7 Common Signs and Symptoms of Hirsutism You Should Know

Hirsutism is a condition that affects women, characterized by excessive growth of dark, coarse hair in areas where men typically grow hair, such as the face, chest, and back. This condition affects approximately 5-10% of women of reproductive age and is often caused by elevated levels of androgens (male hormones) or increased sensitivity to these hormones. Understanding the symptoms of hirsutism is crucial for early detection and proper management of the underlying causes.

While some degree of body hair is normal for women, hirsutism goes beyond typical hair growth patterns and can significantly impact a woman’s quality of life, self-esteem, and emotional well-being. The condition often develops gradually and may be accompanied by other hormonal imbalances. If you notice excessive hair growth in unusual areas, it’s important to recognize the signs and consult with a healthcare provider for proper evaluation.

1. Excessive Facial Hair Growth

One of the most noticeable and distressing symptoms of hirsutism is the growth of thick, dark hair on the face. This typically appears in areas where men commonly grow facial hair, including:

• Upper lip (mustache area)
• Chin and jawline
• Cheeks
• Sideburns

The hair is usually coarse and pigmented, differing significantly from the fine, light-colored vellus hair that normally covers women’s faces. This facial hair growth often starts gradually and may worsen over time if left untreated. Women with this symptom may feel self-conscious and spend considerable time and effort trying to remove or conceal the unwanted hair through plucking, shaving, waxing, or other hair removal methods.

2. Excessive Body Hair in Male-Pattern Distribution

Women with hirsutism develop terminal hair (thick, dark, coarse hair) in areas where men typically have hair growth but women usually do not. These areas include:

• Chest and between the breasts
• Upper and lower back
• Abdomen, particularly around the navel (happy trail pattern)
• Inner thighs
• Buttocks

The hair growth follows a male pattern distribution and is noticeably different from the fine hair that may naturally occur in these areas. The severity can vary from woman to woman, with some experiencing mild growth while others develop extensive hair coverage. This symptom often causes significant emotional distress and may lead women to avoid activities like swimming or wearing certain types of clothing that might reveal the affected areas.

3. Increased Hair Growth on Arms and Legs

While women naturally have hair on their arms and legs, those with hirsutism experience an abnormal increase in the thickness, darkness, and density of hair in these areas. The hair becomes:

• Noticeably thicker and coarser than before
• Darker in color, even if the person is naturally fair-haired
• More densely distributed
• Similar to male-pattern hair growth

This change is particularly evident when compared to the person’s previous hair growth pattern or to other women in their family. The hair may grow back more quickly after shaving or other hair removal methods, requiring more frequent maintenance. Women may notice that their arm and leg hair becomes so prominent that it’s visible from a distance or that it curls and grows longer than typical female body hair.

4. Irregular Menstrual Periods

Many women with hirsutism also experience menstrual irregularities, as both conditions are often linked to hormonal imbalances. These irregularities may include:

• Infrequent periods (oligomenorrhea) – having fewer than 9 periods per year
• Absent periods (amenorrhea) – missing periods for 3 months or more
• Unpredictable cycle lengths
• Very light or very heavy menstrual flow

The hormonal imbalances that cause excessive hair growth, particularly elevated androgens, can interfere with normal ovulation and menstrual cycle regulation. Polycystic ovary syndrome (PCOS), one of the most common causes of hirsutism, is frequently associated with irregular periods. If you’re experiencing both excessive hair growth and menstrual irregularities, it’s important to seek medical evaluation as these symptoms together often indicate an underlying hormonal condition that requires attention.

5. Acne and Oily Skin

Elevated androgen levels that cause hirsutism also stimulate the sebaceous glands in the skin, leading to increased oil production. This often results in:

• Persistent acne, especially on the face, chest, and upper back
• Acne that develops or worsens in adulthood
• Oily skin and scalp
• Acne that is resistant to typical over-the-counter treatments

The acne associated with hirsutism tends to be more severe and may include deep, painful cysts rather than just surface blemishes. The skin may feel perpetually greasy, even shortly after washing. Women may notice that their makeup doesn’t stay in place well due to excess oil production. This combination of excessive hair growth and problematic skin can significantly impact self-confidence and quality of life. The acne may be more inflammatory in nature and can leave scarring if not properly managed.

