Hairiness in women

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
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 sensitive 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 sensitive 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 sensitivity to testosterone. Often, it simply runs in the family and 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 is usually caused by an imbalance of the pituitary and adrenal glands with cysts on the ovary. As a result, the level of male hormone rises. 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 by drugs. Women with polycystic ovary syndrome are often obese, and the hirsutism (hairiness) improves if they lose weight.

Tumour. Very occasionally, a tumour of the ovaries or adrenal gland can be responsible for the excess male hormones, but this is very rare.

What can be done

What you can do

Lose weight if you are overweight. This may greatly improve the problem.

Bleaching is a good way of disguising upper lip hairs, which are usually not very long.

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 or sugaring will deal with the problem temporarily. These are different methods of 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 is not a good idea for the face because it can easily cause scarring. 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.

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, but they will be stubbly, so they may be noticeable if shaving is not repeated daily.

Laser treatment is quicker and less painful than electrolysis. It works best on dark hair, because the dark pigment helps to transmit the laser energy down the hair shaft. The results can be very good, but there are also a few problems.

Electrolysis is probably the best method of getting rid of the unwanted hair long term (possibly permanently). However, 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 needle diathermy or galvinism. In needle diathermy, high-frequency radio waves destroy the hair root in a few seconds, and the hair is then plucked out. A new hair should not form. With galvanism, a low-voltage electrical current is applied to the needle for about 2 minutes. This causes the release of sodium hydroxide around the hair root, destroying it by chemical action.

Treatment can be uncomfortable. It is important that you use a qualified practitioner, registered with the Institute of Electrolysis . 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.

How your doctor can help

See your doctor if any of the following apply:

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 disease. The drug treatment for 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 sensitive 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 cyproterone acetate and ethinyloestradiol (Dianette), which stops 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 might use more powerful drug treatments.

Laser treatment and electrolysis . 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.