Skin and beauty
I have hair where? — coping with unwanted hair growth
Women are incredibly distressed when they discover extra hair growing in places
where they’ve never had hair before, or in greater amounts than usual. Our
feelings about the hair on our bodies and faces can be a highly sensitive topic,
and our perspectives vary widely based on personal preference. Many women want to
get rid of it as quickly and permanently as possible; others are happy to just let
it go, viewing it as a natural (and yes, beautiful, thank you!) expression of themselves.
Body hair also carries with it all kinds of cultural and social associations —
there’s no question that how much is too much is a “time period”
In today’s celebrity fashion craze, for example, no hair anywhere is the rule,
with waxing salons on every corner. (However the Brazilian may be on its way out, and a more natural look
in!) Women who lived through the “hippie days” of the 60’s and
70’s, clearly remember going au naturale with what would appear to
today’s viewers as “shocking” amounts of underarm, leg and pubic
hair. But at one point or another, most women have hair appearing in places they’d
probably rather not for different reasons.
Fortunately, unwanted hair growth is usually just a benign annoyance. But there
are cases where it could be signaling higher-than-normal levels of insulin and —
sometimes as a result of insulin resistance — higher than normal levels of
androgen hormones like testosterone. So let’s talk about the difference between
common and uncommon hair growth, the reasons why you may have more hair than you
used to, and what you can choose to do (or not do!) about it.
Is this hair normal?
Women in menopause will often talk to their doctors about wrestling with alopecia,
or hair loss, but many don’t
realize that hormonal imbalances can also cause unwanted hair growth. For many of
my patients, managing “extra” body hair is more than just an annoyance;
it can create real frustration, anger and resentment — some even have called
it a “battle” they’ve fought all their lives. Aside from wanting
to find the quickest solutions, women often want to know if excess hair could be
a sign of a health problem — maybe they’ve heard that hair growth is
related to a change in their body’s insulin sensitivity, or that it might
even be a signal for PCOS (polycystic
ovarian syndrome). But the question they ask most often is, “What
is normal for a woman when it comes to hair growth?”
To distinguish between normal and not-so-normal hair growth, it helps to think about
the types of hair the human body grows, and the stage of life when it grows, or
doesn’t. We actually have hair all over our bodies from the very beginning
— in the womb, the fine layer of hair that covers a fetus and keeps it insulated
is called lanugo. After birth, we develop very soft and light vellus
hair (better known as “peach fuzz!”) which stays on our bodies for our
entire lives. Vellus hair can be a little thicker or darker depending on the person,
but it’s usually less than 2 mm long, and can appear all over the body.
But uncommon hair growth in women is usually associated with terminal hair. Terminal
(or androgenic) hair begins to appear during puberty with hormone
changes, and continues to develop long after. It’s darker and coarser than
vellus hair, and is found on the scalp, beard or chin region, armpits, and the pubic
area in women. (Because men have higher amounts of androgens in their bodies, they
have more terminal hair on their bodies.)
Based on your genetic makeup, increased or reduced production of certain hormones
can cause unwanted hair to grow in many different ways, depending on a person’s
age, ethnicity and sex — but for some women, this unwanted hair can be a signal
of a condition called hirsutism.
Hirsutism can be a symptom of hormonal imbalance
Hirsutism (also called hypertrichosis) is the growth of terminal hair (or
thickened vellus hair) in places more typically seen in men in women. It can be
genetic, or it can also be one of the body’s natural reactions to hormonal
and biochemical imbalances, like insulin resistance and a high level of androgen
How severely or quickly hirsutism develops (and where) varies depending on many
variables, but here are the three main factors:
- Production of abnormally high levels of androgens like testosterone.
- How much of those androgens are being bound up by SHBG (sex-hormone–binding
globulin), versus how much is freely available in the bloodstream.
- To what degree the androgen receptors around your hair follicles themselves become
sensitized to androgen hormones.
In your body, androgens are being produced by your ovaries, your adrenals, and also
peripherally in your fat tissues. From there, they are transported throughout the
bloodstream to your hair follicles, where testosterone is converted into its more
potent, follicle-active form. More “sensitive” hair follicles can spend
more time in the anagen (or active) phase of hair growth.
If you have higher-than-usual levels of free testosterone, or your hair follicle
receptors have become hypersensitive to androgens, excess or unusual hair growth
can appear anywhere on your body (even on the palms and soles of the feet!). Increased
facial hair, for example, commonly develops in menopausal women, where it is sometimes
said to be caused by “unopposed androgen.” But for most women, hirsutism
is typically identified in the moustache, beard, chest (usually between the breasts
or around the nipples), and genital regions.
What causes hirsutism?
