Hirsutism

Hirsutism - Understanding unwanted hair growth without the awkwardness

Clinical review September 2026

A few extra hairs can feel trivial to everyone except the person checking the mirror under unforgiving bathroom lighting. Hirsutism means coarse, darker hair growing in a male-pattern distribution, such as the face, chest, abdomen or back. It is common, treatable, and never a reason for anyone to make jokes about someone’s appearance.

Hair follicles hear hormones differently

Androgens are hormones made by the ovaries and adrenal glands in everyone. Hair follicles vary in their sensitivity to them, and genetics influences the result. The same blood androgen level can therefore produce very different hair patterns in different people. PCOS is the commonest cause of hirsutism, but not the only one.

The pace of change matters. Gradual hair growth from adolescence or early adulthood, especially with irregular cycles or acne, often fits PCOS. Sudden, rapidly progressive hair growth, a deeper voice, increased muscularity or marked scalp-hair loss is uncommon and needs prompt clinical assessment for rarer causes.

Looking for the useful clues

A consultation should cover timing, periods, skin changes, medicines and supplements, family history and features suggesting Cushing syndrome or other endocrine conditions. Blood tests are selected to match the history and may include testosterone, SHBG, a marker of adrenal androgens, and sometimes 17-hydroxyprogesterone. Tests are most informative when interpreted with the person, their cycle and their medicines in mind—numbers are not tiny judges with gavels.

Many people with mild hirsutism have normal blood tests. That does not make the impact imaginary. It means that follicle sensitivity and hereditary pattern may be doing more of the talking than a single laboratory value.

Choices that work on biology and on daily life

If PCOS is present and pregnancy is not desired, a combined hormonal contraceptive is often a first treatment because it suppresses ovarian androgen production and increases SHBG. Some people need an additional anti-androgen such as spironolactone under specialist guidance; reliable contraception is essential because anti-androgens can harm a developing male fetus. These medicines take time: hair follicles have their own timetable, rather like a very slow committee.

Laser or intense pulsed light can give longer-lasting reduction for suitable hair and skin combinations; electrolysis can help individual lighter hairs. Shaving, waxing, threading and depilatories are valid choices and do not make hair grow back thicker. The best plan is the one that reduces burden while treatment works in the background.

A page for the questions underneath

Later linked pages can explore PCOS, androgen blood tests, acne, laser hair removal and anti-androgen medicines. If hair growth is causing distress, say so plainly; quality of life is clinical information.

Important safety note

This page is for general education and cannot replace individual medical advice. Seek urgent help for severe symptoms, possible pregnancy with pain or bleeding, collapse, confusion, seizure, or any situation in which you feel acutely unwell. A clinician who knows your history can help tailor investigation and treatment.