Hirsutism Causes and Treatments
Hirsutism simply put, means coarse and dark hair growth in unwanted areas on a woman’s body. Like all mammals, women have hairs all over their bodies to help regulate temperature and protect the skin from germs. There are 3 different types of hair humans have during the course of their lives. Lanugo hair is the soft, fine baby hair we all shed within the first 2 months of life. Vellus hair is the soft, thin (peach fuzz) hair on our bodies and terminal hair is the coarse, dark hair that grows out of our scalp, eyebrow and eyelashes.
When a female reaches puberty, vellus hair in the pubic area and armpit change to terminal hair due to hormonal changes, specifically, the production of Androgen. Both male and female bodies make androgen, although androgen is more abundant in men. Most of the androgen made by the female body is converted (aromatized) to estrogen which is the more predominant sex hormone in females.
Ladies, androgen is not our enemy. Androgen actually does a lot of good for our body and is a friend you would want around for a very long time, albeit in just enough doses. Some benefits of androgen include increased energy, increased bone mineral density (stronger bones = delayed osteoporosis), increased metabolism, less body fat-mass and better muscle tone; testosterone, a type of androgen hormone promotes red blood cells production which helps prevent anemia after our monthly period and not to mention better sex drive and delayed menopausal symptoms. So, when is androgen bad for you? When you produce too much, and not enough is converted to estrogen.
Hirsutism is caused by Hyperandrogenism (i.e., too much of androgen) in a woman.
Hirsutism due to hyperandrogenism causes terminal hair growth on the face, chest, back, belly, inner thighs (i.e., male-patterned hair growth) and may cause loss and thinning of hair (female-patterned hair loss) in women.
Causes of Hirsutism
PCOS: Hirsutism is one of the symptoms of Polycystic Ovary Syndrome (PCOS) which is typically caused by hormonal imbalance in women of child bearing age. PCOS causes insulin resistance which then causes high testosterone production leading to hirsutism.
High Cortisol/Androgen Levels and Stress: High cortisol/androgen level whether due to a medical condition (Cushing syndrome, congenital adrenal hyperplasia, tumor) or exposure to steroids and other medications with androgenic properties can cause hirsutism.
Stress is a culprit in triggering many medical conditions. Stress might be unavoidable sometimes in our lives but chronic stress is bad for everyone. Cortisol helps to regulate all of our body functions and needs to be released for our bodies to wake up in the morning and get us through the day.
When faced with danger or under a stressful situation, Cortisol (aka “stress hormone”) is released in higher quantities to prepare the body for a fight or flight response. A temporarily high dose of cortisol in the face of danger keeps us alive. Under chronic stress however, the body is constantly perceiving danger and constantly releasing cortisol. Consistent high cortisol levels cause a lot of problems to the body and women under chronic stress tend to develop hirsutism.
Age: As women age, there is a decrease in estrogen and an increase in androgen levels.
Ethnicity: Hirsutism due to PCOS is perceived to be more prevalent in women of Hispanic, Middle Eastern, African American, and South Asian ethnicity. I would argue that because the hairs on people from these ethnic groups are more melanated, the appearance of darker, coarse hair is more obvious as opposed to prevalence and some ethnic groups just have more body hair. So, there is really no telling but there are a few studies out there to indicate this group of women are more predisposed to hirsutism due to their genetic makeup.
Weight: Weight gain contributes to the development of PCOS and insulin resistance which in turn leads to hirsutism. Losing weight and maintaining a better diet will help reduce this risk.
Effect of Hirsutism
Although there are no physical effects caused by hirsutism, it does affect a woman’s body image and self-esteem which can lead to emotional distress, anxiety and depression, especially in people with severe cases of hirsutism. But do not sweat, there are solutions out there to explore. There are few medications your doctor can prescribe to help correct your hormone levels and reduce the growth of unwanted hairs.
Hair Removal
The two most commonly explored options for hirsutism are electrolysis and laser hair removal. I would not recommend shaving or waxing unwanted terminal hairs. Shaving, waxing or using hair removal creams can lead to more terminal hair growth, vellus hair in the treated area can become terminal once the hair follicles become activated and hyperpigmentation of the skin in that area especially in people with darker skin tone can worsen. Also, there is the concern of ingrown hairs, bumps, infection and other skin problems that may arise. Electrolysis or laser hair removal are currently the best options for unwanted terminal hair removal because they both target and damage individual hair roots to prevent future hair growth.
Electrolysis: Is an FDA approved permanent hair removal method. During electrolysis, electric current is passed through a small, fine needle that is probed into each hair follicle. The needle is pushed down to the root, the current produces enough heat to damage the hair at the root. The damaged hair is then pulled out of the follicle with a tweezer. A few more sessions of electrolysis will eventually damage the root and prevent future hair growth from that follicle. It is always best to catch the hair in its active growth (anagen phase) stage because this is when the hair is still very well attached to the root.
I am currently getting some unwanted hair removed by electrolysis and while my experience is not universal, I will be happy to tell you what I think so far about the method.
Pros
- Could lead to permanent hair loss but there are no guarantees.
- It could be cheaper than laser hair removal
- It is safe. Electrolysis hair removal has been around for over a century. It is a tried and proven hair removal method
Cons
Electrolysis session can be painful especially if you have sensitive skin. The curlier the hair, the more probing in the same hair follicle- ouch, hair damage only happens in the direction of hair growth and sometimes finding the direction of growth of curly hairs can be tricky. Removing hair from its follicle causes bumps. The bumps get better overtime but if you are unlucky enough to have hair growing inside the bump, it is much more painful to remove those.
To help reduce the pain, I numb the area needing treatment with lidocaine cream and wrap up it up with saran wrap hours before each session and I use some pain killers at least 45 minutes before a session. I have had less painful session with this tactic. A quick tip, I noticed when I looked at the needle going under the skin, I felt less pain. I guess my brain is able to gauge the effect from the needle probe and tolerate the pain better without catastrophizing.
Although it is assumed that electrolysis is cheaper than laser hair removal, but depending on the size of the area needing treatment and the number of sessions needed before you start seeing significant result, the cost of each session can add up pretty quickly.
Electrolysis can cause skin discoloration, bumps and hyperpigmentation of the treated areas especially in people with darker skin tone. This goes away overtime with skin regeneration but it can look awful in the beginning.
It is time wasting. A session could take hours and you need several sessions to get result.
Laser hair removal
Laser also targets each hair follicle and destroy the hair at the root to prevent future hair growth.
Pros
- Could lead to permanent hair loss but there are no guarantees
- Less time consuming. Fewer session than electrolysis to see result
- There is laser treatment for all skin tones now
- It is safe
Cons
- It can be expensive depending how the size of the area needing treatment
- People report some discomfort
- May cause skin discoloration
As women, we are constantly trimming, pruning and plucking away unwanted hairs as part of our beauty regimen. Having male patterned hair growth that prove difficult to control can lead to self-esteem issues that could progress to emotional distress, anxiety and depression. Understanding the root cause of a problem, is half the problem solved. There are solutions out there for unwanted hair growth you can explore. Unwanted hair or not, you are always beautiful as you are, take pride in that.
