What to Know About Hirsutism

We get so many question from clients and followers alike about hirsutism, aka excessive hair growth in inconvenient places, who want to know why it’s happening to them and what can be done about it. And I get it! I myself struggled with hirsutism for years leading up to and after my PCOS diagnosis, and I still do see it crop up from time to time. I feel like it often goes overlooked by medical professionals because it can be considered a “cosmetic” problem rather than a life-altering condition—and while it’s not in and of itself dangerous or physically painful, it IS a big sign that something is off in the body, and choosing to ignore it could potentially lead to metabolic issues down the road.

Not to mention, if you are someone who has experienced hirsutism firsthand, you know that the shame and embarrassment that usually accompanies this symptom can be very harmful to a woman’s self-esteem. So I’m setting the record straight on what hirsutism is, the underlying root causes, and tips for getting it under control.

What is hirsutism?

Let’s start with the most obvious question. According to Mayo Clinic, hirsutism is a condition in women that results in excessive growth of dark or coarse hair in a male-like pattern—most commonly on the face, chest, and back (but can also include the toes, lower belly, inner thighs, and around the nipples). There’s not a universal definition for what “excessive” means, but if you’re not sure if the quantity of unwanted hair growth is considered normal or a result of imbalance in the body, a good rule of thumb is to ask yourself if there have been any obvious changes in the past. For example, do you have a “happy trail” where there used to only be peach fuzz? Do you find yourself noticing hair that’s darker or more coarse on your chin or upper lip than usual? If the answer is yes, you could have a mild case of hirsutism.

Similar to acne, hirsutism is annoying at best and anxiety or depression-inducing at worst, but unlike acne, it’s significantly less common (affecting up to 8% of women) and typically a lot harder to get rid of once you have it. But before we dive into how to solve the problem of hirsutism, let’s discuss why it happens to some women in the first place.

What is the underlying cause of hirsutism?

While many consider hirsutism as purely a cosmetic condition, it’s actually a symptom of a metabolic disorder. The most common cause of hirsutism is androgen excess. If you have PCOS, you’re probably familiar with this term, because the underlying root cause can be the same. (PCOS and hirsutism often go hand in hand, but not always.) Androgen excess simply means that your body—or more specifically, your ovaries and adrenals—are producing too much of the male sex hormones like testosterone or DHEAS. Androgen excess is actually one of the more common endocrine disorders in women of reproductive age, and it can lead to male body characteristics in women such as male-pattern baldness, oily skin, unwanted hair growth, and vocal changes.

What’s worth noting is that androgen excess can occur for a number of different reasons. According to my favorite women’s health naturopath, Lara Briden, these reasons include androgen hypersensitivity, adrenal androgen excess, ovarian androgen excess, and taking hormonal birth control with masculinizing progestins. I want to cover each briefly so that you may have a better idea of your own situation.

  1. Androgen hypersensitivity: If you have normal levels of androgens on a blood test but you’re still experiencing androgen excess symptoms, you could simply be hypersensitive to androgens. While it’s possible that this could be genetic, a few other possible causes could be taking progestin-based birth control with a high androgen index, coming off of birth control with a low androgen index (leading to a temporary surge in androgens or post-pill PCOS), chronic inflammation, or elevated prolactin (because it increases DHEAS).
  2. Taking certain kinds of hormonal birth control: Oftentimes, getting down to the root cause of your hirsutism is as simple as looking at the ingredients on your birth control pill. Certain types of progestin-containing birth control options have a “high androgen index” and can cause unwanted hair growth. The “cure” in this case is to simply switch to a pill that’s less masculinizing. Personally, we recommend ditching the pill altogether and using the Fertility Awareness Method for contraception purposes instead.
  3. Adrenal androgen excess: This is when the adrenals are producing too much DHEAS but the ovarian production of testosterone is normal. This can stem the genetic condition of late on-set congenital adrenal hyperplasia, elevated prolactin levels, or adrenal PCOS (brought on by stress factors rather than insulin resistance).
  4. Ovarian androgen excess: This is when the ovaries are producing too much testosterone and androstenedione. This is your classic PCOS, which can also be defined by irregular periods and insulin resistance. (It’s the the overproduction of insulin and metabolic dysfunction that lead to excess androgens in this case.) Try to rule out all of the above before you assume that you have PCOS, and work with a medical professional to determine if this is what’s causing your hirsutism.

