Hirsutism

Hirsutism is the funny word that means women are growing dark or coarse hair in places where men normally grow hair, such as on the face and up the middle of abdomen or on the breasts. Hirsutism is often associated with oily skin and hair and with acne. Both women and men have the possibility of growing hair all over our bodies (just not on our palms or soles!). Whether or not we do grow hair in various places depends on our sex, our age and our heredity. Hair growth on women's faces is normal but it is usually blond, soft and almost invisible. Women with a genetic tendency to grow more hair may normally grow darker but soft hair in front of their ears and on their upper lip.

Hair grows from special follicles in the skin—each follicle has the potential to grow hair and to make a fatty substance in response to hormonal stimulation. Hirsutism is caused when the normal hair follicle sees higher levels of men's hormones (androgens, chiefly testosterone). Testosterone needs to be made into dihydrotestosterone to stimulate coarse and dark hair. Other adrenal stress hormones (such as DHEA or androstenedione) or some synthetic progestins (such as levonorgestrel or norethindrone that are common in birth control pills) also can increase hirsutism and acne.

The most common reason for hirsutism is anovulatory androgen excess (AAE, also called polycystic ovary syndrome or PCOS) which is experienced by about 5 out of every 100 women. This means that a woman, usually starting when she is a teen, begins to not ovulate, because her progesterone levels are low, testosterone levels rise, she starts getting acne (related to androgen stimulation of hair follicle fat) and then develops hirsutism as well as far-apart periods. AAE, including acne and hirsutism, is very treatable with progesterone and a medicine called spironolactone that blocks androgen receptors on the hair follicles.