ConditionHormones & metabolism
Hirsutism
Hirsutism is excess coarse, dark hair in a male pattern in women, on the upper lip, chin, chest, lower belly, back or inner thighs. It affects about 5 to 10% of women of reproductive age and is caused by androgens (male-type hormones) or by hair follicles that are extra sensitive to them. Polycystic ovary syndrome is the cause in most women. Birth control pills, anti-androgen medicines and hair removal methods such as laser or electrolysis work well together.
Also called: Excess hair growth in women, male-pattern hair growth, androgen excess, unwanted hair
At a glance
- What it is
- Male-pattern terminal hair in women, driven by androgens.
- Most common cause
- PCOS. Next is idiopathic hirsutism, with normal hormone levels and periods.
- How it is measured
- The modified Ferriman-Gallwey score, which grades hair in 9 body areas.
- Tests
- Testosterone and, depending on the picture, 17-hydroxyprogesterone, prolactin, thyroid and other tests.
- Treatment
- Hair removal plus birth control pills, often with an anti-androgen such as spironolactone. Results take at least 6 months.
When to get help
See a doctor within a day or two
- Hair growth that appears quickly over a few months, especially after age 25 to 30
- Deepening voice, enlarged clitoris, male-pattern balding, more muscle bulk or shrinking breasts (virilization), which can signal a hormone-producing tumor
- New hirsutism after menopause
Book a routine appointment
- Male-pattern hair with irregular or absent periods, acne or trouble getting pregnant
- Hirsutism with weight gain in the belly, purple stretch marks, easy bruising and a round face (possible Cushing syndrome)
- Hair growth that troubles you, even if mild
Usually safe to manage at home
- A few dark hairs on the chin or upper lip, stable for years, with regular periods
- Fine, light hair over the body that has always been there
If you mainly want to know why you have unwanted hair and how to tell it from normal hair, see unwanted hair. This page explains how hirsutism is assessed and treated medically.
What causes hirsutism
Hair follicles in androgen-sensitive areas switch from fine, pale vellus hair to thick, dark terminal hair when exposed to androgens such as testosterone. Hirsutism happens when androgen levels are high, or when skin converts more testosterone to its stronger form, dihydrotestosterone (DHT), even with normal blood levels.
| Cause | How common | Clues |
|---|---|---|
| Polycystic ovary syndrome (PCOS) | Most cases, roughly 7 in 10 | Irregular periods, acne, weight gain, insulin resistance, starting around puberty |
| Idiopathic hirsutism | Common | Regular ovulation and normal androgen levels; often family or ethnic pattern |
| Nonclassic congenital adrenal hyperplasia | Uncommon | Inherited enzyme defect; more common in Ashkenazi Jewish and some Mediterranean populations |
| Androgen-secreting tumors of the ovary or adrenal gland | Rare | Rapid onset, virilization, very high testosterone |
| Cushing syndrome | Rare | Central weight gain, stretch marks, muscle weakness, high blood pressure |
| Hyperprolactinemia, thyroid disease | Uncommon | Milky nipple discharge, period changes |
| Medicines | Variable | Testosterone (including a partner's gel by skin contact), anabolic steroids, danazol |
Insulin resistance and obesity raise androgen levels by stimulating the ovaries and lowering the protein that binds testosterone in the blood, which is why weight loss can help.
Hirsutism vs hypertrichosis
Hypertrichosis is increased hair anywhere on the body, including non-androgen areas, and is not caused by androgens. It is often fine hair and can follow medicines such as minoxidil, cyclosporine or phenytoin, or occur with eating disorders and some genetic conditions. Treatment is different, so the distinction matters.
Symptoms
- Coarse, dark hair on the upper lip, chin, sideburns, neck, chest, around the nipples, lower belly, back, buttocks or inner thighs
- Often acne, oily skin or thinning hair at the crown (androgenetic alopecia)
- Irregular or missed periods in PCOS
- In severe androgen excess, virilization signs
Hirsutism also has a real emotional cost. Many women spend a lot of time on hair removal and feel self-conscious, which is a valid reason to seek treatment.
How hirsutism is diagnosed
The Ferriman-Gallwey score
Doctors score hair in 9 areas (upper lip, chin, chest, upper and lower abdomen, upper and lower back, upper arms and thighs) from 0 (none) to 4 (male-level growth). A total of 8 or more usually defines hirsutism in women of European or African descent. Lower cutoffs are used for East Asian women, who typically have less body hair. The score is ideally checked before recent shaving or waxing.
