If you notice coarse, dark hair appearing on your chin, upper lip, chest or abdomen, you may wonder whether it is simply your natural hair pattern or linked to hormonal changes. Hirsutism specifically refers to excessive terminal hair growth in areas affected by androgens, such as your face, chest, abdomen, back or thighs.
Androgens such as testosterone are naturally produced by your body, but increased activity or sensitivity to these hormones can cause hirsutism. PCOS is a common cause, although some women have normal hormone levels and no clear underlying condition. You should seek medical advice if the hair growth develops quickly or occurs alongside irregular periods, severe acne, scalp hair loss or a deeper voice.
What Exactly Is Hirsutism?
Hirsutism means excessive growth of coarse, dark hair in areas affected by androgens. You may notice it on your upper lip, chin, chest, abdomen, back or thighs, and hirsutism affects around 5–10% of women of reproductive age.
Your natural hair growth varies with genetics and ethnic background, so having more visible hair does not necessarily mean you have a medical problem. You should pay attention to changes in your usual hair growth rather than comparing yourself with others.
Is Hirsutism the Same as Simply Being Hairy?
No. You can naturally have noticeable facial or body hair without having hirsutism.
- Hair type: Hirsutism involves coarse, dark terminal hair rather than fine body hair.
- Hair pattern: It usually appears in areas influenced by androgens, such as the chin, chest or abdomen.
- Natural variation: Genetics and ethnic background can affect how much visible hair you naturally have.
- Age-related changes: Hair patterns can also change over time, particularly after menopause.
What matters most is whether you develop new or increasing coarse hair in an unusual pattern for you.
What Do Androgens Have to Do With Hair Growth?
Androgens such as testosterone influence how your hair follicles grow. You may develop thicker facial hair when your follicles are more sensitive to these hormones, even when your blood androgen levels are normal.
Hirsutism can therefore result from higher androgen levels or increased follicle sensitivity. You may also notice facial hair growth alongside thinning scalp hair because different follicles respond differently to androgens.
Why Is PCOS So Commonly Linked With Hirsutism?
PCOS is the most common hormonal condition linked with hirsutism before menopause. You may notice coarse facial or body hair because PCOS can increase androgen activity, and you may also have irregular periods, acne, fertility difficulties or thinning scalp hair.
Having facial hair does not automatically mean you have PCOS. If you notice new hair growth alongside irregular periods, acne or scalp thinning, you should speak to your doctor, as these symptoms may indicate that further assessment is needed.
Can You Have Hirsutism With Normal Hormone Levels?
Yes. You can have hirsutism even when your blood androgen levels are normal, as your hair follicles may be more sensitive to these hormones. Sometimes, no clear hormonal cause is found, which is known as idiopathic hirsutism.
If your periods are regular and the hair growth has developed gradually without other signs of androgen excess, a serious underlying hormonal disorder may be less likely, although persistent or troublesome hirsutism can still be assessed.
Research Insight
The 2023 international PCOS guideline recommends taking unwanted excess hair growth seriously even when it does not appear severe during an examination. Many women remove hair before appointments, which can make the clinical pattern less obvious.
The guideline recommends using a modified Ferriman-Gallwey score when appropriate, with a threshold around 4–6 depending on ethnicity rather than applying one universal cut-off to every woman.
When Should Rapid Hair Growth Concern You?
Most hirsutism develops gradually, so slowly increasing facial hair over several years is usually less concerning. However, you should seek medical advice if you suddenly develop coarse, dark hair, particularly alongside a deeper voice, increased muscle mass or rapidly worsening scalp hair loss.
These changes may indicate virilisation caused by high androgen activity. You may not have a tumour, as androgen-producing ovarian or adrenal tumours are rare, but you should have rapid or dramatic changes assessed promptly. New or rapidly worsening hirsutism after menopause should also be assessed, particularly if it is accompanied by other signs of androgen excess.
What Other Conditions Can Cause Hirsutism?
PCOS is the most common cause of hirsutism, but other hormonal conditions can also increase androgen activity. You may develop hirsutism with conditions such as non-classic congenital adrenal hyperplasia, Cushing’s syndrome or, rarely, an androgen-producing tumour.