Let’s start off by saying that hirsutism is a lot more common than most people
think. At least one in 20 women in America deals with this kind of hair growth,
and the reasons for it can vary depending on the person. Hirsutism is not
a disease per se; it’s a natural expression of a woman’s hormonal makeup,
which may or may not be in its optimal state. So many things influence our hormones
and the growth of our hair, some of which we can influence through diet and lifestyle.
But hirsutism is usually linked to one or more of the following factors:
Genetics. In most cases, the specific cause for hirsutism
is genetic, as the underlying blueprint for how much hair we have is linked to our
familial heritage. It can also be caused by relatively rare, yet “normal”
genetic variants called atavisms, or throwbacks to an earlier time in human
evolutionary history — in this case, to a time when our ancestors were much
hairier creatures than we are!
Drugs, hormones and other growth factors. In some women,
hirsutism may be related to past or present use of drugs or growth factors, or exposure
to toxins that increase androgen production or disrupt the way in which hormones
are metabolized in the body. These are factors that we do have some control over,
and include (but are not limited to) the following:
- phenytoin sodium, carbamazepine or Tegretol (anti-seizure medications)
- minoxidil (Rogaine, Regaine)
- glucocorticoids or steroids like cortisone
- danocrine or Danazol
- diazoxide or Proglycem
- metyrapone or Metopirone (given to treat Cushing’s disease)
- bFGF (basic fibroblast growth factor)
- PDGF (platelet-derived growth factor)
- IGF-I (insulin-like growth factor I)
- birth control pills (which can also decrease hair growth)
All of these can trigger an excess in the level of androgens in the body. But what’s
unique about androgens is that just having an excess of androgens won’t necessarily
mean that a woman will experience hirsutism. Women with high testosterone are not
necessarily more aggressive or do better in sports either!
As explained above, some women with hirsutism have hair follicles that are extra-sensitive
to normal amounts of androgens (combined with higher-than-normal circulating androgen
levels), whereas others have decreased metabolism, or enhanced receptor bindings.
So both too much and too little are possible causes of hirsutism. And then there
is also the idiopathic variety, where the medical profession just can’t
find a cause. So how it happens can be a real mystery until you meet with your healthcare
Am I “hirsute,” or just a little hairy? — Talking about hair with
your healthcare practitioner”
If you experience a marked change in your hair growth over several weeks or months,
then having your hormonal profile checked is probably a good idea. In other words,
the speed and amount of your body hair growth matters. It can be just the expression
of your genetic heritage, or a representation of where you are in relation to your
hormonal or life cycle. If it’s the latter, it’s best not to think about
this hair growth as the end-all-be-all, but merely one piece of your current whole
hormonal expression. Ask yourself the following questions:
- Is the amount of hair growth unusual, given my past or family hair history?
- Do I have other irregular symptoms, such as irregular periods, weight gain/loss,
or a deepening of the voice
- Is the hair growth sudden or gradual?
- Is the hair growth appearing in an “uncommon” place?
- Have I recently experienced an emotional change in my life?
Knowing those answers will help your healthcare practitioner more quickly identify
whether this unwanted hair is genetic, a symptom of hormonal imbalance, or a signal
for something more serious, like PCOS. It can also help to specifically target where
you’re seeing more hair than unusual, in identifying whether you’re
hirsute, or just a little hairy.
The body areas where you can look for androgen sensitivity first are the places
where terminal hair usually grows on women (in descending order of sensitivity):
- pubic area
- axillae (underarms)
- perianal area
- upper lip
- periareolar (around the nipple) areas
- the chin and “beard” region
- arms and legs
- between the breasts area
Hair growing in the above areas more heavily (or earlier) than is normally seen
such as in puberty can be a sign of androgen excess. If caught early enough, it
can often be treated relatively easily by making sure our hormones return to their
regular healthy levels. But if you’re curious whether this unwanted hair growth
is something you should bring up with your healthcare practitioner, you can begin
by evaluating your hair growth yourself with a scoring tool known as the Ferriman–Gallwey score.
The Ferriman–Gallwey test was developed in the 1960’s, and is still helpful
today for measuring the degree of hairiness or hirsutism a woman is experiencing.
You can take a look at the images and gauge where your hair growth ranks from 0
(no terminal growth) to 4 (maximal growth). You can print the chart, bring it in
to your healthcare practitioner, and talk about what’s normal for your own
personal hair growth versus what’s been happening lately. Although the results
can vary for everyone, women with scores higher than 3 represent hair growth that’s
typically outside the norm.
The last step is making sure that this hair you’re seeing genuinely is something
unusual for you. Dramatic changes in our external lives can also sometimes trigger
changes in how we perceive ourselves — as well as how we think others perceive
Self-perception: emotions and our hair
Confidence about our bodies oftentimes mirrors our inner emotional lives. So if
you find yourself blaming the hair on your body for negative emotions, it might
be time to step back and ask yourself whether you have recently experienced an emotional
shift in your life (though some women would call them earthquakes!).