Tests
The Endocrine Society advises testing testosterone in women with more than mild hirsutism or with sudden onset, rapid progression or other worrying features. Other tests depend on the story:
- Total and free testosterone, ideally an early-morning sample
- 17-hydroxyprogesterone for nonclassic congenital adrenal hyperplasia
- Prolactin and thyroid tests if periods are irregular
- DHEA-S and imaging of the ovaries and adrenal glands if a tumor is suspected
- Pregnancy test, glucose or A1c and lipid tests in women with PCOS features
- Overnight dexamethasone test or other cortisol tests if Cushing syndrome is suspected
Treatment
Treatment works on two fronts: slowing new hair growth with medicine, and removing hair that is already there. Because hair grows in cycles, medicines take at least 6 months to show their full effect.
Medicines
- Combined oral contraceptives: first-line for most premenopausal women. They lower ovarian androgen production and raise the binding protein that inactivates testosterone. They also regulate periods in PCOS.
- Anti-androgens: spironolactone is the most used, and finasteride is an alternative. They are usually added if the pill alone is not enough after 6 months. They can cause birth defects in a male fetus, so reliable contraception is essential.
- Eflornithine cream: a prescription cream that slows facial hair growth. It works best combined with laser.
- Treating the cause: surgery for tumors, steroids for some cases of congenital adrenal hyperplasia, and treatment of Cushing syndrome or high prolactin.
- Weight loss: losing 5 to 10% of body weight in women with obesity and PCOS can lower androgen levels and improve hair growth.
Hair removal
| Method | Lasts | Notes |
|---|---|---|
| Shaving | Days | Does not make hair thicker or darker |
| Waxing, threading, epilating | Weeks | Can irritate skin and cause ingrown hairs |
| Creams (depilatories) | Days | Test a small area first |
| Laser hair removal | Long-term reduction | Works best on dark hair; lasers suited to darker skin reduce burn risk; needs several sessions |
| Electrolysis | Permanent | Treats each hair individually; works on all hair colors |
Medicine plus laser or electrolysis gives better results than either alone, because medicine stops new follicles from being stimulated.
Outlook
Hirsutism is usually long-term, especially with PCOS, and hair growth returns if medicines are stopped. With combined treatment, most women see clear improvement within a year. Underlying conditions such as PCOS also need attention for their links to diabetes, heart risk and fertility.
Frequently asked questions
What is the main cause of hirsutism?
Polycystic ovary syndrome causes most cases. It raises ovarian androgen production and often comes with irregular periods, acne and insulin resistance. Idiopathic hirsutism, where hormones and periods are normal but follicles are more sensitive to androgens, is the next most common cause.
Can hirsutism be cured?
When it is caused by a tumor or a medicine, removing the cause can resolve it. Hirsutism from PCOS or idiopathic hirsutism is usually controlled rather than cured: medicines slow hair growth and laser or electrolysis removes existing hair, but regrowth occurs if treatment stops.
Does shaving make hirsutism worse?
No. Shaving cuts hair at the surface and does not change the follicle, so it does not make hair grow faster, thicker or darker. The blunt tip of regrowing hair can feel coarser. Shaving is a safe and quick option, alone or alongside medical treatment.
What is a normal Ferriman-Gallwey score?
A modified Ferriman-Gallwey score below 8 is generally considered normal for women of European and African descent. Cutoffs are lower for East Asian women, around 4 to 6. The score is a guide only: mild hair growth that bothers you can still be treated.
Is hirsutism a sign of cancer?
Rarely. Androgen-secreting tumors of the ovary or adrenal gland are uncommon. Warning signs are hair growth that develops quickly over months, deepening voice, clitoral enlargement, balding or onset after menopause. These need prompt testosterone testing and imaging.
Sources
This guide was written from current patient and clinical guidance, including:
- Endocrine Society: Evaluation and Treatment of Hirsutism in Premenopausal Women, Clinical Practice Guideline
- American College of Obstetricians and Gynecologists (ACOG): Polycystic ovary syndrome
- American Academy of Family Physicians (AAFP): Hirsutism, Diagnosis and Treatment
- MedlinePlus: Hirsutism
- NHS: Hirsutism