Certain medicines and hormonal products, including anabolic steroids or other treatments with androgenic effects, can also contribute to excess hair growth. You should tell your doctor about any medicines, supplements or hormonal products you use, as this information can help identify whether your hair growth is linked to PCOS, medication or another hormonal condition.
How Different Causes of Excess Hair Growth Can Differ
| Possible cause | Typical clues | What may be considered |
| PCOS | Gradual hirsutism, irregular periods, acne or scalp hair thinning | Hormonal assessment and broader PCOS evaluation |
| Idiopathic hirsutism | Gradual terminal hair growth with no clear hormonal abnormality | Diagnosis after other relevant causes have been considered |
| Non-classic congenital adrenal hyperplasia | Hirsutism or androgen excess, sometimes with menstrual disturbance | Specific hormone testing such as 17-hydroxyprogesterone when clinically indicated |
| Medication-related hair growth | Hair changes developing after starting a relevant medicine or hormonal product | Medication review |
| Androgen-producing ovarian or adrenal condition | Rapid progression, very high androgen activity or virilisation | Prompt specialist investigation |
| Hypertrichosis | Increased hair that is not limited to androgen-sensitive areas | Assessment for non-androgen causes |
What Other Symptoms Should You Mention?
You should mention irregular, infrequent or absent periods, as well as acne or scalp hair thinning. These changes can occur with increased androgen activity and conditions such as PCOS.
You should also tell your doctor about voice deepening, unexpected weight changes or increased muscularity. You do not need to identify the cause yourself; simply explain what has changed so your doctor can assess the pattern.
How Is Hirsutism Diagnosed?
Diagnosis usually starts with questions about when your hair growth began, how quickly it developed and where it appears. Your doctor may also ask about your periods, acne, scalp hair thinning, weight changes, medicines and family history, followed by a physical examination.
A specialist may use the modified Ferriman-Gallwey score to assess hair growth across different areas. However, you should know that hair patterns vary with genetics and ethnicity, so your symptoms and how much they affect you are also important when deciding whether treatment is needed.
UK Guidance Note
In the UK, you can seek medical advice for hirsutism even if unwanted hair is mainly affecting your confidence or wellbeing. Medical assessment is recommended when thick, dark hair develops in androgen-sensitive areas, particularly when it occurs with irregular periods or other hormonal symptoms.
Sudden new hair growth accompanied by a deeper voice or increasing muscle size needs more urgent assessment. Your GP may arrange hormone blood tests and refer you to dermatology, endocrinology or gynaecology depending on the suspected cause.
Which Blood Tests Might You Need?
Your doctor may recommend blood tests if you have significant hirsutism or other signs of hormonal imbalance. Total and free testosterone are commonly assessed when biochemical androgen excess needs to be investigated. Additional hormone tests, such as 17-hydroxyprogesterone, may be considered when your symptoms or medical history suggest another cause, such as non-classic congenital adrenal hyperplasia.
You may not need extensive hormonal testing if you only have a few isolated unwanted hairs, regular periods and no other signs suggesting androgen excess. If PCOS is suspected, you may also need other health checks, and an ultrasound can sometimes help, although you cannot diagnose PCOS from an ovarian scan alone.
Clinical Tip
Tell your doctor about all hormonal medicines and supplements you take before having androgen blood tests. The combined contraceptive pill can alter testosterone-related blood results, so your clinician may need to consider this when deciding how and when testing should be performed.
Do not stop contraception yourself simply to have a hormone test. If biochemical testing is essential, your clinician can advise you about the safest approach.
Can Losing Weight Improve Hirsutism if You Have PCOS?
If you have PCOS and a higher weight, lifestyle changes and weight management can improve metabolic health and may also improve some androgen-related features. However, hirsutism may not improve substantially from weight loss alone.
You should also keep your expectations realistic, as existing coarse hairs may not disappear quickly even when hormone levels improve. You may still need cosmetic or medical hair-removal treatments alongside lifestyle changes.
Can the Combined Contraceptive Pill Help?
If you have PCOS or hormonally driven hirsutism, the combined contraceptive pill may help reduce androgen activity and unwanted hair growth. However, you should not expect quick results, as hair follicles grow slowly and improvement can take several months.
