Facial Hair

Unwanted facial hair is also called hirsutism. It occurs when women have an excess amount of male sex hormones. Collectively, these are called androgens – the most commonly-known is testosterone. Although it is a male sex hormone, smaller levels of testosterone are also found in women. In women, it increases libido, and also affects fertility and the menstrual cycle.

In around 72% of premenopausal women with hirsutism, the primary cause is polycystic ovary syndrome (PCOS). Other possible causes of excess androgen activity include:

• Cushing’s syndrome – an uncommon hormonal disorder, which leads to sudden weight gain and bloating of the torso
• Congenital adrenal hyperplasia – a hereditary condition affecting the production of sex hormones
• Acromegaly – a disorder leading to an excess of growth hormone
• An androgen-producing tumour
• Obesity
• Medicines e.g. anabolic steroids

For about 23% of cases, there is no single identifiable cause.

PCOS is a medical condition whereby tiny sacs of fluid (cysts) form on the outside of a woman’s ovaries. Because the ovaries produce sex hormones, PCOS can lead to an imbalance of androgens, leading to unwanted hair growth. On top of this, PCOS can cause acne and weight gain, and affect the regularity of the menstrual cycle.

A woman has reached menopause once she has stopped ovulating and has not done so for at least one year. Many hormonal changes are associated with menopause. In some cases, this will lead to an excess of androgens in the body, causing an excess of body and facial hair.

If you have unwanted facial hair, you may want to see a GP. This is because excess hair may contribute to problems with self-confidence and depression.

Before recommending treatment, your GP will determine the severity of the hirsutism and of any other symptoms. This procedure involves looking at the hair growth on nine different parts of the body, and then grading this growth on a scale from zero to four. This will produce a total ‘score’ between zero and 36. On this scale, a total above 15 corresponds to at least moderate hirsutism.

On top of this diagnosis, the doctor will try to identify the cause of the hair growth. They will try to see whether the hair growth might be connected to medication or to a tumour, or whether you exhibit symptoms of PCOS.

If the GP determines that the hair growth might be due to another condition, one or more further tests might be required. This might include a blood test to determine testosterone levels, an ultrasound scan for cysts near the ovaries, or a urine test for cortisol in the case of Cushing’s syndrome.

There is no permanent cure for hirsutism, but many treatments exist to manage the appearance of unwanted hair.

It affects up to 15% of premenopausal women.

Due to the hormonal changes associated with menopause, excess facial hair is much more common in older women. Three in every four women might experience the condition.

There is a myth that shaving causes increased hair growth, but this untrue. Some women, however, may dislike the stubble that grows back, and regular shaving can cause skin irritation. Waxing, while effective for many women, has the risk of irritating and even scarring the skin. Both shaving and waxing can also inflame hair follicles.  Use caution if waxing facial hair. 

Hair removal creams are called depilatories. They leave no stubble, because they chemically dissolve each shaft of hair. These also have the risk of irritation, especially for women with sensitive skin. Ensure that you follow the appropriate instructions before testing and using any of these creams.

Bleaching creams lighten dark hairs, making them less visible. These are often unsuitable for women with darker skin tones, and can also irritate the skin.

In electrolysis, a hair follicle receives a small electric current, in an attempt to permanently destroy the hair root. Before an electrolysis treatment, ensure that the operator is recognised as qualified by the Institute of Electrolysis. The practitioner must use new disposable needles. Electrolysis can cause scarring, and can be very dangerous if the equipment is not used properly and by trained professionals.

Electrolysis may not be available on the NHS, as it is expensive and time-consuming.

Other methods that involve permanently destroying the hair root are intense pulsed light (IPL) and laser treatments. These must be performed at specialty clinics by fully qualified operators – members of the British Medical Laser Association or Healthcare Commission. Laser and IPL treatments can cause scarring, as well as a slight change in the colouration of the skin. During these treatments, patients must stop all other hair removal procedures and avoid exposure to ultraviolet radiation, such as from tanning beds.

Again, these treatments may not be available on the NHS due to their cost and duration.

Eflornithine cream, unlike depilatory creams, only slows down hair growth. It is a recently-developed treatment which is most often recommended for women who cannot use other treatments, or for whom other treatments have been unsuccessful. The cream is left on the skin, and so it can be used in conjunction with any other method of hair removal. Eflornithines take at least two months of consistent use before having a visible effect. Acne and burning can occur as side effects, but these are most often mild.

Anti-androgens can be prescribed to inhibit the hormonal activity that sometimes causes unwanted hair. This medication often takes from four to six months to take effect. After this time, hair growth will slow down and the hair itself will be noticeably thinner. There are several anti-androgens, including:

• Low-dose combined oral contraceptive pills. One such pill is specifically designed to impede the activity of androgens.
• Side effects: nausea, headaches, menstrual irregularities. Some women are more susceptible to these problems, and so are advised against taking oral contraceptives.

• Cyproterone tablets, when combined with an oral contraceptive pill.
• Side effects: blood clots in the legs, depression, loss of libido.
• Spironolactone, more commonly prescribed in the US than in the UK. When taken daily, can reduce androgen activity and hence slowly reduce unwanted hair growth.
• Side effects: liver damage, irregular menstruation

• Finasteride is as effective as spironolactone, but is not approved for treating hirsutism in women in the UK. It blocks the enzyme that converts testosterone into dihydrotestosterone, an active androgen, and so has anti-androgen effects at higher doses.

For each of these anti-androgens, hair will return once you stop regularly taking the medication. Furthermore, they have been shown to harm unborn male babies. As such, they must only be taken while using effective contraception.

Excess hair itself is not hereditary, though some of the underlying causes may be.