Excessive Hair Growth in Females

Excessive Hair

Excessive hair growth in females, otherwise known as hirsutism, can be embarrassing.  However, this is due to an hormonal/endocrine disturbance which is not in any way the fault of the woman involved.

This condition affects 5 to 15% of women.

There is a strong genetic component to excessive hair growth in females.

Hirsutism usually refers to excessive male-pattern hair growth.  That is, where females usually do not grow hair such as on the face.

Hirsutism is often also accompanied by acne and abnormal menstruation.

This excessive hair growth in females usually indicates an increased level of androgen hormones.  It particular, increased levels of free, unbound plasma testosterone.

It is important to know that total plasma testosterone levels can remain normal.  This is due to the fact that testosterone-estradiol-binding globulin levels can be reduced leaving increased levels of free testosterone in the plasma but normal total plasma testosterone levels.

Polycystic ovary syndrome (PCOS), is by far the most common cause of excessive hair growth in females.  PCOS is a multifactorial and extremely complex endocrine disorder.

Pilosebaceous units can develop either a terminal hair follicle or sebaceous gland unit in the presence of testosterone.  This is why when free plasma testosterone levels increase these pilosebaceous units seem to either grow hairs or develop acne.

To determine the source of increased testosterone levels, dexamethasone suppression testing may be used.  How this test works and what it reveals is beyond the scope of this article.

However, it is important to know that depending on the reason for the increased levels of testosterone the treatments will vary.

Treatment options include:

  • hormonal suppression (e.g. oral contraceptives or gonadotropin-releasing hormone analogues)
  • medications that block testosterone (e.g. spironolactone, flutamidecyproterone acetate, or finasteride)
  • cosmetic removal and eradication of unwanted hair growth (e.g. laser hair removal, electrolysis)
  • application topical eflornithine hydrochloride 13.9%

Glucocorticoid therapy is utilized in some cases and is often first line therapy.  Estrogen-progestin therapy is utilized if glucocorticoid treatments are not successful.

To learn more about other health issues please visit our Conditions page.