PCOS & Hirsutism

Although hair growth across the body is a normal part of being human, 70 to 80 percent of individuals with PCOS report excess body and facial hair. Hirsutism is the abnormal growth of hair across the face, chest, and back in male-like patterns. Normal versus abnormal hair growth is very subjective, and what is deemed excessive can differ on an individual and cultural level.

Signs of atypical hair growth

Hirsutism varies from general hair growth because it occurs along a male-like distribution. This includes dark and coarse body hair primarily across the face, chest, lower abdomen, inner thighs, back and toes.

There are different degrees of hirsutism. You can learn more by consulting the Ferriman-Gallwey scale for hirsutism. A score of under 8 is considered “normal” and a score of 8 to 15 is considered mild hirsutism. Someone experiencing mild hirsutism may experience significant hair growth on their upper lip, chin, sideburn area, nipples, and lower abdomen. Unlike “peach fuzz” hair that can be found essentially all over our body, this hair will appear coarser, thicker, and more similar to the hair on our head.

More severe cases of hirsutism depend on the density of hair growth you are seeing in these areas. A score over 15 indicates moderate or severe hirsutism.

The hormones behind hirsutism

Higher levels of androgen hormones leads to the abnormal hair growth seen in hirsutism.

Androgens are a group of hormones related to the metabolism, sexual development, and muscle development. These androgen hormones stimulate hair follicle development and growth in a recognizable pattern across the body. The pattern is often described as “male-like” because males have higher androgen levels and tend to have hair grow in these areas, for example on the face as a beard.

Androgen hormones include testosterone, DHEAS, DHEA, androstenedione (A4), dihydrotestosterone (DHT), and others. These hormones act on hair follicles by changing the length of time the hair is growing and the size, shape, and activity of the associated pilosebaceous units.

Individuals with PCOS have excess androgens produced primarily by the ovaries, with a small amount from the adrenals.

Other potential causes of hirsutism

While high androgens seen with PCOS commonly lead to hirsutism, there are other catalysts that could potentially be behind this symptom.

For example, some individuals also can also have a heightened sensitivity to androgens at these hair follicles (the pilosebaceous units), making them more likely to develop hirsutism. This can occur even for people whose androgen levels fall within a normal range.

Medications can also cause hirsutism, such as minoxidil, danazol, testosterone medications and DHEA supplements.

Treatment options for hirsutism

Excess hair growth is not a necessity to treat, although many individuals see it as an indicator to treat an underlying hormonal imbalance, or dislike the atypical hair growth for socio-cultural reasons. When choosing how to treat hirsutism, one can either directly treat the hormonal imbalance stimulating the hair growth, or use indirect options that remove the hair.

Treating the hormonal imbalances

• Estrogen containing contraceptive such as the pill, patch, or ring can rebalance hormones and have anti-androgenic effects throughout the body. It could take up to 6 months to see the maximum effects.
• Aldactone (spironolactone) is a prescription anti-androgen medication that works to treat hormonal acne and excessive body hair, although it is often used for blood pressure regulation as well. This is often prescribed with contraception because aldactone has been linked to genital deformities in the male fetus during pregnancy. It may take 9-12 months to see the maximum effects.

Treating the excess hair growth

• Hirsutism hair treatment options include shaving, waxing, depilatory creams, bleaching creams, electrolysis, and laser hair removal.
• Eflornithine (Vaniqa) is a prescription cream that helps slow new hair growth without getting rid of existing hair, and can be used in tandem with laser therapies.

If hirsutism is a concern of yours, be sure to bring it up with your Pollie care team. While this symptom can take longer to see changes given the hair growth cycle and other factors, many people with PCOS are able to manage and even reverse hirsutism with the proper treatment.

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