The pill is not suitable for everyone, so your doctor will consider factors such as migraine with aura, your risk or history of blood clots, smoking, blood pressure and other cardiovascular risk factors. If you are trying to conceive, you will need a different treatment approach.
Can Spironolactone or Other Anti-Androgens Help?
Spironolactone and other anti-androgens may be considered when hirsutism remains troublesome despite other treatment, often after at least six months of combined contraceptive and/or cosmetic therapy where these approaches are appropriate.
Anti-androgens should not be used during pregnancy because they may interfere with normal development of a male foetus. If pregnancy is possible, you should use reliable contraception and take these medicines only under medical supervision, as some are prescribed off-label and may require monitoring.
Can Eflornithine Cream Reduce Facial Hair?
Eflornithine is a prescription cream licensed to slow unwanted facial hair growth in adult women. You may still need your usual hair-removal method while it takes effect, as the cream does not remove existing hair or permanently destroy the follicles.
Its benefits do not persist after treatment is stopped, and hair growth can gradually return towards its previous level. Availability can vary across the NHS, so your clinician can advise whether eflornithine is suitable for you and whether combining it with another hair-removal method would give better results.
What About Shaving, Waxing, Electrolysis and Laser Hair Removal?
You can safely remove unwanted hair while your hormonal treatment is being assessed. Shaving does not make hair grow back thicker, while waxing, plucking and depilatory creams can work but may irritate your skin or cause ingrown hairs.
Laser and light-based treatments can provide longer-lasting hair reduction, particularly for pigmented hair, while electrolysis can be useful for individual lighter hairs that respond less well to laser. If you have darker skin, you should choose an experienced practitioner and an appropriate laser to reduce the risk of skin injury or pigmentation changes.
Myth vs Fact
| Myth | Fact |
| Facial hair always means you have PCOS. | No. PCOS is a common cause, but some women have idiopathic hirsutism or another underlying cause. |
| Normal testosterone means your hair growth cannot be hormonal. | No. Hair follicles can be particularly sensitive to androgens even when blood levels are within the normal range. |
| Shaving makes facial hair grow back thicker. | No. Shaving cuts hair at the skin surface and does not increase the number or thickness of hair follicles. |
| You need an ovarian ultrasound to diagnose PCOS. | Not always. If irregular cycles and hyperandrogenism are already present, current guidelines say ultrasound may not be required. |
| Treatment should remove unwanted hair immediately. | No. Medical treatments affect future hair growth, so improvement usually takes months and existing hairs may still need physical removal. |
| Rapid new facial hair is always caused by PCOS. | No. Rapid progression, particularly with voice deepening or increased muscularity, should be assessed promptly for other causes of androgen excess. |
When Should You See a Dermatologist About Hirsutism?
You can speak to a healthcare professional if unwanted hair is affecting your confidence or wellbeing. You should seek assessment if new coarse hair appears alongside irregular periods, acne or scalp hair thinning, as these may suggest hormonal changes.
Rapid hair growth needs quicker assessment, especially if you notice voice deepening or increased muscularity. You should also mention any medicines or supplements that may affect hair growth, so your doctor can identify the cause and discuss suitable treatment options.
Key Takeaways
- Hirsutism means excessive coarse, dark terminal hair growing in areas that are sensitive to androgens.
- PCOS is the most common hormonal cause, but facial or body hair does not automatically mean you have PCOS.
- Hirsutism can occur even when your androgen blood tests are normal because hair follicles differ in their sensitivity to hormones.
- Rapid new hair growth, voice deepening or increasing muscularity should be assessed promptly.
- PCOS cannot be diagnosed from an ovarian ultrasound alone, and some women do not need an ultrasound for diagnosis.
- Treatment may include the combined contraceptive pill, anti-androgens, eflornithine or physical hair-removal methods depending on the cause and your circumstances.
- Anti-androgens such as spironolactone require medical supervision and effective contraception when pregnancy is possible.
- Shaving does not make hair grow back thicker, while laser and electrolysis can provide longer-lasting hair reduction for suitable hair and skin types.
Frequently Asked Questions
1. What is hirsutism in women?
Hirsutism means excessive growth of coarse, dark hair in areas affected by androgens, such as the face, chest, abdomen, back or thighs. You can have noticeable body hair naturally without having hirsutism.