Briden goes into deeper detail on each one of these possibilities in her blog post, but for the sake of time, we’re going to focus on recommendations for what we see most often in our clients: adrenal or ovarian androgen excess (aka metabolic PCOS or stress-induced PCOS).

What can be done to fix hirsutism?

I’m going to start out by saying that there’s no easy fix for hirsutism. I know, that might not have been the answer you were looking for when you started reading this newsletter. But it is also kind of straightforward, if you think about it, because it relates back to what we are always focusing on in our newsletters, blog posts, and social media posts: METABOLISM.

Yep, androgen excess—whether stemming from the adrenals or the ovaries—is just another symptom of poor metabolic health. Think about it: When we talk about the underlying root causes of either type of PCOS, we’re talking about adrenal dysfunction and/or insulin resistance (two common issues we see in our clients). Depending on which area you think you struggle with, you can choose to work on them each separately OR you can kill two birds with one stone by simply focusing on nourishing your metabolism to support your body as a whole. Chances are, if you’re excessively stressed and pumping out cortisol all day, your insulin regulation is probably not great—and on the flip side, if you’re experiencing insulin resistance, you can darn well bet that your body is stressed AF. Nothing in the body works in isolation, and the same can be said for dysfunction. You can’t fix one piece of the equation without addressing it all.

That said, I’m sure you’re wondering, what are the tangible things we can do to better support our metabolic health, adrenals, AND our hormones to lower those androgens and see an improvement in our hirsutism? First, we go back to the basics. Ask yourself:

  1. Am I getting enough restful sleep (8+ hours per night)?
  2. Am I eating breakfast within 1 hour of waking and again every 3-4 hours after?
  3. Am I consuming enough calories per day and including a balanced ratio of protein, fat, and carbs in all of my meals/snacks?
  4. Am I incorporating some type of movement (walking, stretching, weight lifting, yoga, etc.) into my daily routine?
  5. Am I prioritizing stress-relieving activities and making time for relaxation at least a few times a week?
  6. Do I have a community of people I trust that I can lean on for support?

Balancing your first level minerals (sodium, potassium, magnesium, and calcium) can also be integral for healing the adrenals and addressing insulin imbalance. Including the adrenal cocktail into your day is a great start, but consider doing an HTMA to learn your mineral status for further support. (Master Your Minerals can help with this!)

Once you’ve made sure that ALL of these foundational steps are taken, you can start to experiment with supplements that help to naturally reduce testosterone production. These include inositol, NAC, nettles, reishi mushroom, saw palmetto, spearmint, and progesterone. (Those with high prolactin levels may also benefit from taking Vitex.) Again, always work with a doctor before adding any supplements to your regimen.

Unfortunately, since hirsutism affects the hair follicles—which are even slower to change than hormones—you won’t notice the benefits of these changes overnight. (Although you’ll most likely experience other benefits like increased energy, easier periods, better sleep, etc.) For many, it can take 12 months or longer to see an obvious improvement in the quantity or texture of your unwanted hair. (I can attest to this!) But take heart; by implementing these positive lifestyle changes to nourish your body, you will be on the road to healthier hormones and all of the exciting things that come with that, including a better quality of life.

In the meantime, if you are really struggling with your self-esteem due to hirsutism, there are hair removal techniques that you can choose to temporarily (or in some cases, permanently) get rid of the unwanted hair. I personally opted for shaving or trimming (because it’s painless and cheap), but I’ve also been told that laser hair removal (a more permanent option) and waxing are great tools.

Whatever route you try, remember that you are not defined by your physical features. Every woman has “flaws” that she’d like to hide, and oftentimes, it’s more a matter of mindset + how we see those imperfections that needs improvement over what we can do to get rid of them. If you need a reminder today, take it from me (a fellow PCOS sister): Hirsutism or not, you are beautiful and worthy of confidence!

If you are struggling with PCOS and Hirsutism here are two great podcast episodes to checkout from the Are You Menstrual? Podcast, PCOS Part 1 and PCOS Part 2.

reminder: i’m currently taking on 1:1 clients. if you’d like to explore what it would be like to work together and if we are a good fit, fill out this form to get more details!​

Amanda Montalvo

Amanda Montalvo is a women's health dietitian who helps women find the root cause of hormone imbalances and regain healthy menstrual cycles.

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