Hirsutism and Cushing’s Syndrome: Signs, Tests and Treatment

Short answer: Yes, Cushing’s syndrome can cause hirsutism. Women with it may grow extra hair on the face, neck, chest, abdomen and thighs, and their periods may become irregular or stop.^{[1], [2]} But it is an uncommon cause of excess hair. Doctors usually test for it only when there are other telltale signs, such as easy bruising, wide purple stretch marks or weak muscles in the hips and shoulders.^{[3], [4]}

Cushing’s syndrome happens when the body is exposed to too much cortisol, a hormone made by the adrenal glands.^[1] Because it can cause excess hair, irregular periods and weight gain, it can look a lot like PMOS, previously called polycystic ovary syndrome (PCOS), which is by far the most common cause of hirsutism.^{[4], [5], [6]}

This article explains how the two differ, when testing makes sense, how Cushing’s is diagnosed and treated, and what you can do about the hair.

What is Cushing’s syndrome?

Cushing’s syndrome is the general name for having too much cortisol from any cause. According to the US National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), the causes are:^[1]

• Glucocorticoid medicines. Long-term, high-dose use of cortisol-like medicines, such as prednisolone for asthma, arthritis or autoimmune diseases, is the most common cause.^[1]
• A pituitary tumor. A usually benign tumor in the pituitary gland makes too much adrenocorticotropic hormone (ACTH), which tells the adrenal glands to make cortisol. This form is called Cushing’s disease.^[1]
• A tumor elsewhere that makes ACTH, for example in the lungs. This is called ectopic Cushing’s syndrome.^[1]
• An adrenal gland tumor that makes cortisol directly.^[1]

Cushing’s syndrome caused by the body itself is rare, at roughly 40 to 70 people per million. It affects about three times as many women as men and most often starts between ages 30 and 50.^[1]

Can Cushing’s syndrome cause hirsutism?

Yes. The US National Institute of Child Health and Human Development lists more hair on the face, neck, chest, abdomen and thighs, along with irregular or stopped periods, as symptoms in women.^[2] The Endocrine Society hirsutism guideline also lists Cushing’s syndrome among the conditions doctors should consider. It stresses that it is an uncommon cause and that patients usually also have features typical of the condition.^[3] DermNet and the NHS likewise describe it as a rare cause of hirsutism.^{[7], [8]}

For comparison, in a study of 950 women referred to specialist clinics with signs of androgen excess, 72.1% had PCOS (now PMOS). The main diagnoses did not include Cushing’s syndrome at all.^[5] So if you have excess hair, Cushing’s is possible but statistically unlikely, unless you have other signs.

Signs that point to Cushing’s rather than PMOS

Many symptoms overlap. Weight gain, excess hair, acne and irregular periods can happen in both conditions, and the Endocrine Society’s Cushing’s guideline lists PCOS as a condition with overlapping features.^[4] The signs that best distinguish Cushing’s syndrome are:^[4]

• Easy bruising
• A red, flushed face (facial plethora)
• Weakness in the muscles of the hips and shoulders (proximal myopathy), for example trouble getting up from a chair
• Reddish-purple stretch marks, especially if they are wider than 1 cm

Other features include weight gain around the trunk with slimmer arms and legs, a rounded face, a fatty lump between the shoulders, thin skin, weak bones, high blood pressure and high blood sugar.^[2] The guideline notes that most of these signs are not very sensitive on their own. What raises suspicion is having several of them, having them get worse over time, or having features that are unusual for your age, such as osteoporosis or high blood pressure in a young woman.^[4]

Should you be tested for Cushing’s syndrome?

Most women with hirsutism do not need Cushing’s tests. The Endocrine Society hirsutism guideline suggests checking for Cushing’s syndrome only if features of it are present.^[3] The Cushing’s guideline recommends against widespread testing in people without suggestive features.^[4] The international PCOS guideline says Cushing’s should be excluded when it is clinically suspected, or when androgen levels are markedly raised.^[9]

If you take or have recently taken steroid medicines, in any form, tell your doctor. The guideline says the first step is a thorough drug history to rule out steroid medicines as the cause.^[4] Don’t stop a steroid medicine on your own. Talk to the doctor who prescribed it.

How is Cushing’s syndrome diagnosed?

No single test is perfect, so doctors usually use two of these first-line tests:^{[1], [4]}

• 24-hour urine free cortisol: You collect all your urine for a day, at least twice.^[4]
• Late-night salivary cortisol: You collect a saliva sample late at night, usually on two nights.^{[1], [4]}
• Low-dose dexamethasone suppression test: You take a dose of dexamethasone, a steroid tablet, at night, and your cortisol is measured the next morning. Normally it should be suppressed.^[4]

If Cushing’s is confirmed, further tests are needed to find the source, such as a pituitary, lung or adrenal tumor.^[1] If your excess hair is being investigated more broadly, see diagnosing hirsutism: Blood tests, ultrasound and other labs.

How is Cushing’s syndrome treated?