2. Is hirsutism always caused by a hormonal problem?
No. Hirsutism can occur because your hair follicles are more sensitive to normal androgen levels, and sometimes no clear cause is found. PCOS is a common cause, but having unwanted facial hair does not automatically mean you have a hormonal condition.
3. Does hirsutism mean you have PCOS?
Not necessarily. PCOS is commonly associated with hirsutism, particularly when you also have irregular periods, acne or scalp hair thinning. Your doctor can assess your symptoms and decide whether hormone tests or other investigations are appropriate.
4. When should you be concerned about sudden facial hair growth?
Rapid development of coarse, dark hair should be assessed, particularly if you also notice voice deepening, increased muscle mass or rapidly worsening scalp hair loss. These changes can indicate significant androgen activity and need prompt medical evaluation.
5. What blood tests are used to investigate hirsutism?
Your doctor may check testosterone and other hormones depending on your symptoms and medical history. You may not need extensive blood tests if you have mild, gradual hair growth, regular periods and no other concerning features.
6. Can losing weight improve hirsutism caused by PCOS?
If you have PCOS and a higher weight, lifestyle changes and weight management can improve metabolic health and may improve some androgen-related features. Existing coarse hairs may not disappear with weight management alone, so separate medical or hair-removal treatment may still be needed.
7. Can the combined contraceptive pill treat hirsutism?
The combined contraceptive pill can reduce androgen activity and may gradually improve unwanted hair growth in some women with PCOS. You should discuss whether it is suitable for you, particularly if you have other health risks or are trying to become pregnant.
8. Can spironolactone help with unwanted facial hair?
Spironolactone can sometimes reduce androgen-driven hair growth when other treatments are not sufficient. Improvement is gradual, and you may still need hair-removal methods alongside treatment. If pregnancy is possible, effective contraception is important while taking an anti-androgen.
9. Does shaving make hirsutism worse?
No. Shaving does not make your hair grow back thicker or increase the number of hair follicles. You can safely shave unwanted hair, while waxing, plucking, laser hair reduction and electrolysis are other options depending on your hair type and skin.
10. When should you see a dermatologist about hirsutism?
You can seek medical advice if unwanted hair is affecting your confidence or wellbeing, even if you have no other symptoms. You should arrange an assessment more promptly if the hair growth develops quickly or occurs with irregular periods, acne, scalp hair loss or signs of increased androgen activity.
Final Thoughts: Understanding and Managing Hirsutism
Hirsutism can have several causes, from PCOS and increased androgen sensitivity to certain medicines or changes that occur with age. If you notice gradual unwanted hair growth, treatment can help manage it, while rapid or sudden changes, particularly alongside irregular periods, acne, scalp hair loss or voice deepening, should be assessed by a healthcare professional.
If you would like to arrange a consultation with one of our Dermatologist in London, you can contact our team at the London Dermatology Centre.
References:
- Teede, H.J. et al. (2023) ‘Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome’, Human Reproduction, 38(9), pp. 1655–1679. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC10477934/
- Elliott, J., Liu, K. and Motan, T. (2023) ‘Guideline No. 444: Hirsutism: evaluation and treatment’, Journal of Obstetrics and Gynaecology Canada, 45(12), 102272. Available at: https://www.sciencedirect.com/science/article/pii/S1701216323006357
- Spritzer, P.M., Marchesan, L.B., Santos, B.R. and Fighera, T.M. (2022) ‘Hirsutism, normal androgens and diagnosis of PCOS’, Diagnostics, 12(8), 1922. Available at: https://www.mdpi.com/2075-4418/12/8/1922
- Khare, V.R. et al. (2024) ‘Practise updates: diagnosis and management of idiopathic hirsutism’, Indian Journal of Endocrinology and Metabolism, 28(3), pp. 239–249. Available at: https://pmc.ncbi.nlm.nih.gov/articles/PMC11288517/
- Tan, K. et al. (2024) ‘Laser and light-based therapies for hirsutism management in women with polycystic ovarian syndrome: a systematic review’, JAMA Dermatology, 160(7), pp. 746–757. Available at: https://pubmed.ncbi.nlm.nih.gov/38630483/