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PCOS Hirsutism: excess hair growth causes and treatments

In people with PCOS, hirsutism, or excess hair growth, is a common symptom affecting up to 80% of people. Hirsutism is linked to excess testosterone levels and can contribute to poor body image in people with PCOS. Let’s dig into the causes of excess hair growth, commonly asked questions and hirsutism treatments.

What is PCOS?

PCOS is a common endocrine disorder that impacts 1 in 10 people assigned female at birth. There are various symptoms and signs of PCOS including irregular periods, acne, oily skin, alopecia and hirsutism.

What is hirsutism?

Hirsutism is defined as the presence of terminal hair (i.e. longer, thicker, and darker hair that grows on the head) on areas of the body like the face, chest, back and stomach in people assigned female at birth.

Excess hair growth is a common feature or symptom in people with PCOS. The prevalence of hirsutism in PCOS ranges from 70 to 80%. In comparison to the range of 4% to 11% in people assigned female at birth in the general population.

Diagnosing hirsutism

If you have PCOS and notice thick, dark hair on your face, neck, tummy, lower back, buttocks or thighs, then you may have hirsutism.

You should speak to your doctor, GP or endocrinologist who will check what is causing the hair growth. You may have a blood test to measure your hormone levels.

Two researchers developed a way to measure hirsutism via a reference range scoring system known as a Ferriman-Gallwey score. It can be helpful for research purposes but tends to be less useful in a clinical setting as is doesn’t take into account the differences between ethnic groups and not all doctors will score in the same way – it is subjective, not objective. But, none the less, some doctors do use the Ferriman-Gallwey score system to measure hirsutism.

Modified ferriman-gallwey score for hirsutism in PCOS

What causes excess hair growth in PCOS?

Excess hair growth in people assigned female at birth is usually caused by an excess of androgens in the body. Androgens are “male-type” hormones, including testosterone. Testosterone switches on hair growth in some areas of the body, primarily the face, tummy and legs.

We have hair all over our body, but mainly this is vellus hair which is fine and has no colour to it. Terminal hair, however, is thick, coarse and dark hair. Testosterone can convert vellus hair to terminal hair.

In people with PCOS, androgen levels (hormones like testosterone) are higher than in the general population. This is likely because levels of insulin are higher in people with PCOS. High circulating insulin levels contribute to ovarian testosterone production.

Unfortunately, terminal hair cannot be converted back to vellus hair, but you can reduce the growth pattern of terminal hair until its appearance is similar to vellus hair.

What is considered excess hair growth?

It is challenging to determine what excess hair growth is, as excess hair growth to one person can be perceived differently by another person. Ethnicity also plays a role in determining what is considered “excess”.

Many people with hirsutism and PCOS describe excess hair growth as dark, coarse hair growth in areas on the face such as the upper lip and cheeks, as well as the back, chest, tummy and buttocks.

What does PCOS hirsutism look like?

Hirsutism looks different for everyone with the condition. But generally, it causes thick, coarse and dark hair to grow on parts of the body that normally have fine, thin hair. This includes the face, back, chest, tummy, buttocks and arms.

How does hirsutism impact people with PCOS?

Hirsutism is not a harmful or damaging condition in itself but can impact someone’s quality of life, self-esteem and body image. It has also been linked in some research to symptoms of anxiety and depression.

How can hirsutism be treated or managed in people with PCOS?

PCOS hirsutism treatment can range from medication to hair removal techniques to supplements.

Medication for PCOS facial hair

Hormonal birth control, specifically the combined contraceptive pill, is a recommended treatment for PCOS. The combined contraceptive pill contains oestrogen and progesterone. The mini-pill is not a suitable treatment for hirsutism. The oestrogen in the pill slows the production of testosterone in the ovaries. Blood testosterone levels can drop by half, as the adrenal gland still makes testosterone.

Metformin is a medication that is commonly prescribed to people with PCOS. It is classed as an insulin sensitiser which means it makes the action of insulin in the body more efficient at controlling glucose. Lowered insulin levels reduce the drive to the ovaries to make testosterone, therefore reducing the incidence of hirsutism.

Anti-androgens are a form of medication that can help with hirsutism and alopecia in people with PCOS. There are two types of anti-androgens: testosterone receptor blockers and conversion blockers. Anti-androgens either block the testosterone receptor on the hair follicle or stop testosterone from being turned into its more potent cousin dihydrotestosterone.

Speak to your healthcare professional, doctor or endocrinologist if you’re interested in taking medication for PCOS facial hair.

Cosmetic hair removal for PCOS hirsutism

If you prefer to remove excess hair then there are several options including waxing, shaving or plucking. This form of hair removal works well if the hair growth is scattered or across small areas.

A more efficient method of hair removal is laser hair removal. Laser hair removal disrupts hair follicles over a wider area and can provide long-lasting hair removal. One at-home laser hair removal technique is IPL (intense pulsed light) treatment. It can be an effective treatment for removing the hair of people with PCOS and hirsutism. But, it is important to note that for people with PCOS, hair is much more likely to grow back, so more IPL sessions are needed.

Supplements for PCOS hirsutism

Inositol, an insulin sensitiser, could be a helpful supplement for facial hair in people with PCOS. Inositol may help with insulin resistance, which in turn lowers testosterone levels in the body. Lower testosterone levels may result in a reduced incidence of hirsutism and other hyperandrogenism symptoms like acne, oily skin and hair loss.

Key takeaways: PCOS hirsutism

Hirsutism is a common symptom of PCOS, affecting up to 80% of people with PCOS. It is the presence of dark hair growth on areas of the body where we don’t usually see excess hair like the face, chest and back. There are many treatments for PCOS hirsutism including medication like metformin, birth control and anti-androgens, or cosmetic hair removal techniques, and even some supplements.

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Alex Okell ANutr Founder and Editor

Founder and Editor | Registered Associate Nutritionist

 

Founder of Be The Collective LTD [The PCOS Collective & The Endo Collective] Alex Okell ANutr is a London-based reproductive health nutritionist with experience in research, private practice and digital media. She holds a Master’s degree in Nutrition from King’s College London and has co-authored papers with the University of Cambridge, King’s College London, The Food Foundation and the Food Standards Agency. Alex offers 1:1 PCOS support in our virtual PCOS clinic.

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