6. Male-Pattern Baldness or Hair Thinning

Paradoxically, while hirsutism causes excessive hair growth on the body and face, some women also experience hair loss on the scalp. This condition, called androgenic alopecia, manifests as:

• Thinning hair at the crown and top of the head
• Widening part line
• Receding hairline at the temples
• Overall decrease in hair volume and density

The same androgens that stimulate excessive hair growth on the body can cause hair follicles on the scalp to shrink, leading to thinner, shorter hair strands and eventually hair loss. This male-pattern baldness in women can be particularly distressing when combined with excessive facial and body hair. The hair loss usually occurs gradually over months or years and may become more noticeable when styling hair or when the scalp is wet. Unlike body and facial hair growth, which responds to hormone-blocking treatments, scalp hair loss can be more difficult to reverse.

7. Deepening of the Voice and Other Virilization Signs

In more severe cases of hirsutism, particularly when androgen levels are significantly elevated, women may experience virilization – the development of masculine characteristics. These include:

• Deepening or lowering of the voice
• Increased muscle mass and strength
• Decreased breast size
• Enlarged clitoris
• Changes in body shape with more masculine fat distribution

These symptoms indicate a more serious hormonal imbalance and require immediate medical attention. Virilization occurs when androgen levels are extremely high and may suggest conditions such as androgen-secreting tumors of the ovaries or adrenal glands, or severe forms of congenital adrenal hyperplasia. Unlike simple hirsutism, which develops gradually, virilization often progresses more rapidly. If you notice voice changes along with excessive hair growth, it’s crucial to seek medical evaluation promptly, as this may indicate a condition that needs urgent treatment.

Main Causes of Hirsutism

Understanding the underlying causes of hirsutism is essential for proper management. The main causes include:

Polycystic Ovary Syndrome (PCOS)

PCOS is the most common cause of hirsutism, accounting for approximately 70-80% of cases. This hormonal disorder causes the ovaries to produce excess androgens, leading to irregular periods, multiple ovarian cysts, and symptoms like excessive hair growth, acne, and weight gain.

Idiopathic Hirsutism

This refers to cases where excessive hair growth occurs without any identifiable underlying cause. Hormone levels appear normal, but the hair follicles may be more sensitive to normal levels of androgens. This accounts for about 10-20% of hirsutism cases.

Congenital Adrenal Hyperplasia

This genetic condition affects the adrenal glands, causing them to produce excessive amounts of androgens. It can be mild or severe and is often inherited. Non-classic forms may not be diagnosed until adolescence or adulthood when hirsutism develops.

Medications

Certain medications can trigger hirsutism as a side effect, including anabolic steroids, testosterone, danazol, and some medications used for endometriosis or immunosuppression. Hair growth typically improves after discontinuing the medication.

Cushing’s Syndrome

This condition results from prolonged exposure to high levels of cortisol, which can increase androgen production. It may be caused by tumors or long-term use of corticosteroid medications.

Androgen-Secreting Tumors

Rarely, tumors of the ovaries or adrenal glands can produce excess androgens, leading to rapid onset of hirsutism and virilization. These cases typically show very high androgen levels and require prompt medical intervention.

Insulin Resistance

High insulin levels can stimulate the ovaries to produce more androgens. This is often associated with PCOS, obesity, and metabolic syndrome, creating a cycle that worsens both insulin resistance and hirsutism.

Prevention Strategies

While some causes of hirsutism cannot be prevented, particularly genetic conditions, several strategies may help reduce the risk or severity of symptoms:

Maintain a Healthy Weight

Excess body weight, particularly obesity, can worsen insulin resistance and increase androgen production. Maintaining a healthy body weight through balanced nutrition and regular physical activity can help regulate hormone levels and may reduce the severity of hirsutism, especially in women with PCOS.

