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How to Stop Hair Growth on a Woman’s Face

Increased body hair is an unwanted feature to any woman. Hirsutism is developing male pattern hair growth in unwanted areas such as face, chest and back. The hair in these areas is dark and course. Excess facial hair will be especially noticeable above upper lip, as side burns and around chin. None of us want excess hair, especially not in our faces. In hirsutism your body hair will grow in excess and be thicker than usual too. 

What Are the Causes of Hirsutism or Excessive Hair Growth in Women?

Familial Hirsutism

Females with familial Hirsutism have excessive amounts of testosterone in their bodies, due to their genes and it can run in families.

Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome is the commonest cause of Hirsutism in females of reproductive age. The affected female develops symptoms such as obesity, irregular menstruation, acne, subfertility, multiple cysts (bubble like lesions) in ovaries, along with hirsutism. Some may develop insulin resistance leading to diabetes.

Tumors which secrete androgens 

• Adrenal tumors 

Tumors can occur in the adrenal glands which produce androgens leading to hirsutism. Adrenal tumors can produce increased levels of cortisol and aldosterone hormones in addition to high testosterone levels. This may cause high blood pressure, weight gain and diabetes in addition to excessive hair growth.

• Ovarian tumors 

Not all ovarian tumors produce androgen, but only 10% of all ovarian tumors secrete testosterone which leads to hirsutism. Testosterone levels are elevated, more than 200 ng/dl. 

Cushing syndrome

Your body is exposed to high levels of Cortisol hormone due to over production of cortisol from the cortex of your adrenal glands or due to chronic administration of prednisolone (as in asthma, auto immune diseases etc.) leading to hirsutism. 

Congenital Adrenal Hyperplasia 

Congenital Adrenal Hyperplasia (CAH) is an inherited disorder where there is visible hirsutism as the androgens are produced in excess by the adrenal cortex which is enlarged and hyperactive. Severe CAH can be detected in infancy. Milder forms of CAH may be evident from childhood. Affected female babies will have genital ambiguity due to enlarged clitoris and genitals at birth. When severe, there can be deficiencies in other hormones, which can be life threatening if not treated early.

Medications

Certain medications can give rise to hirsutism in females. Exampes are:

• Systemic corticosteroids and other anabolic steroids
• fluoxetine (Prozac) used in depression,
• Danazole which is given for endometriosis in females
• Phenytoin which is used to treat fits
• Minoxidil which is used for hair loss, can cause hair growth in unwanted places as a side effect

Treatment Options for Hirsutism

Treatment for excessive hair growth should be aimed at treating the underlying disease if there is one diagnosed, prescribing medicines to reduce unnecessary hair growth, removal of unwanted hair and practicing self- care methods.

To treat the underlying disorder every effort should be taken to make a complete diagnosis. The doctor should go in to a detailed history from the affected individual. A female will seek help from a doctor when she is worried about her excessive hair growth. The doctor should be compassionate towards her as she is already distressed about it.

How to Diagnose Hirsutism and its Underlying Disorders?

Taking a detailed history and physical examination

Hirsutism is diagnosed clinically by a thorough physical examination by your doctor who determines the severity of hirsutism by the extent of hair growth, thickness and its distribution. The doctor will also look for other associated signs of virilization such as acne, increased muscle mass, male pattern balding, signs of breast atrophy, deepened voice etc.

As tumors can be a main reason behind excessive androgens, a thorough Abdominal and pelvic examination is performed to examine for any abdominal masses or fluid collections in the abdomen which can associate with cancers of ovaries and adrenals.

Blood pressure is checked by your doctor as high blood pressure can develop due to adrenal tumors.

If your history is suggestive of taking certain long term medications which can cause hirsutism as a side effect, the doctor will try to omit or change the medication in to another suitable drug.

You will have to go through a variety of tests to determine the underlying cause as there can be many reasons behind your hirsutism. 

Blood Tests  – Hormone Levels in the Blood

Serum testosterone level, oestrogen level, progesterone level, Serum gonadotrophin levels such as FSH and LH hormones, serum cortisol level are some of the hormones which are checked.

Normal level of testosterone in a female should be between 15 – 70 ng/dl. When this level exceeds, a female can develop hirsutism. If the serum testosterone level is higher than 200 ng/dl, it is highly suggestive of an ovarian or an adrenal tumour.

• Fasting blood sugar – to determine associated diabetes as in poly cystic ovarian disease 
• Serum Cholesterol and triglyceride levels – when serum cortisol is high, the level of your blood cholesterol and triglycerides can rise 

Ultra Sound Scan of the Abdomen

US scan of abdomen will be performed to visualize your ovaries and uterus. The doctor will specifically look for polycystic ovaries which are enlarged and have a string of pearl appearance due to multiple cysts. The adrenals are checked for enlargement or any tumors. Thickening of the uterine wall is assessed as hormonal imbalance can make the uterine wall thick. Uterus may not be visible in congenital adrenal hyperplasia.

Radiological Imaging 

To come to a proper diagnosis a variety of X -Rays and CT scan of abdomen or MRI scanning will be done to evaluate your adrenal glands and ovaries. They will be useful in detecting any tumors or cysts.

Once the diagnosis is made and underlying disorder is known, every effort should be taken to treat the underlying cause of hirsutism. If it is not addressed properly hirsutism cannot be properly controlled.

