FACIAL HAIR IN WOMEN

Family Medicine, Endocrinology/Diabetes.

Hirsutism, which causes excessive hair growth in those born women, is typically caused by an increase in hormones called androgens. It’s fairly common, and affects between 5 to 10 percent of women.
The main difference between more typical hair on a woman’s body and face (often referred to as “peach fuzz”) and hair caused by hirsutism is the texture. When caused by hirsutism, the hair on a woman’s face, arms, chest, stomach or back is usually coarse and dark.
Hirsutism is a common condition affecting between 5 and 10 percent of women. It tends to run in families; women of Mediterranean, South Asian and Middle Eastern heritage are also more likely to develop the condition.
The presence of excess body hair can lead to feelings of self-consciousness, but the condition itself isn’t necessarily dangerous. However, the hormonal imbalance that can lead to it may complicate a person’s health.

Hirsutism vs. Hypertrichosis
Hirsutism isn’t the same as hypertrichosis, which refers to excess hair in areas that aren’t dependent on androgens.
Hypertrichosis can increase hair anywhere on the body, while hirsutism typically causes excess hair in areas usually seen in men, such as the face and lower stomach.

CAUSES
Women can develop excessive body or facial hair due to higher-than-normal levels of androgen hormones. These hormones include testosterone and androstenedione.
All individuals produce androgens, but these levels typically remain low in individuals assigned to females at birth. However, if a woman’s skin suddenly becomes sensitive to androgens, or her body begins to produce these hormones in excess, she can develop hirsutism. There are a few conditions that can cause this hormone imbalance.
Polycystic ovarian syndrome
Polycystic ovarian syndrome (PCOS) is one common cause of hirsutism. It accounts for 85 percent of cases. PCOS causes benign cysts to form on the ovaries, which can affect hormone production. This can lead to irregular menstrual cycles and decreased fertility.
The Office of Women’s Health states that individuals living with obesity, and those who have a family history of the condition, are at a higher risk of developing PCOS.
In addition to hirsutism, other symptoms of PCOS can include:
Irregular menstrual cycle
Weight gain, or difficulty losing weight
Acne
Thinning hair
Skin tags
Fertility difficulties

Adrenal gland disorders
Other forms of hormonal imbalance that can cause hirsutism include certain adrenal gland disorders, such as:
Adrenal cancer
Adrenal tumours
Congenital adrenal hyperplasia
Cushing disease
People with congenital adrenal hyperplasia are born without an enzyme that’s necessary for hormone production. An adrenal tumour can cause the overproduction of certain hormones, such as prolactin. Individuals with Cushing disease have higher-than-normal levels of cortisol (cortisol is sometimes called the “stress hormone”). All of these conditions can affect the way the body produces androgens.

Symptoms of adrenal gland disorders can include:
High blood pressure
Bone and muscle weakness
Excess weight in the upper body
Headaches
Fatigue
Unexplained weight loss
Weight gain
High or low blood sugar levels
Irregular periods
Lowered libido
Medications
Excessive body or facial hair growth can also result from taking any of the following medications:
Minoxidil, which is used to stimulate hair growth
Anabolic steroids, which are synthetic variations of testosterone
Testosterone, which can be taken in case of a testosterone deficiency
Cyclosporine, which is an immunosuppressant drug that’s often used before organ transplants

Idiopathic hirsutism
In some cases, women may experience idiopathic hirsutism, which means that there’s no detectable cause for why the hirsutism developed. It’s usually chronic, and may be harder to treat.

DIAGNOSING HIRSUTISM
Doctors will take a detailed medical history when diagnosing hirsutism. Discuss medication use with a doctor to help that doctor determine the cause of the condition. The doctor will likely order blood tests to measure hormone levels. In some cases, the doctor may also order blood work, to make sure there is no other underlying condition, such as Diabetes, Cushing’s, or thyroid issues.
Ultrasounds or MRI scans of the ovaries and adrenal glands may be necessary to check for the presence of tumours or cysts.

TREATMENT OPTIONS
Hormone management
If a person is obese, the doctor may suggest losing weight to reduce the symptoms of hirsutism. Because obesity can change the way the body produces and processes hormones, maintaining a moderate weight may correct the level of androgens without the use of medication.
If excessive hair growth is a symptom of PCOS or adrenal disorders, additional pharmacological treatment may be needed. Drug therapy in the form of birth control pills and anti-androgen medications can help balance your hormone levels.
Anti-androgen medications: Steroidal androgens and nonsteroidal (or pure) anti-androgens can block androgen receptors and lower androgen production from the adrenal glands, ovaries, and pituitary glands. eg- Spironolactone, Flutamide, Finasteride
Combination birth control pills: These pills, which have both estrogen and progesterone, may help shrink the cysts from PCOS. The estrogen can also help reduce excess hair. These drugs are usually a long-term solution for hirsutism. Improvement will be noticed after 3 to 6 months of drug therapy.

Eflornithine cream
The cream eflornithine may be prescribed to reduce the growth of facial hair. This cream works by interfering with a chemical in hair follicles under the skin, slowing hair growth. Facial hair growth should slow after 1 to 2 months. Side effects of eflornithine include skin rash and irritation.

Hair removal
Hair removal techniques are a nonmedical way to manage excessive hair. These are the same hair removal methods that some people use to keep their legs, bikini lines, and underarms free of hair.
Waxing, shaving, and depilatories: These are all pretty affordable and take effect immediately, but they require continual treatment.
Laser hair removal: Laser hair removal involves using concentrated light rays to damage hair follicles. Damaged follicles can’t produce hair, and the hair that’s present falls out. With sufficient treatments, laser hair removal can provide permanent or near-permanent results.Electrolysis: Electrolysis is the removal of hair using an electric current. It treats each hair follicle individually, so the sessions can take longer.
Both laser hair removal and electrolysis can be expensive and require multiple sessions to achieve the desired results. Some patients find these treatments uncomfortable or slightly painful.

PREVENTING FACIAL HAIR
It’s generally not possible to prevent hirsutism.
Excessive body and facial hair due to hirsutism can be a long-term challenge. Most women with diagnosed hormonal imbalances respond well to treatment, but the hair can grow back if their hormone levels become out of sync again.
Depending on the underlying cause and choice of treatment, treating hirsutism may or may not be a lifelong commitment. Laser hair removal or electrolysis can provide more permanent results than shaving, waxing, or depilatories.
Conditions that cause hirsutism, such as PCOS or adrenal gland disorders, may require lifelong treatment.
Managing hormone levels, managing weight, focusing on a nutrient-rich diet, and seeking support if the symptoms of hirsutism are distressing are all ways to make living with the condition easier.