Follow a Balanced Diet

Eating a diet low in refined carbohydrates and rich in whole grains, lean proteins, fruits, and vegetables can help manage insulin levels. This is particularly important for women with insulin resistance or PCOS. A balanced diet also supports overall hormonal health and may help prevent metabolic complications.

Regular Exercise

Physical activity improves insulin sensitivity and helps maintain healthy hormone levels. Aim for at least 150 minutes of moderate-intensity exercise per week, combining both cardiovascular activities and strength training. Regular exercise also helps with weight management and reduces stress.

Manage Stress

Chronic stress can affect hormone production and worsen hormonal imbalances. Practicing stress-reduction techniques such as meditation, yoga, deep breathing exercises, or other relaxation methods may help support hormonal balance.

Regular Medical Check-ups

Early detection of hormonal imbalances can lead to prompt intervention and better outcomes. If you have a family history of PCOS or other endocrine disorders, regular check-ups can help identify problems before symptoms become severe. Discuss any concerns about unusual hair growth with your healthcare provider.

Avoid Unnecessary Medications

Be cautious about using supplements or medications that may affect hormone levels unless prescribed by a healthcare provider. Anabolic steroids and certain performance-enhancing substances should be avoided as they can trigger hirsutism.

Frequently Asked Questions

Is hirsutism a serious health condition?

While hirsutism itself is not life-threatening, it often indicates an underlying hormonal imbalance that may require medical attention. The emotional and psychological impact can be significant, and some underlying causes, such as tumors, need prompt treatment. It’s important to get evaluated by a healthcare provider.

Can hirsutism go away on its own?

Hirsutism rarely resolves without treatment, especially if caused by conditions like PCOS. However, if caused by medication, symptoms may improve after stopping the drug. Addressing underlying causes and managing hormone levels is typically necessary for improvement.

At what age does hirsutism typically start?

Hirsutism most commonly begins during puberty or in the early reproductive years, typically between ages 15-30. However, it can develop at any age depending on the underlying cause. Sudden onset of severe hirsutism, especially in older women, requires immediate medical evaluation.

How is hirsutism diagnosed?

Diagnosis involves a physical examination, medical history review, and often blood tests to measure hormone levels including testosterone, DHEA-S, and other androgens. Your doctor may also check for signs of underlying conditions like PCOS or thyroid disorders. Imaging studies may be ordered if a tumor is suspected.

Can women with hirsutism still get pregnant?

Many women with hirsutism can become pregnant, though some underlying causes like PCOS may affect fertility. The irregular ovulation associated with hormonal imbalances can make conception more challenging, but with proper management and sometimes medical assistance, pregnancy is often possible.

Does shaving or waxing make hirsutism worse?

No, hair removal methods like shaving or waxing do not cause hair to grow back thicker, darker, or faster. This is a common myth. However, these methods only provide temporary relief and don’t address the underlying hormonal cause of hirsutism.

Is hirsutism hereditary?

There is a genetic component to hirsutism. Women with family members who have PCOS or hirsutism are at higher risk of developing the condition. Certain ethnic backgrounds, including Mediterranean, Middle Eastern, and South Asian, also have higher prevalence rates.

When should I see a doctor about excessive hair growth?

You should consult a healthcare provider if you notice sudden or rapid hair growth in male-pattern areas, if the hair growth is accompanied by other symptoms like irregular periods or voice changes, or if the excessive hair is causing significant emotional distress. Early evaluation can help identify treatable underlying causes.

References:

• Mayo Clinic – Hirsutism
• National Institute of Child Health and Human Development – PCOS Symptoms
• MedlinePlus – Hirsutism
• Johns Hopkins Medicine – Polycystic Ovary Syndrome
• NHS – Hirsutism