text: Hirsutism, which causes excessive facial hair growth in cisgender females, 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, back, or chest is usually coarse and dark.
  Hirsutism is a common condition, affecting between 5 and 10 percent of women. It tends to run in families, so you may be more likely to have this hair growth if your mother, sister, or another female relative also has it. 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 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.
  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 female at birth. However, if a women’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.
  - irregular menstrual cycle
  - weight gain or difficulty losing weight
  - 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:
  The adrenal glands, located just above your kidneys, are responsible for hormone production.
  People with congenital adrenal hyperplasia are born without an enzyme that’s necessary for hormone production. An adrenal tumor 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 your body produces androgens.
  - high blood pressure
  - bone and muscle weakness
  - excess weight in the upper body
  - unexplained weight loss
  - weight gain
  - high or low blood sugar levels
  - irregular periods
  - lowered libido
  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
  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.
  Hirsutism can affect anyone, at any age, but you’re more likely to experience it if you have a family member who has also been diagnosed with it.
  Women of Middle Eastern, European, and South Asian ancestry are also more predisposed to hirsutism.
  Individuals previously diagnosed with PCOS have a higher risk of developing hirsutism.
  Your doctor will take a detailed medical history when diagnosing hirsutism. Discuss your medication use with a doctor to help them determine the cause of your condition.
  If you’re living with obesity, your doctor may suggest losing weight to reduce the symptoms of hirsutism. Because obesity can change the way your body produces and processes hormones, maintaining a moderate weight may correct your level of androgens without the use of medication.
  If excessive hair growth is a symptom of PCOS or adrenal disorders, you may need additional pharmacological treatment. 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.
  - 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. You’ll most likely notice improvement after 3 to 6 months of drug therapy.
  Your doctor may prescribe the cream eflornithine to reduce the growth of facial hair. This cream works by interfering with a chemical in hair follicles under the skin, slowing hair growth.
  Your facial hair growth should slow after 1 to 2 months. Side effects of eflornithine include skin rash and irritation.
  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 line, and underarms free of hair.
  Waxing, shaving, and depilatories: If you have hirsutism, you may want to be more proactive about waxing, shaving, and using depilatories (chemical foams). 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 your 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.
  It’s generally not possible to prevent hirsutism.
  If your doctor has recommended it, losing weight may help with the symptoms, especially if you’ve previously been diagnosed with PCOS.
  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 your 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 your hormone levels, managing your weight, focusing on a nutrient-rich diet, and seeking support if the symptoms of hirsutism are distressing to you are all ways to make living with the condition easier.
  What is the Ferriman-Gallwey score?
  The Ferriman-Gallwey index is a method to score the degree of male pattern body hair growth in women. It consists of pictures of hair distribution on the upper lip, chin, chest, back, abdomen, arm, forearm, thigh, and lower leg. Each area is scored from 0 to 4, with 4 being heavy hair growth. After each area is scored, the numbers are added together for a total score.
  Most experts agree that a total of 8 indicates hirsutism.
  The Ferriman-Gallwey score is a simple, inexpensive, and reliable diagnostic tool for hirsutism. There are more elaborate and expensive methods to determine the extent of excess hair growth that may be more precise. These include photographic measures, computerized assessment of photographs, and microscopic measurement and counting of hair shafts.
  Deborah Weatherspoon, PhD, RN, CRNA, COIAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.