or drospirenone which stop testosterone having an effect on the skin. It will take about 3 months before there is any improvement, and 12 months to achieve the full effect. After this, the drug is stopped. Hair may regrow about 6 months later, in which case another course of the drug can be given.
If none of these treatments work, your doctor can refer you to a hospital dermatologist or endocrinologist who could suggest other medication (spironolactone is also commonly used).
Laser treatment and electrolysis. In the UK, some hospital dermatology departments provide laser or electrolysis treatment under the NHS, but this is usually available only for individuals with a great deal of excess hair, or who are particularly distressed by it.
Eflornithine is a cream that slows hair growth. Applied twice a day, it reduces hair growth in about 60% of people who use it (American Journal of Clinical Dermatology 2001;2a:197–201). It contains a chemical called eflornithine, which blocks a key enzyme in the hair follicle. Because it does not destroy existing hairs, it may take several weeks (or even months) before you see any result. It is probably best used after hair has been removed by another method (such as laser), to slow down the return of unwanted hair (American Family Physician 2002;66:1907–1911). Eflornithine is not a permanent method of hair removal; when you stop using it, the hair will regrow, usually within about 8 weeks. The cream can cause a burning or stinging sensation and acne. It is not suitable if you are pregnant or breastfeeding. Clinically it is usually only used for small areas such as the chin or moles.
First published on: embarrassingproblems.com
Reviewed and edited by: Dr Ahmed Kazmi
Last updated: October 2020