Hirsutism

Medically Reviewed by Stephanie S. Gardner, MD on September 03, 2022
Written by Lisa Fields, Julie Marks
6 min read

Hirsutism is a condition in women and people assigned female at birth (AFAB) in which you have a lot of hair growing in places where it usually does just for men.

It can also affect men and people assigned male at birth (AMAB), but the condition is often harder  to identify. In men, hirsutism may look like typical hair growth. 

The hair is often dark and coarse instead of the light, fine “peach fuzz” that covers most of the body.

About 5%-10% of women in the U.S. have hirsutism.

Hypertrichosis 

Hypertrichosis also causes excess hair growth, but it’s a different condition than hirsutism. With hypertrichosis, excess hair grows anywhere on your body. On the other hand, people with hirsutism have a lot of hair growth on specific areas that depend on male hormones, such as the face, chest, back, and stomach. 

With hirsutism, extra hair will grow on your:

  • Face
  • Chest
  • Lower stomach
  • Inner thighs
  • Back

Virilization

Virilization is a process in which women or people AFAB develop male traits. It can happen when people with hirsutism have high hormone levels. Signs of virilization include:

  • A deep voice
  • Balding
  • Acne
  • More muscle mass
  • Smaller breasts
  • An enlarged clitoris

Hirsutism is caused by high levels of male hormones (called androgens). It's normal for women's bodies to make androgens, and low levels don't cause excess hair growth. But when these amounts are too high, they can cause hirsutism and other things, like acne, a deep voice, and small breasts. 

Sometimes, a person’s androgen levels may be normal, but their hair follicles are overly sensitive to male hormones. This is called follicle sensitivity, and it can also lead to hirsutism.  

Some possible reasons for high levels of androgens include:

  • Polycystic ovary syndrome (PCOS), which causes small cysts, or fluid-filled sacs, to form on your ovaries.
  • Cushing's syndrome, which you get when you have high levels of the stress hormone cortisol for long periods of time.
  • Tumors in your adrenal glands (which make hormones like cortisol) or your ovaries.
  • Medication. Some drugs can change the hormone levels in your system, so you grow unwanted hair on your face or body. This can happen with:
  • High insulin levels. Insulin can trigger the ovaries to produce androgens.
  • Congenital adrenal hyperplasia is an inherited condition that can cause your adrenal glands to make too much androgen. 
  • Menopause. Hormone changes can happen after menopause.  

Some women and people AFAB have idiopathic hirsutism, which means there’s no known cause. 

Does hirsutism mean you have PCOS?

PCOS is the most common cause of hirsutism. But hirsutism, by itself, doesn’t mean you have PCOS. Extra hair growth is simply a symptom of PCOS that affects up to 70% of women and people AFAB with the condition.

Other signs of PCOS are:

  • Irregular menstrual cycles
  • Weight gain
  • Thinning hair
  • Acne
  • Darkening of skin or skin tags

Women and people AFAB are most likely to develop hirsutism. A few other things can make hirsutism more likely, including:

  • Family history. Some conditions that run in families and affect your hormones can cause hirsutism.
  • Ancestry. People of Mediterranean, Hispanic, South Asian, or Middle Eastern descent are more likely to have extra body hair. 
  • Obesity. Being overweight causes your body to make more male hormones, which can make hirsutism worse.

Your doctor will look at your hair growth and check for any other signs of hirsutism, like acne. They might rule out other conditions with tests including:

  • Blood tests to check your hormone levels
  • Ultrasound to look at your ovaries and uterus
  • X-ray or CT scan to examine your adrenal glands
  • MRI of the brain

Once a diagnosis is made, your doctor might use something called the Ferriman-Gallwey scale. This tool helps them determine how severe your condition is by looking at hair growth in nine areas of your body. To calculate the Ferriman-Gallwey score, health providers use a scale that ranges from 0 to 4 for each body location. A lower score means your hirsutism is mild, while a higher core indicates a more severe condition. 

If you have more facial or body hair than you want, there are a number of ways you can remove it:

  • Weight loss. If you’re overweight and drop pounds, your body may make fewer male hormones.
  • Shaving. You can remove unwanted hair easily with a razor or electric shaver. You may need to shave daily to avoid stubble growth. Some people get razor burn from shaving too often, but a soothing cream may help.
  • Tweezing or threading. There are different ways to pluck hair out at the root. You can use tweezers. Or you can hire someone to “thread” – use a long, tight strand to loop around and remove each unwanted hair. These methods can cause pain and redness.
  • Waxing. A quick way to remove lots of unwanted hair by the root is with melted wax. Often, you get this done in a salon. Wax is applied to the skin and then removed quickly. It can cause pain and redness.
  • Creams. Some creams have strong chemicals called depilatories. You apply the cream and let it sit for a while, and when you wipe it off, the hair goes with it. They can irritate sensitive skin, so test a small spot before you use one on a large area.
  • Electrolysis. You can remove hair for good with electrolysis, a service that zaps hair at the root with an electric current. After you repeat the process several times, hair should stop growing in treated areas.
  • Laser hair removal. The heat from lasers removes hair at the root, but you need to repeat the process several times, and it sometimes grows back. 
  • Medication. Doctors can prescribe drugs that change the way your body grows hair. But when you stop using it, hair will grow back.
  • Birth control pills make the body produce fewer male hormones. With regular use, you should have less hair on your face or body.
  • Anti-androgens help your body make and use fewer male hormones.
  • Eflornithine (Vaniqa) is a face cream that slows hair growth where you apply it.
  • Bleaching products can lighten the hair on your body.
  • Low-dose steroids may be prescribed if your adrenal glands are overactive. 
  • Gonadotropin-releasing hormone (GnRH) agonists lower the amount of androgen that’s produced in the ovaries. They are injected and can be expensive. 
  • Insulin-lowering drugs, such as metformin (Glucophage) or pioglitazone (Actos), can also lower levels androgens in the blood. But because they can cause side effects, they usually aren’t used as a first-line treatment option.

Hirsutism can cause emotional distress. People with the condition can have a poor self-image due to the unwanted hair. You may even have symptoms of depression or anxiety.   

You may be able to lessen your chances of getting hirsutism, depending on the cause. If you have PCOS, here are some ways to lower your risk:

  • Eat a healthy, low-calorie diet
  • Lose weight
  • Exercise regularly 

Talk to your doctor if you take medicines that can cause hirsutism. You may be able to adjust some of these drugs. 

Hirsutism causes excessive hair growth, mainly in women and people AFAB. Though the symptoms of this condition can feel embarrassing, there are treatments available if you want to lessen the amount of facial and body hair. Talk to your doctor if you think you might have hirsutism.

What is the cause of hirsutism?

Hirsutism is caused by too many male hormones (called androgens) in your body. Or, a hair follicle sensitivity to male hormones is another possible culprit. Various conditions can cause your body to make too many androgens. And sometimes, doctors don’t know why this happens.

How do you get rid of hirsutism?

There are treatments to help slow down your hair growth and lessen unwanted hair. But no therapies will make the hair completely go away.

Can you ever get rid of hirsutism?

If you have hirsutism, you will need continuing treatment if you want to address your symptoms. Most people find an effective therapy that they can use as a long-term fix.