Are you suffering from hirsutism (abnormal hair growth)?
Abnormal hair growth, especially facial hair growth, is one of the most indicative symptoms of PCOS. The medical term for this condition is hirsutism. Although not all women with PCOS have it, for those that do it can be one of the more embarrassing and time-consuming symptoms of PCOS.
I see questions on threads and forums on a daily basis from women asking for advice on the most effective form of hair removal. Laser hair removal is a popular choice, but there are a number of women complaining that they’ve spent hundreds, if not thousands, on laser hair removal, only for the hair to continue growing back.
I believe that there is a reason for this. The biggest mistake that most women are making is not treating the underlying cause of the excessive hair growth: excess hormones.
What causes hirsutism?
You may not think it, but you’re not actually sprouting new hairs. All women have hair on their faces, but it’s usually so fine and short that it’s unnoticeable. Our bodies are actually covered in hair. The only places that we don’t have it is on the soles of the feet, palms of the hands, and lips. But not all areas of the body have the same type of hair – there are two distinct types:
- Villus hairs are soft and short (less than 2m length) hairs that cover the areas of the body that you would generally regard as ‘hairless’, i.e. your face, chest, and back.
- Terminal hairs are the coarse, pigmented hairs that make up your scalp hair, eyelashes, brows, pubic hair, etc.
In female ‘male pattern’ hair growth (hirsutism), villus hairs are converted into terminal hairs due to hormones, such as insulin and androgens. This process only happens in areas that are sensitive to these hormones, i.e. chin and beard area, upper lip, chest, stomach, and back. The hair on your scalp and eyelashes (where we often want thicker hair) is not sensitive to these hormones. In fact, hair may actually fall out in these areas.
What hormones are responsible for hirsutism?
Androgens
Androgens are a group of hormones that are typically found in higher levels in males. The androgen that you’ll probably be most familiar with is testosterone. Another androgen is DHEA-S, which is produced by the adrenal glands when the body is under stress.
Your liver is responsible for regulating hormone levels. However, when hormone levels are unexpectedly high it cannot handle them effectively and excess hormones remain in the blood. The unfortunate result of this is that the hormones are able to cause absolute havoc in the body. For women with PCOS, androgen levels are typically higher. The excess levels of them get into the hair follicles on the face and chest. As a result, they turn the very fine hair that normally grows there into thick, dark hair.
Androgens can also get into the hair follicles on your head and cause hair to fall out. This condition is called androgenic alopecia. Excess androgens may also seep into the glands under your skin and cause acne.
Hirsutism is incredibly common in women with Polycystic Ovarian Syndrome. In fact, 95% of women with hirsutism also have PCOS. PCOS is caused by a certain combination of genes and environmental factors. These factors include inflammation, stress, hypothyroidism, and the birth control pill, but the most common one is insulin resistance.
Insulin
Insulin is your storage hormone. It binds to specific receptors on certain cells and tells them to open up and let glucose in. This allows the body to store glucose. Although this process is efficient for most people, some people can develop insulin resistance. This occurs when insulin doesn’t work properly and the body is subsequently unable to store excess glucose effectively.
High insulin levels stimulate the ovaries to produce more androgens. They also reduce the amount of Sex Hormone Binding Globulin (SHBG). SHBG acts a bit like a sponge for excess hormones. If it’s low then the level of excess hormones will be much higher.
Studies have shown that high insulin has a twofold impact on hirsutism. Not only does it increase the androgens that contribute to hirsutism (and decrease SHBG), it also independently causes hirsutism.
One study of 749 women with PCOS, showed that high insulin was actually a larger contributory factor in causing unwanted hair growth, compared to high androgen levels.
The ONE mistake most women are making when treating unwanted facial hair growth
You may feel like you’ve tried everything to tackle unwanted hair growth. However, the one mistake that a lot of women make is not treating the root cause of the problem correctly. You simply haven’t been given the advice and tools to correct your hormone excess.
