Hirsutism (excess hair growth in women)
Hirsutism is the appearance in women of coarse, dark hair in areas where it usually grows in men: upper lip, chin, chest, abdomen, back and inner thighs.
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Medicines commonly prescribed for Hirsutism (excess hair growth in women)
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: TABLET, 1000 mgActive substance: metforminManufacturer: Laboratorios Normon S.A.Prescription requiredDosage form: TABLET, 0.1 mg/0.02 mgActive substance: levonorgestrel and ethinylestradiolManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: TABLET, 0.1 mg/0.02 mgActive substance: levonorgestrel and ethinylestradiolManufacturer: Laboratorios Cinfa S.A.Prescription required
Hirsutism is the appearance in women of coarse, dark hair in areas where it usually grows in men: upper lip, chin, chest, abdomen, back and inner thighs. It is not the same as having a lot of fine hair on the arms and legs, which is a normal and highly variable trait. The distinction matters, because true hirsutism reflects an excess of, or greater sensitivity to, androgens and deserves investigation.
How to tell them apart
- hirsutism: coarse, pigmented, long hair in androgen-dependent areas;
- hypertrichosis: increased fine hair anywhere on the body, with no male pattern; usually constitutional or drug-related;
- there is wide ethnic variation in the normal amount of body hair, and on its own it means nothing.
Causes
- polycystic ovary syndrome: by far the commonest cause, around three in four cases. It comes with irregular periods, acne, difficulty conceiving and sometimes excess weight and insulin resistance;
- idiopathic hirsutism: normal hormones and regular periods; the skin is simply more sensitive to androgens;
- non-classical congenital adrenal hyperplasia;
- medicines: anabolic steroids, testosterone, danazol, some progestogens, ciclosporin, minoxidil, phenytoin;
- Cushing's syndrome;
- raised prolactin;
- thyroid disorders;
- the menopause, through the change in hormone balance;
- androgen-producing tumours of the ovary or adrenal gland: uncommon, but the reason for the warning signs below.
Signs that call for prompt assessment
- hair has appeared rapidly, over months;
- there are signs of virilisation: a deeper voice, clitoral enlargement, temporal hair recession, increased muscle bulk, breast reduction;
- periods have stopped;
- there is weight gain around the trunk, purple stretch marks and muscle weakness;
- it began after the menopause.
That combination points to a significant androgen excess and should be investigated without delay.
When to see a doctor
- body hair has increased noticeably in male-pattern areas;
- periods are irregular or have stopped;
- there is persistent acne or hair loss at the crown;
- you are unable to conceive;
- it started after beginning a medicine;
- there are dark velvety patches on the neck or in the armpits, suggesting insulin resistance;
- it affects you psychologically — a perfectly legitimate reason;
- there is a family history of polycystic ovary syndrome or adrenal hyperplasia.
How it is investigated
The doctor assesses the distribution and density of hair using a standardised scale and looks for signs of virilisation and insulin resistance. Blood tests: total and free testosterone, SHBG, DHEA-S, 17-hydroxyprogesterone, prolactin, thyroid function, LH and FSH, glucose and insulin, and cortisol if Cushing's is suspected. Hormone tests are taken in the first days of the cycle, in the morning, and off hormonal contraception, which alters the results. Gynaecological ultrasound is performed and, if androgens are markedly raised, imaging of ovaries and adrenal glands.
Treatment
Two approaches are combined: reducing the hormonal drive and removing the hair already present. Neither works alone, and both take time.
Medical treatment
- combined oral contraceptives: first line in most cases;
- anti-androgens — spironolactone, cyproterone, finasteride: always with reliable contraception, because of the risk in pregnancy;
- metformin where there is insulin resistance;
- topical eflornithine for facial hair, which slows its growth;
- low-dose corticosteroids in congenital adrenal hyperplasia;
- weight loss in polycystic ovary syndrome with excess weight: it improves both hormones and periods;
- withdrawal of the responsible medicine, on medical advice.
Hair already formed does not disappear with tablets: what they do is slow the appearance of new hair. The effect starts to show at around six months.
Hair removal
- laser or intense pulsed light: the most effective long-term method, working best on dark hair and light skin; several sessions and maintenance are needed;
- electrolysis: permanent and suitable for pale hair, though slow;
- shaving: it does not thicken the hair — that is a myth; it simply leaves a blunt tip;
- waxing, depilatory creams and bleaching as temporary options;
- avoid repeated plucking on the face: it encourages ingrown hairs and folliculitis.
Common questions
Does shaving make hair grow back thicker? No. That impression comes from the cut tip.
How long does hormonal treatment take? At least six months before judging it, with the maximum effect at around a year.
Is it a disease? Not always. Idiopathic hirsutism is not, but treatable causes are worth excluding.
Can I get pregnant? With polycystic ovary syndrome it can take longer, and effective treatments exist. Anti-androgens must be stopped before trying to conceive.
Is laser permanent? It greatly reduces hair permanently, but maintenance sessions are usually needed, particularly if the hormonal cause persists.
Online consultation
In an online consultation the doctor assesses the distribution of hair, distinguishes hirsutism from constitutional hypertrichosis, recognises the signs requiring prompt investigation, advises which tests to have and at which point in your cycle, and proposes a strategy combining hormonal treatment with hair removal on a realistic timescale.
This material is for information only and does not replace a medical consultation.
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Reviewed on Jul 8, 2026
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