Hairiness in a male pattern
Hirsutism is a condition that affects women. It is the presence of excessive hair growth in a male pattern, i.e. on the face, chest and back.
Different body regions respond differently to the presence of male and female sex hormones (testosterone and oestrogen). It is normal for women to have a small amount of testosterone in their system, but there are some medical conditions, such as ovary-syndrome/'>polycystic ovary syndrome, which cause an imbalance in the levels of testosterone and, as a consequence, male pattern hair growth can occur.
A change in the normal distribution and texture of hair growth should raise suspicion of hirsutism. The areas affected include the chest, arms, back and face (which can be especially distressing). The hair is often coarser and darker than normal. It is often accompanied by greasy skin, acne and oily hair and potentially, male pattern baldness.
Hirsutism is common, but the extent of it can vary significantly. There are racial differences in hair growth. The point at which hair growth becomes defined as hirsutism may vary depending upon the racial type or cultural attitudes.
Genetic factors play a part in how sensitive an individual’s skin is to the sex hormones. Polycystic ovary syndrome accounts for 95% of cases and it is known that in half of these patients, there is a family history.
Hirsutism is diagnosed on the basis of the nature and change of the pattern of hair growth. It also normally involves a physical examination. The search for an underlying cause involves hormonal blood tests, which can be performed as an outpatient.
Hirsutism can be treated with cosmetic treatments such as hair-removing (depilatory) creams, shaving, waxing and laser hair removal. Input from a beautician can provide invaluable support and advice. Eflornithine is a medicated cream that reduces hair growth, so can be used to treat mild to moderate hirsutism. However, its use is currently approved for the facial region only.
Moderate or severe hirsutism during polycystic ovarian syndrome can be treated with medications to reduce the body’s production of testosterone. These medications may involve the contraceptive pill, or testosterone-blocking drugs such as spironolactone and cyproterone. It can take several months to respond to treatment for hirsutism.
Some cosmetic treatments may require repeated courses to remain effective. Hair removal can potentially cause skin irritation and scarring.
If hirsutism is a symptom of polycystic ovary syndrome, there is a huge array of oral contraceptive pill medications available, and different types will suit different patients. Furthermore, the contraceptive pill or cyproterone can increase the risk of thrombosis (blood clots) so may not be suitable in some patients. A discussion with your specialist will be needed to agree the best course of treatment.
The cosmetic consequences can often cause psychological problems such as anxiety and depression.
Last reviewed: Apr 2015