Treatment depends on the cause:^[1]

• Steroid medicines: If medicines are the cause, your prescribing doctor will discuss whether the dose or treatment can be changed safely.
• Tumors: Options include surgery, radiation, chemotherapy and cortisol-lowering medicines. When done by a highly experienced surgeon, pituitary surgery can succeed in up to 90% of cases.^[1]

Cushing’s syndrome can usually be cured, but it can be fatal if left untreated, which is why prompt investigation matters when the signs are there.^[1]

Treating excess hair from Cushing’s syndrome

We could not find good studies on how much hirsutism improves after Cushing’s syndrome is cured, or how fast. Treating the cause comes first. In the meantime, or if hair remains, the options are the same as for other kinds of hirsutism. Note that most studies of these treatments were done in women with PCOS or idiopathic hirsutism, not Cushing’s.

Shaving, waxing and other temporary methods

These are safe, cheap and immediate. DermNet classifies them as temporary hair removal.^[10] See the guide to shaving your face as a woman.

Laser and light-based hair removal

Evidence: Moderate The Endocrine Society suggests laser or light-based treatment (photoepilation) for brown or black hair. It rates the supporting evidence as low quality.^[3] DermNet classes these methods as hair reduction rather than permanent removal.^[10]

Electrolysis

Evidence: Limited The Endocrine Society suggests electrolysis for white or blonde hair, again based on low-quality evidence.^[3] It is classed as a permanent hair removal method.^[10] See the guide to permanent hair removal.

Eflornithine cream

Evidence: Moderate Eflornithine is a prescription cream that slows facial hair growth.^[8] The Endocrine Society suggests adding it for women who want a faster response to laser treatment.^[3]

Hormonal medicines such as the pill and anti-androgens are the usual treatments for androgen-driven hirsutism. Whether they are suitable for you depends on the cause and your health, so discuss it with your specialist.^[3] See hirsutism medication.

When to see a doctor

See a doctor if you have excess hair along with any of the following:

• Easy bruising, wide purple stretch marks or a red, rounded face^[4]
• Muscle weakness in your hips or shoulders^[4]
• Irregular or missing periods^[2]
• Long-term use of steroid medicines^[1]

Seek an urgent appointment if new thick, dark hair suddenly starts growing on your face and body, your voice is getting lower or your muscles are getting bigger.^[8] These can be signs of virilization.

Frequently asked questions

Does Cushing’s syndrome cause facial hair in women?

It can. Women may grow more hair on the face, neck, chest, abdomen and thighs.^[2] But Cushing’s is an uncommon cause of hirsutism overall.^[3]

How can I tell if it’s Cushing’s or PMOS?

You can’t tell for sure on your own, because the symptoms overlap. Easy bruising, wide purple stretch marks, facial flushing and hip or shoulder muscle weakness point more toward Cushing’s.^[4] A doctor can arrange the right tests. See the difference between hirsutism and PCOS.

Can steroid medicines cause excess hair?

Long-term, high-dose glucocorticoid use is the most common cause of Cushing’s syndrome, which can include extra hair growth.^{[1], [2]} More in drugs that can cause hirsutism.

Will the hair go away after Cushing’s is treated?

We found no good data on this. Hair removal treatments work regardless of the cause, so you don’t have to wait to manage hair you already have.

Key takeaways

• Cushing’s syndrome, meaning too much cortisol, can cause facial and body hair and irregular periods in women.
• It is an uncommon cause of hirsutism. PMOS (formerly PCOS) is far more common.
• Easy bruising, wide purple stretch marks, a flushed face and hip or shoulder muscle weakness are the clues that point to Cushing’s.
• Testing is recommended only when such features are present, and diagnosis usually needs two tests.
• Steroid medicines are the most common cause. Never stop them without your doctor.

Sources

1. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Cushing’s Syndrome. Accessed October 2026. Link
2. Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD). What are the symptoms of Cushing syndrome? Accessed October 2026. Link
3. Martin KA, Anderson RR, Chang RJ, et al. Evaluation and Treatment of Hirsutism in Premenopausal Women: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2018;103(4):1233-1257. PubMed 29522147
4. Nieman LK, Biller BMK, Findling JW, et al. The Diagnosis of Cushing’s Syndrome: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008;93(5):1526-1540. DOI 10.1210/jc.2008-0125
5. Carmina E, Rosato F, Jannì A, Rizzo M, Longo RA. Extensive clinical experience: relative prevalence of different androgen excess disorders in 950 women referred because of clinical hyperandrogenism. J Clin Endocrinol Metab. 2006;91(1):2-6. PubMed 16263820
6. Teede HJ, et al. Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. Lancet. 2026;407(10545):2329-2339. Published online May 12, 2026. PubMed 42119588
7. DermNet. Hirsutism: Excessive hair in females. Accessed October 2026. Link
8. NHS. Excessive hair growth (hirsutism). Accessed October 2026. Link
9. Teede HJ, Tay CT, Laven JJE, et al. Recommendations From the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. J Clin Endocrinol Metab. 2023;108(10):2447-2469. PubMed 37580314
10. DermNet. Hair removal techniques. Accessed October 2026. Link

This article is for education and is not medical advice. Talk to a doctor about diagnosis and treatment.