The common ‘treatments’ (and I put treatments in quote marks, as they are nothing of the sort) for hirsutism, are the birth control pill (BCP) and Spironolactone.
Spironolactone fits into testosterone receptors on your hair follicles, therefore preventing testosterone from doing damage. However, like all drugs it has side effects. It kills your sex drive, affects your adrenal glands, and causes fatigue. Oh, and you can’t take it when you’re pregnant as it causes birth defects. Spironolactone also does nothing to help treat insulin resistance. If you remember from above, insulin resistance is even more to blame for hirsutism than excess androgens.
The BCP, also works to block androgens, but it actually increases insulin resistance by 30-40%. This is why the pill should never be a treatment for PCOS.
Metformin is another drug that is frequently prescribed for insulin resistance. However, in a previous article I explain why it might not be the ‘safe’ wonder drug it’s cracked up to be.
The BCP and Spironolactone are comparable to giving a haemophilic patient a band aid. Neither of them do anything to fix the cause of the problem. Neither drug makes you more sensitive to insulin or stops your body from pumping out excess testosterone. They literally just plug the hole. When you rip this metaphorical bandaid off – for example, if you want to get pregnant – then the hair growth and other symptoms will come back, worse than ever.
Fix the Cause of High Androgens and Insulin Resistance
In this article I’ve detailed the known causes of PCOS and hirsutism, such as high androgen levels and insulin resistance. But how are they caused in the first place? Here’s a summary of the top three causes:
Insulin Resistance
The most common cause of PCOS and excess androgens is insulin resistance. 70% of women with PCOS have insulin resistance.
I’ve created a mammoth article all about about insulin resistance, including the most accurate blood tests to diagnose this. However, if you can’t convince your doctor to do the tests for you then these are alternative measures. For example, the tape measure test can give you a very accurate reading of your risk.
Stress
This can be physical stress (such as too much high intensity exercise), or psychological stress. However, most often it’s a combination of the two, e.g. a highly stressful job and too much high intensity exercise.
When you are putting yourself under a lot of stress, your brain detects this and stimulates your adrenal glands to produce stress hormones. These include adrenaline (the fight-or-flight hormone) and cortisol. However, at the same time the brain also produces androgens, such as DHEA-S and androstenedione.
Most people (including physicians) are not aware that 50% of women with PCOS have excess adrenal androgens.
If you’re experiencing any of the following then your stress hormones might be causing or contributing to hirsutism:
- feeling fatigued all the time
- waking up tired, even after 8 hours sleep
- feeling exhausted after exercise
- feeling tired but wired at night
Inflammation
Inflammation occurs when your immune system is chronically activated. It goes hand in hand with insulin resistance, but can also act alone.
Inflammation can be caused by many things:
- Eating foods that you’re intolerant to
- Poor gut health
- High stress hormones (yes, it goes hand in hand with adrenal PCOS too)
- Environmental toxins
Inflammation has been shown to increase androgens, without insulin resistance. If you get recurrent infections or are sick all the time, have allergies or asthma, sore joints, irritable bowel syndrome, or skin problems like eczema, this could be an indicator that you have chronic inflammation.
If Drugs Aren’t the Answer, What Is?
Unfortunately, doctors often aren’t given enough time or funding to thoroughly look at the potential causes that I’ve detailed above. Instead, you’re prescribed drugs, sent on your merry way, and told to come back when you want to get pregnant.
If you are currently taking the BCP or Spironolactone at the moment, I’m not saying that you need to stop taking them immediately. Instead, I’d suggest that you start to try to reduce your androgen levels and insulin resistance (if you have it). After that, you can then look at coming off the drugs.There are many alternative methods that you can use.
Summary
Unwanted hair growth (hirsutism) is an incredibly common symptom of PCOS. Drugs and laser hair removal are frequently recommended to reduce or remove unwanted hair. However, they don’t help to treat the root causes of the hirsutism: excess androgens and insulin resistance.
