Excessive Hair Growth
Evaluation and treatment of unwanted excessive hair growth, including hormonal assessment when indicated
What is excessive hair growth?
Hair follicles in certain areas of the body respond to androgens, the hormones present in both sexes and in higher amounts in men. When the androgen signal rises, or when the follicle becomes more sensitive to a normal signal, the fine pale hair in those areas is replaced by thicker, darker, longer hair.
In women the commonest reason for this is polycystic ovary syndrome, where the ovaries produce more androgen than usual, often alongside irregular cycles and difficulty with weight. In a sizeable group the blood levels are entirely normal and the follicles are simply more responsive, which runs in families and in some communities is a normal variation.
Less commonly it comes from the adrenal glands, the thyroid, raised prolactin, or a medicine you are taking. Growth that appears over a few months and comes with a deepening voice or increasing muscle bulk is a different situation and needs assessing promptly.
What you might notice
- Thick hair on the face or body
- Irregular or painful periods
- Acne and weight changes
How it is diagnosed
Your doctor begins by examining where the hair is and how thick it is, scoring the areas that respond to androgens, and looking for what sits alongside it: weight and waist measurement, blood pressure, acne, thinning at the scalp, and the velvety darkening of the skin at the neck and armpits that points to insulin resistance.
They will ask when it started and how quickly, about your cycles from the beginning, about pregnancies and fertility, about family members with the same pattern, and about every medicine and supplement you take.
Blood tests measuring androgens, thyroid function, prolactin and blood sugar are drawn early in the cycle where possible, and an ultrasound of the ovaries is often arranged. Rapid onset leads to a wider search.
Recovery
Hair that is already thick and dark does not thin back on its own when the cause is treated. Medical treatment works on the follicles that have yet to convert, so it prevents progression and gradually reduces what is there, and six months is the earliest it can be judged with twelve months for the full effect.
Removal methods deal with the hair you already have. They are given as a course of sessions spaced four to six weeks apart, because only hairs in their growing phase respond, and most people need six to eight sessions with maintenance afterwards. Each session leaves the skin pink for a few hours and needs no time off work.
Where weight is part of the picture, losing five to ten per cent of body weight often restores cycles and lowers androgens over three to six months, and it improves the response to everything else.
If it is left untreated
Hair growth in itself does no physical harm, and many women decide to manage it cosmetically and leave it there.
What matters is what it is a sign of. Polycystic ovary syndrome untreated carries a substantially raised risk of type 2 diabetes, high blood pressure and abnormal cholesterol over the following decades, and Indian women develop these earlier and at a lower body weight than the figures from Western studies suggest. Long stretches without a cycle also leave the lining of the uterus unopposed, which over years raises the risk of abnormal cells there, so cycles that come less than four times a year need medical attention on their own account.
The other cost is untreated distress, which is consistently underestimated. And growth that has come on rapidly, particularly with voice change, needs assessment without delay.
Questions about excessive hair growth
Does this mean I have PCOS?
It is the commonest explanation in women of reproductive age, and it is not the only one. Your doctor will look at your cycles, your weight and waist, blood sugar, blood pressure and skin, and arrange blood tests and often an ultrasound of the ovaries before saying so. A sizeable group of women have entirely normal hormone levels and simply have follicles that respond more strongly, which runs in families. Thyroid problems, raised prolactin, the adrenal glands and certain medicines account for most of the rest. The diagnosis matters because the treatment differs.
Will treatment remove the hair I already have?
Not on its own. Medical treatment works on follicles that have yet to convert to thick dark hair, so it stops the spread and slowly softens what is there, and six to twelve months is a fair timescale for judging it. The hair already present is dealt with by removal methods, given as a course of sessions four to six weeks apart, since only hairs in their growing phase respond at any sitting. Most people need six to eight sessions and periodic maintenance. Doing both together gives a better result than either alone.
Can losing weight help?
Where weight is part of the picture it helps considerably. Losing five to ten per cent of body weight lowers insulin, which lowers androgen levels, and for many women it restores regular cycles within three to six months and improves the response to every other treatment. It also reduces the long-term risk of diabetes and high blood pressure that comes with the condition. Women who are not overweight get less from this route, and for them treatment is directed at the hormones and the follicles themselves. Your doctor will tell you which group you are in.
Other dermatology & cosmetology treatments
Treatment of acne and acne-related marks based on skin type, severity and recurrence
Day CareEvaluation and treatment of uneven skin tone, dark spots and other pigmentation concerns
Day CareTalk to a care coordinator about excessive hair growth
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one