Hirsutism is the excessive growth of thick or dark hair in women in locations that are more typical of male hair patterns (for example, mustache, beard, central chest, shoulders, lower abdomen, back, and inner thighs). Hypertrichosis is an increase in hair growth anywhere on the body in men and women.

• Overproduction of male hormones because of tumors or the use of certain drugs can cause hirsutism.
• In women, excess hair caused by overproduction of male hormones may be accompanied by acne, a deepened voice, and male-pattern hair loss.
• Doctors review the person's current drug use, changes in physique, family history, and hormone levels.
• Treatment may include hormonal therapy and hair removal.

Hirsutism is excessive thick or dark hair in women in locations on the body where men usually have more hair, such as the mustache and beard areas, central chest, shoulders, lower abdomen, back, and inner thighs. Whether hair growth is considered excessive may differ depending on ethnic background, cultural interpretation, and individual opinion. Men vary significantly in amount of body hair, but they rarely seek medical evaluation for large amounts of body hair.

Hypertrichosis is simply an increase in the amount of hair growth anywhere on the body. Hypertrichosis may be generalized or localized.

Causes

A person's age, sex, racial and ethnic origin, as well as hereditary factors, determine the amount of body hair. Rarely, excess hair is present at birth because of a hereditary disorder. Usually, excess hair develops later in life.

Hirsutism: Hirsutism most often is the result of

• A familial tendency, particularly among people of Mediterranean or Middle Eastern ancestry
• Polycystic ovary syndrome (see Menstrual Disorders and Abnormal Vaginal Bleeding: Polycystic Ovary Syndrome)

Sometimes, excess hair is caused by tumors or other disorders of the pituitary gland, adrenal glands, or ovaries that cause levels of male hormones (androgens) to increase abnormally. Anabolic steroids, which may be abused by female athletes and bodybuilders, are androgens. Excess androgens in women also may cause enlarged muscles, acne, a deepened voice, male-pattern hair loss, and an enlarged clitoris. Menstrual periods may become irregular or stop. These changes are called virilization.

Hypertrichosis: Hypertrichosis is usually caused by a body-wide (systemic) illness or a drug. Illnesses include the following:

• Dermatomyositis
• General systemic illness (such as advanced HIV infection)
• Hypothyroidism or other endocrine disorders
• Undernutrition
• Porphyria cutanea tarda
• Some central nervous system disorders

Drug causes of hypertrichosis include minoxidilSome Trade Names
ROGAINE
, phenytoinSome Trade Names
DILANTIN
, cyclosporineSome Trade Names
NEORAL SANDIMMUNE
, and anabolic steroids.

Diagnosis

Because some excess hair results from medical disorders, doctors must distinguish excess hair that is the result of an underlying medical problem from hair growth that is simply a cosmetic concern.

Doctors first look for other symptoms of virilization or features of Cushing's syndrome (see Adrenal Gland Disorders: Cushing's Syndrome), such as a large, round face and a pad of fat between the shoulders. Doctors also ask about excess hair in family members, review the person's drug use (including illicit use of anabolic steroids), and look for an underlying medical condition.

Unless the cause of the excess hair is clearly the use of a particular drug, women should have blood tests to measure various hormone levels, as well as ultrasonography or computed tomography (CT) scanning to check for a tumor of the adrenal glands or ovaries.

Did You Know... Shaving does not increase the thickness of hair or the rate of hair growth.

Treatment

Doctors treat any specific cause of excess hair. Drugs that may be the cause are stopped or changed if possible. Treatment for the excess hair itself is unnecessary unless people find the hair cosmetically objectionable.

Hormonal Treatments: When androgen excess is the cause, two types of hormonal drugs can be used.

• Oral contraceptives reduce ovarian androgen production.
• Antiandrogenic drugs block the effects of testosterone.

Antiandrogenic drugs, such as spironolactoneSome Trade Names
ALDACTONE
, flutamide, and finasterideSome Trade Names
PROSCAR
, may cause birth defects, so they are usually used together with oral contraceptives.

Hair Removal

Hair removal methods may be temporary or permanent.

Temporary hair removal methods include shaving or clipping the hair. Shaving does not increase the thickness of hair or rate of hair growth. Other common temporary hair removal measures include plucking, waxing, and use of a depilatory (a liquid or cream preparation), which chemically removes hair at the skin surface.

Permanent hair removal requires that the hair follicles be destroyed. Electrolysis, in which an electric needle is inserted into each hair follicle, destroys the hair follicles by heat and electrical current. Multiple treatments are often necessary, and many follicles often survive the procedure, allowing hair regrowth. Laser treatments also may permanently reduce unwanted hair (see see Noncancerous Skin Growths: Using Lasers to Treat Skin Problems). However, while multiple laser treatments may permanently destroy many hair follicles, some hair eventually grows back.

As an alternative to hair removal, eflornithineSome Trade Names
VANIQA
cream substantially slows hair growth in many people and may decrease the need to manually remove hair. Hair bleach may mask excess hair by lightening it, rendering it less noticeable.

Last full review/revision August 2008 by Wendy S. Levinbook, MD