Hirsutism and PCOS

What Is Hirsutism?

What Causes It?

Removing Unwanted Hair - Depilation &Epilation

Removing Unwanted Hair - Electrolysis

Removing Unwanted Hair - Laser Treatment

Removing Unwanted Hair with Drugs

Reducing Hair Growth with Natural Methods

What Is Hirsutism?

Hirsutism affects 5-10% of all women and a much higher percentage of women with PCOS. Women of European ancestry have higher rates than women of African descent. Asian women have the lowest rate.

You may have hirsutism (excessive hair growth) if you have coarse, mature facial hair, hair on the chest, back or arms, or excessive pubic hair.

Because physical appearance has so much to do with how people relate to each other, hirsutism can be a painful experience. Women may be chronically stressed by the amount of time and money they spend removing unwanted hair, to say nothing of the frustration of having it continually grow back.

What Causes Hirsutism?

Interacting factors - hormonal, genetic, and lifestyle - combine to determine how much hair you have, and where it grows.

Hirsutism is thought to be mostly due to excessive levels of androgenic hormones. Examples of androgens are testosterone, androstenedione, and DHEA. Testosterone is the main androgen we're concerned about. It's normal for men to have a lot of testosterone and for women to have some. When women have too much testosterone, hirsutism may result. When men have excessive testosterone, prostate problems can occur.

But even if your androgens are normal, you may develop hirsutism because your body is overly sensitive to hormones. And some women who have normal androgens and don't have PCOS will develop excessive hair. This is called "idiopathic" hirsutism, meaning the cause is unknown.

Your genes are a contributing factor to hirsutism. Your inherited genetic predisposition may incline your metabolism towards creating conditions favoring the growth of unwanted hair.

However, what you eat, whether you exercise, how well you sleep, how you manage stress, and the pollutants you are exposed to directly influence what your genes do. So your hirsutism is partially under your control.

Here are some specific things you can do about unwanted hair.

There are basically two ways to handle hirsutism. You can physically remove or destroy the unwanted hair, or you can reduce the androgen and related hormone imbalances that are causing the hair to grow.

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Removing Unwanted Hair - Depilation & Epilation

Temporary hair removal can be achieved through depilation or epilation. Continued use of these methods works well for many women.

Depilation is the removal of the part of the hair above the skin's surface. It can produce results lasting several hours to several days. Two main depilation methods are shaving and creams. Shaving is inexpensive, virtually painless, and provides good results in the privacy of your own home.

There are creams and lotions that chemically dissolve your hair away. The effect is similar to shaving, but using them can leave a rather bad smell that lasts for days afterward and may cause rashes if you have sensitive skin.

Epilation is the removal of the entire hair from the follicle. Tweezing can work well for small areas. Waxing or sugaring works by applying a sticky paste and then peeling it off the skin, along with the hairs embedded in it. Friction, using a mitt with a rough surface, is used mainly for fine leg hair. Threading involves rolling a twisted thread across the hairs to catch and pull them out. Rotary epilators are similar to electric razors, except they have tweezers that pull your hairs out.

Hair removal can be painful. There is also a tendency for rashy bumps and possible infection after treatment. If you're doing epilation at home, you may not be able to reach all the areas that need treatment. Epilation works better on hair that grows straight and lies flat. Curly hair or hair that grows in different directions is more painful to pull out and often requires repeated applications over the same area to get a hairless result.

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Removing Unwanted Hair - Electrolysis

More permanent hair removal may be achieved with methods that destroy the hair follicle. The success of these methods depends a great deal on the skill of the practitioner, and your skin and hair type. Despite some advertising claims, none of these methods are 100% painless, and none can guarantee 100% permanent results for all women.

All involve risk of infection or some kind of damage to the skin surrounding the hair follicle. Your best chance of a happy result will be with a method that has been around for a while, in the hands of an experienced practitioner. Regulation varies by state, so check to see if the practitioner is licensed or registered. If there is regulation, there will be a mechanism for you to verify the practitioner's credentials through a state agency. Contact your state consumer protection division for information. At the very least, get a referral to a competent practitioner from someone who has been a satisfied client.

Electrolysis is one of the oldest hair removal methods and has a reliable track record for hirsutism. In the hands of a well-trained and experienced technician, it is safe and effective. A thin metal probe is slid into a hair follicle and electricity flows along the probe to damage the follicle so that the hair does not re-grow. Electrolysis can be expensive, painful, tedious and difficult for large amounts of hair. If done improperly, it can result in infection, scarring, and possible re-growth of hair. Small battery-powered probe units are advertised as easy to use, but performing electrolysis on yourself is difficult and not recommended.

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Removing Unwanted Hair - Laser Treatment

Laser hair removal is newer than electrolysis. Lasers use a special light wave that is absorbed by dark hairs and damages the hair follicle. Laser therapies have not been in use long enough for hirsutism to fully determine how permanent the hair destruction is.

Laser treatment should not be used by dark-skinned women and is less effective with blond, red or white hair. Light-skinned women with dark hair get the best results. Laser treatment is useful for large areas of hair. Most types of laser hair removal are considered safe if performed properly. However, recent studies suggest other skin structures can be adversely affected by laser irradiation and no one yet knows what the long-term consequences are. Hair re-growth will occur in some women.

Click here for information on Intense Light Pulsed therapy

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Reducing Hair Growth with Drugs

If you have seen a medical doctor about hirsutism, you're probably taking birth control pills, possibly in combination with one or more other drugs. Drugs to retard hirsutism fall into three broad categories:(1)

• Androgen receptor blockers: Cyproterone, flutamide (Eulexin), and spironolactone (Aldactone).
• Androgen-suppressing agents: GnRH agonists (Lupron), estroprogestins (birth control pills), corticosteroids, and insulin-sensitizing agents (metformin/Glucophage).
• 5 alpha-reductase inhibitors: Finasteride (Proscar), eflornithine hydrochloride (Vaniqa).

All of these drugs work to some extent. They have helped some women see measurable reductions in androgen levels and unwanted hair growth. Most have side effects. All are recommended in conjunction with birth control pills, partly to control the side effects of these medications.

These synthetic drugs are designed to either suppress testosterone production or inhibit its effect so that new hair growth is reduced Existing hair is not affected; it falls out on its own, like all hair eventually does.

You can expect to take these medications for at least six months before seeing significant results. It's advisable to defer electrolysis or laser therapy until the drug treatment has had at least six months to suppress new growth. Then, your doctor may recommend electrolysis or laser treatment to remove existing hair.

Impaired liver function is a potentially serious side effect as you metabolize and eliminate these synthetic drugs. This same problem relative to birth control pills was discussed in the July 2002 newsletter on this site. Research also suggests that most of these drugs work best when used along with some other drug, so choosing medicine for hirsutism usually involves multiple medicines. The health consequences of using these drugs for more than about two years has not been studied.

For some women, the reduction of unwanted hair (hirsutism) is well worth the expense and potential health risks of these drugs. Others are concerned about side effects and long term consequences of using drug treatments. Some feel strongly about avoiding drugs of all kinds. So, other than drugs, depilation or expilation, is there anything else you can do about hirsutism?

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Find out about

Natural Treatments for Hirsutism

Find out about

Hair Loss and PCOS

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