• If it is due to an androgen secreting tumor in ovaries or adrenals, surgical removal of the tumor will cure the hirsutism. 
• Frequent follow up and regular monitoring of hormone levels are necessary where hormonal replacement therapy is prescribed such as in congenital adrenal hyperplasia. 

What are the medications which are prescribed for Hirsutism?

• Oral medications
• Oral contraceptive pills and other hormonal contraceptives –  

Birth control pills contain oestragen and progesterone which will act against androgen. These are commonly used to treat females with hirsutism, who doesn’t want to become pregnant while on treatment. Oral contraceptives should be continued for at least 6 months. There can be side effects like nausea, vomiting, headache, dizziness, stomach disturbances, and mood changes. With continuous use, these symptoms will reduce with time.

• Anti-androgens – Spironolactone (Aldactone) is the commonly prescribed anti -androgen medication. As these drugs can give rise to birth defects, proper contraception should be used while taking the drug to prevent pregnancy. Anti-androgens block androgens getting attached to their receptors in the body, thus preventing its action. These can be prescribed along with oral contraceptives or after trying hormonal contraceptives for at least 6 months with a poor outcome.

Oral medications should be tried for at least 6 months to see a visible result. Life cycle of a hair follicle is about 6 months. So do not stop them on your own, if a response is not seen immediately.

• Topical medications which are used in females with excessive facial hair

There are certain prescription creams which help to slow down the growth of new hair, although it doesn’t remove existing hair. 

Ex: Eflornithine (Vaniqa) – This cream should be applied directly to the affected area of your face

Treatment procedures

Unwanted hair can be removed permanently by doing following procedures. They are expensive treatment options and should be performed in a specialized unit.

LASER therapy

LASER treatment damages your hair follicles and prevents hair from growing. LASER is a beam of highly concentrated light which is passed over the affected areas of skin. This should be done by a qualified dermatologist as LASER can burn the skin if not done properly. This is a painful procedure, even after applying a local anesthetic before the therapy. You may develop swelling and redness of the area. Burning and skin discoloration is possible especially in people with dark complexion.

Electrolysis

Hair follicles are destroyed by inserting a tiny needle which emits a pulse of electrical current in to each and every hair follicle. This procedure is painful, but effective. A local anesthetic is applied to numb the area of skin before the procedure.

Both LASER therapy and Electrolysis will not work by a single effort. You may need multiple treatments for permanent hair removal.

Treatment of associated symptoms

• If the female has subfertility she should be managed by a gynecologist. As inability to conceive can be a very distressing issue to a couple who will want a child.
• If there is associated diabetes, blood sugar should be controlled with oral medications or insulin injections. She should be ideally referred to an endocrinologist for management and follow up. 
• Hormonal imbalance – regular monitoring of hormonal levels should be done especially in congenital adrenal hyperplasia. They are ideally managed by an endocrinologist.
• Ambiguous genitalia – in severe congenital adrenal hyperplasia, females will have enlarged clitoris and genitals. Reconstruction surgery is offered to them to correct the ambiguous genitalia.
• Addressing depression and psychological support
• If the female is distressed and constantly worrying about here excessive hair growth, psychological counseling will help. If she has features of depression, she may need to be referred to a psychiatrist for management.

What are the home remedies you can try?

Following self- care methods can be tried by you at home to get rid of unwanted facial hair.

Shaving

Shaving by using a razor is quick and not an expensive method to remove unwanted hair. Shaving should be done regularly as only the hair above the skin surface is removed.

Plucking

Tweezers can be used to remove stray hairs. But it can be painful and not practical to remove hair in large areas. 

Threading

Hair is removed by using thread with fingers. Certain amount of practice is necessary for hair removal to be successful. Threading can be done in salons.

Waxing

Warm wax is applied on the area with unwanted hair growth. Once it is hardened you should pull it away to remove hair. This is a good method to remove hair in large areas of skin. Sometimes skin irritation and redness can occur after treatment. Waxing can be done at home or in a salon.

Epilating

Electric hand held epilator can be used to get rid of hair in large areas. Since the hairs are plucked from the roots, regrowth takes time. Sometimes folliculitis (inflammation of hair follicles) and ingrowing of hair in to skin can occur.

Use of chemical depilatories 

They act by breaking down the protein structure of the hair shaft. These are available as creams, gels or lotions. You can apply it on areas with unwanted hair and wipe off after sometime. Since these are strong chemicals, some can develop allergic reactions.

Bleaching

Hair is not removed but bleached by using a chemical product containing a bleaching agent. Once the hair is bleached the hair becomes less visible. As it is a chemical, bleaching can cause allergic reactions and skin irritation. It is advised to test in a small area of skin first before use. If you have a dark complexion, bleached hair will be prominently seen.

Some advice for females with Hirsutism

• Maintain a healthy weight, lose weight if you are obese
• Eat a balanced nutritious diet, reduce intake of too much sugar and oily foods
• Regular exercise will help you to maintain a healthy weight
• If you are stressed, try yoga and meditation techniques to calm yourself. If you are worried and if it affects your self- esteem do not hesitate seek psychological support
• Compliance to medication is very important especially if you are on hormone replacement therapy. Comply with instructions given by your doctor. Do not miss your follow up appointments.