Such transitions can involve a partner entering or leaving your life, or some other
unsettling event that triggers the quake — and menopause often qualifies!
In such events, the hair on our bodies may or may not have changed all that dramatically,
but the way we see ourselves has. So before you leap to the conclusion that the
hair is something that needs to be “fixed,” ask yourself whether this
growth is sudden, or whether it’s happened gradually over time. Is there really
a difference in your hair growth, or are you looking at yourself differently these
days? Everything should be taken in context.
For a woman who has had heavy hair growth much of her life, the issue this usually
isn’t indicative of a serious physical problem. If the heavy hair growth is
sudden, however, it might be time to speak with your healthcare practitioner about
your hormone status. Meantime, let’s get to the question that most women want
answered: “So what can I do about it?”
Solutions for unwanted hair growth
Most women who deal with their extra hair on a regular basis have some sort of system
in place: they shave (and No, shaving does not cause hair to grow faster or coarser
— that is a myth!), pluck, tweeze, use creams or wax for immediate hair removal.
But for women who have sudden, rapid hair growth, or other signs of hormonal imbalance,
here are some suggestions to help get you started:
- Learn your hormonal profile. Although it’s tempting
to just grab the tweezers and get to work, remember that removing the unwanted hair
from our bodies is not as important as identifying our condition as common or uncommon,
and (if uncommon) finding the treatment that’s right for you. This includes
speaking with a healthcare practitioner and finding out about your own personal
hormonal profile to see if you have insulin resistance; or see a specialist to check
for an imbalance of androgens or androgen metabolites.
- Reverse your insulin resistance. You can facilitate your
body’s natural healing pathways with dietary and lifestyle changes that reduce
insulin resistance. Regular gentle exercise, along with meals and snacks with a
low glycemic load, can
bring both insulin and androgen production, regulation, and metabolism back to a
more balanced state.
If your insulin resistance is more advanced, or you find the nutritional aspects
of insulin control difficult, there are medical foods available today that are specifically
designed to support insulin and glucose stabilization. (You will need to work with
a practitioner of functional
medicine when using medical foods.) Studies have shown that the specific
phytonutrients these products contain work by modulating insulin signaling and actions
in the body. By targeting pathways upstream of where drugs like metformin (Glucophage)
do their work, the nutrients help heal your metabolism without the unwanted side
effects associated with drugs.
Best of all, healing your metabolism may not only help diminish unwanted hair growth,
but will also bring you better balance on every other level. For more guidance,
see our page on
insulin control and the four food groups.
- Drink spearmint tea regularly. New studies in the journal
Phytotherapy Research show a promising natural alternative. Drinking spearmint
tea twice a day reduces the effects of the levels of androgens in the body which
can cause hirsutism. Hot spearmint tea with a dollop of honey is very soothing and
satisfying after meals, in place of dessert. Spearmint tea is delicious chilled,
too — add a bit of stevia or unfiltered apple juice if you need a little sweetener.
- Laser or electrolysis treatments. Laser therapy is being
chosen by more and more women as an alternative to the skin irritation, scarring,
messiness, re-growth, and inconvenience associated with older methods of hair removal.
As laser technology has become more advanced, it has also become more available
and more affordable. It can leave your skin feeling smoother, and the results can
last for much longer than with electrolysis or the somewhat painful, at-home removal
techniques. Laser hair removal has also been shown to help women who have genuine
anxiety, depression, or just plain frustration about their hair.
- Try a prescriptive medication. There are no FDA–approved
medications for hirsutism at this time. There are some drugs, like spironolactone
or aldactone, which bind to the hormone receptors that react with androgens
— and that can decrease unwanted hair growth. Metformin, a treatment for PCOS,
does seem to reduce testosterone, and thus decrease hair growth. But this is also
our least favorite solution for general treatment. Many of the anti-androgen medications
take a long time to work (over a year) if they work at all, and once you stop, the
hair growth comes back. They also have some undesirable side effects, like nausea
and diarrhea, or more seriously, high blood sugar and chest pain.
Loving the hair we have — the Women's Health Network approach
How much hair we choose to keep (and where we decide to keep it) are deeply personal
decisions. But for the most part, the kind of hair that will develop on our bodies
is determined by our lineage: many studies have shown that our natural hair growth
varies widely in amount and thickness, largely due to our genetic makeup, and even
the region of the world where our ancestors came from. Learning to accept your natural
hair growth can be very liberating, or if you feel more confident without it, that
can be equally liberating. What we want you to know is that you have a choice!
But if you have experienced a rapid amount of sudden hair growth (and especially
alongside other health concerns), it’s a good idea to speak with your healthcare
practitioner, as it could be your body’s response to underlying hormonal and
chemical imbalance. View this as an opportunity to improve your total health —
to feel healthy and beautiful, inside and out.
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Related to this article:
References & further reading
on unwanted hair growth
Last Modified Date: 10/17/2013