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Family Health Magazine
WOMEN'S HEALTH

Unwanted Body Hair (Hirsutis)
When and how it should be treated

Body hair can be a source of pride for men and a source of shame for women. Smooth, hairless faces stare out from glossy women's magazines. Bodies that have been shaved and depilated with waxes and creams are the picture of femininity. Small wonder that women with noticeable facial and body hair often feel unattractive - not quite the women they think they should be. These feelings are often kept hidden, as some women suffer and silently worry that they may not be "normal".

Facial hair and excess body hair (hirsutism) is actually quite common in women. It is rarely a sign that a woman is becoming masculine or is going to change in other ways. It is more likely a case of the body getting its cues mixed up. The hormone balance may tip slightly, or the skin may become overly sensitive to normal hormones that can cause hair growth.

The challenge for doctors treating hirsute women is to deal not only with the problem of the hair itself, but also to deal with the feelings caused by the hair growth. Women need reassurance that their sexuality is not changing, that there is no serious disease, and that cosmetic improvement is possible. They may also need reassurance that the menstrual changes that often accompany hirsutism do not necessarily mean they will be infertile.

How does hair grow?

Hair grows out of small pits in the skin called hair follicles. These follicles can grow small white hairs (vellous hairs) or darker longer hairs (terminal hairs). Men tend to produce beards because the follicles on their face grow terminal hairs when stimulated by male hormones (androgens) after puberty. Some ethnic groups are hairier than others. Mediterranean people are generally hairier than northern people, and caucasians are hairier than orientals. Women who belong to a hairy ethnic group are more likely to be hirsute. Oriental women are rarely hirsute.

Irregular or infrequent menstrual periods often accompany hirsutism. When the ovaries do not produce the normal cycle of female menstrual hormones, they may make a little bit more of the male hormones than usual. All women, whatever their cycles, have some male hormones in their systems. Hirsute women may just have a bit more, or their skin may be overly sensitive to normal levels of androgens. It often does not take much of a change to stimulate terminal hair growth on the face or body.

Rarely, a tumor that produces large amounts of male hormones causes hirsutism. When this is the case, the hair growth usually starts suddenly and worsens quickly. Women with this sort of pattern should see a doctor.

What can be done about excess hair?

There are two types of treatment for hirsutism. The first is removal of the hair by methods such as shaving or waxing, while the second uses medication to stop hair growth.

There are advantages and disadvantages to both approaches. Shaving, waxing and similar methods need to be done on a regular basis, often daily. They may cause some irritation and discomfort. They are, however, safe and effective, and have no other side effects.

Pills, on the other hand, all carry the risk of side effects. They may be very effective in slowing or stopping hair growth, but often must be taken for several months before this effect is evident. The hair may regrow after pills are stopped. This means that taking pills to control hirsutism may be a long term commitment.

Many women balk at the suggestion of shaving. It seems unfeminine, and reinforces the sense that having facial hair is masculine. Many people also believe that shaving causes the hair to grow thicker and faster. This is not true. Shaving has no effect on how much hair grows or how bushy it might become. Shaving is, in fact, an easy way to remove excess hair, and for some women may be the only treatment they need or want. For those women who take pills for hirsutism, they may still have to shave, but less often.

Zapping the hair follicles with electrolysis is another popular option. This is the only permanent method of hair removal. The follicles are destroyed by electrolysis so new hair can no longer grow out of them. It is effective, although there is a 10 to 50 per cent rate of hair regrowth. It also can be costly and time consuming.

Waxing and plucking can also be used when there are only a few hairs.

There are many different types of pills used for hirsutism. The birth control pill can be useful in younger women, especially those who also want birth control or those with irregular periods. Other popular pill types are spironolactone and other hormonal medications which prevent male hormones from stimulating hair follicles to grow coarse hair.

There is no one simple answer about how to treat excess hair. Indeed, whether it needs to be treated, and how it should be treated, depends on a woman's self image and how much hair there is. One woman may scarcely notice an amount of hair that another woman finds devastating.

Other considerations, such as whether menstrual cycles need to be restored, may affect which type of treatment is chosen. A woman who feels she has excess hair should give careful consideration to all aspects of the problem before she makes any decisions about treatment. If simple methods such as shaving or waxing are not enough, or if the hair growth is developing rapidly, she should see her doctor.